A Practical Workflow for MR-Guided Stereotactic Body Radiation Therapy to the Pancreas.

The increased adoption of stereotactic body radiation therapy (SBRT) has allowed for delivery of higher doses, potentially associated with better outcomes, but at the risk of higher toxicity. The intimate association of radiosensitive organs at risk (e.g., stomach, duodenum, bowel) has historically limited the delivery of ablative doses to the pancreas. The advent of MR-guided radiotherapy with improved soft tissue contrast allows for gated delivery without an internal target volume (ITV) and online adaptive replanning to maximize the therapeutic ratio. Patient selection requires additional resources, including increased patient on-table time, physician time, and physics support. Within our center's workflow, integrating an educational video at consultation as well as optimizing biofeedback mechanisms have significantly improved the experience for our patients.