ArticleActa oncologica (Stockholm, Sweden)2025
Feasibility of a reduced gadolinium dose protocol for MRI-guided radiotherapy in glioblastoma.
Article in Acta oncologica (Stockholm, Sweden), 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
background and purposeMagnetic resonance imaging-guided radiotherapy (MRIgRT) enables precise tumour targeting through adaptive planning, which is particularly relevant for glioblastoma due to its dynamic morphology. Gadolinium-based contrast agents (GBCAs) enhance tumour visibility, but frequent use during MRIgRT raises safety concerns related to cumulative gadolinium exposure. This study investigated the feasibility of a reduced GBCA dose protocol for patients with glioblastoma undergoing MRIgRT, aiming to balance tumour conspicuity with minimisation of GBCA-related risks. Patient/material and methods: Nine patients with glioblastoma received hypo-fractionated MRI-Linac radiotherapy (10 × 3.4 Gy) with MRI performed with either full-dose, half-dose or no GBCA enhancement. Online gross tumour volume (GTV) delineation was performed by radiation oncologists, while offline GTV delineation was independently conducted by an expert neuroradiologist on GBCA-enhanced scans. Objective assessment using automatic thresholding and a structured Likert-scale evaluation were also performed.
resultsDuring online adaptation, GTV volumes generally remained stable or increased, whereas offline expert assessments revealed a general volume reduction and systematic volume underestimation with half-dose scans (~18%). Relative delineation volume discrepancies were most pronounced in small tumours. Structured radiologist feedback reported lower confidence, tumour conspicuity and image quality in half-dose scans, particularly for small lesions. Otsu's thresholding revealed reduced edge definition with decreasing contrast dose. No signs of GBCA retention were observed between fractions.
interpretationReduced-dose GBCA-protocols are feasible. Full-dose contrast is recommended at key fractions (e.g. baseline and mid-treatment) and for small tumours, with half-dose imaging reserved for selected intervals or larger tumours. This hybrid approach may balance safety and imaging precision in adaptive MRIgRT.
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