The use of functional MR monitoring over the course of treatment may help predict which patients are most likely to respond to additional radiation therapy and, potentially, chemotherapy, and which patients may require less. More timely adaptation of the treatment plan based on fMRI data could minimize unnecessary radiation exposure for patients who are not having a response to treatment, and enable personalization of radiation therapy regimens based on the unique biology of each patient’s tumor. Importantly, fMRI may also provide insight into which regions of the tumor are the most biologically active, resulting in refined dosing plans that have the potential for maximizing efficacy and reducing toxicity.

A new paradigm for radiation therapy innovation
While MR-linac is itself an innovative radiation delivery system, the process by which it was developed is also highly innovative. Elekta developed MR-linac in collaboration with the Elekta MR-linac Consortium, which comprises clinicians and scientists from leading cancer centers around the globe. This approach ensured that clinical need – with respect to optimizing both clinical outcomes and clinical workflows – was a key driver throughout the development and evaluation process.

Yet innovating new technology is not necessarily sufficient for improving patient outcomes. Developing the data and guidelines that enable clinicians to identify patients most likely to benefit from MR-linac and use the system effectively is also essential for optimizing patient care. Toward this end, the consortium is taking a systematic approach to evaluating the use of MR-linac for specific cancer indications.

The initial focus is on those indications most likely to benefit from MR-linac, which includes common cancers such as breast, prostate and lung cancers. This collaborative yet systematic approach creates a value proposition for the MR-linac system that comprises both technology and validated clinical insights, and helps to ensure that the full potential of this new technology is realized for patient benefit.

The future is at our doorstep
The MR-linac may be cutting-edge, but it is also a here and now technology. The system received CE mark in June 2018 (under the name Elekta Unity), and is being made available to patients throughout Europe. A 510(k) Premarket Notification has been submitted to the U.S. Food and Drug Administration, and its clearance is pending.

Radiation therapy has been a pillar of cancer care for decades. With MR-linac, this important treatment modality will enter the age of personalized, precision cancer therapy and advance new treatment paradigms. As has been the case with previous technological advances in radiation therapy, MR-linac may support the development of novel combination regimens utilizing other agents that previously couldn’t be delivered with radiation therapy due to potential overlapping or excessive toxicities, and may open the door to wholly new regimens that combine radiation with immunotherapy.

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