Prospective Assessment of MR Guided Single-Fraction Stereotactic Ablative Radiation Therapy for Peripheral Lung Metastases: Dosimetric and Clinical Outcomes

OBJECTIVES: This study aimed to evaluate the feasibility and safety of online MR guided single-fraction stereotactic ablative radiation therapy (SABR) and to assess acute changes in pulmonary function tests (PFTs), inflammatory markers, patient-reported quality of life (QoL), and dosimetric outcomes. METHODS AND MATERIALS: Patients with lung metastases were included in this single-center prospective study. Patients underwent MR guided single-fraction SABR. The primary endpoints encompassed local control (LC) and overall survival. Secondary endpoints included acute toxicity (Common Terminology Criteria for Adverse Events version 5.0), changes in PFTs, inflammatory markers, QoL, and dosimetric outcomes. RESULTS: Between 10/2020 and 10/2022, 26 patients with 30 lung metastases were prospectively enrolled. At a median follow-up of 19.9 months (range, 16.1 to 25.6 months), the 1- and 2-year LC rates were 96.2% (95% CI, 88.7% to 100.0%) and 77.5% (95% CI, 55.9% to 99.1%). No Common Terminology Criteria for Adverse Events grade 3+ side effects were observed. While there was a slight median reduction of 4% in forced expiratory volume in 1 second (L) (P = .009, range, -24% to 20%), other PFT parameters remained stable. The neutrophil-to-lymphocyte ratio increased by a median of 13% (P = .002, range, -10% to 207%), while serum C-reactive protein and albumin levels remained unchanged. Patient-reported QoL did not exhibit significant changes, except for a minimal increase in the median score for cognitive functioning from 1 to 1.5 (P = .041). CONCLUSIONS: MR guided single-fraction SABR is a safe and effective treatment option for peripheral lung metastases, demonstrating encouraging LC.