A team of clinical experts have determined the clinical indications that will most benefit from the MR Linac. These will be progressively implemented.
In summary, they are:
- Oligometastases where surrounding critical organs-at-risk limit the ability for Stereotactic Body Radiotherapy (SBRT) target doses to be delivered safely.
- Locally advanced pancreatic cancers where stereotactic image guided radiotherapy is limited by the proximity of adjacent critical organs- at- risk proximity.
- Liver metastases where stereotactic image guided radiotherapy is limited by organs at risk proximity and other treatment modalities are not feasible.
- Primary liver carcinoma and cholangiocarcinoma where image guided radiotherapy is limited by organs at risk proximity and other treatment modalities are not feasible.
- Re-irradiation of head and neck tumours.
- Primary prostate cancer not suitable for current fiducial-based image guidance technique.
- Re-irradiation of recurrent dominant prostate cancer nodule.
- Highly mobile (>1cm) early stage non-small cell lung cancer and lung metastases.
Ultra-central tumours (primary and metastases) within the thorax, abutting organs-at-risk where conventional stereotactic treatment is not feasible, due to limited conventional imaging tissue plane clarity.
- Re-irradiation of locally recurrent primary lung cancers or lung metastases
- Radical (Boost Dose) cervix carcinoma treatment where brachytherapy is not feasible.
- Recurrent endometrial carcinoma where surrounding organs at risk (bowel) limits radical radiotherapy.
- Radical dose escalated radiotherapy for rectal cancer where surgical management is not possible.
- Kidney SBRT where surrounding organs at risk or motion limit conventional image guided treatments.
- Adrenal SBRT where surrounding organs at risk or motion limit conventional image guided treatments.
- Pelvic re-irradiation where other modalities may not be feasible and dose delivery is limited by critical organs at risk.
- Paraspinal tumours where reliable localisation of primary and organs at risk such as spinal cord will allow for safe dose delivery.
Other scenarios can be considered on a case-by-case basis.