Quality of life and clinical outcomes in rectal cancer patients treated on a 1.5T MR-Linac within the MOMENTUM study

L A Daamen; J M Westerhoff; A M Couwenberg; P M Braam; H Rütten; M D den Hartogh; J P Christodouleas; W A Hall; H M Verkooijen; M P W Intven

doi:10.1016/j.ctro.2023.100721

Quality of life and clinical outcomes in rectal cancer patients treated on a 1.5T MR-Linac within the MOMENTUM study

Clin Transl Radiat Oncol. 2024 Jan 4:45:100721. doi: 10.1016/j.ctro.2023.100721. eCollection 2024 Mar.

Authors

L A Daamen¹, J M Westerhoff¹, A M Couwenberg², P M Braam³, H Rütten³, M D den Hartogh⁴, J P Christodouleas^{5

6}, W A Hall⁷, H M Verkooijen¹, M P W Intven⁸

Affiliations

¹ University Medical Center Utrecht, Division of Imaging and Oncology, Utrecht, The Netherlands.
² The Netherlands Cancer Institute, Department of Radiation Oncology, Amsterdam, The Netherlands.
³ Radboud University Medical Center, Department of Radiation Oncology, Nijmegen, The Netherlands.
⁴ Radiotherapiegroep, The Netherlands.
⁵ Elekta AB, Stockholm, Sweden.
⁶ Hospital of the University of Pennsylvania, Department of Radiation Oncology, Philadelphia, PA, United States.
⁷ Medical College of Wisconsin, Department of Radiation Oncology, Milwaukee, WI, United States.
⁸ University Medical Center Utrecht, Department of Radiation Oncology, Utrecht, The Netherlands.

Abstract

Background and purpose: This study assessed quality of life (QoL) and clinical outcomes in rectal cancer patients treated with magnetic resonance (MR) guided short-course radiation therapy (SCRT) on a 1.5 Tesla (T) MR-Linac during the first 12 months after treatment.

Materials and methods: Rectal cancer patients treated with 25 Gy SCRT in five fractions with curative intent in the Netherlands (2019-2022) were identified in MOMENTUM (NCT04075305). Toxicity (CTCAE v5) and QoL (EORTC QLQ-C30 and -CR29) was primarily analyzed in patients without metastatic disease (M0) and no other therapies after SCRT. Patients who underwent tumor resection were censored from surgery. A generalized linear mixed-model was used to investigate clinically meaningful (≥10) and significant (P < 0.05) QoL changes. Clinical and pathological complete response (cCR and pCR) rates were calculated in patients in whom response was documented.

Results: A total of 172 patients were included, of whom 112 patients were primarily analyzed. Acute and late radiation-induced high-grade toxicity were reported in one patient, respectively. CCR was observed in 8/64 patients (13 %), 14/37 patients (38 %) and 13/16 patients (91 %) at three, six and twelve months; pCR was observed in 3/69 (4 %) patients. After 12 months, diarrhea (mean difference [MD] -17.4 [95 % confidence interval [CI] -31.2 to -3.7]), blood and mucus in stool (MD -31.1 [95 % CI -46.4 to -15.8]), and anxiety (MD -22.4 [95 % CI -34.0 to -10.9]) were improved.

Conclusion: High-field MR-guided SCRT for the treatment of patients with rectal cancer is associated with improved disease-related symptom management and functioning one year after treatment.

Keywords: Clinical outcomes; MR-guided radiotherapy; Patient-reported outcomes; Quality of Life; Rectal cancer; Response assessment; Short-course radiation therapy; Toxicity.