fig2

Figure 2. Case example of a patient with unresectable iCCA treated with MRgRT. An 81-year-old woman with a pacemaker and cochlear implant, who was diagnosed with a 4 cm iCCA, was initially treated with 3 cycles of gemcitabine and cisplatin followed by MRgRT after stabilization of disease. Due to the proximity of the tumor to the stomach and duodenum, she was treated on a 0.35T MR-Linac and prescribed 50 Gy in 5 consecutive fractions. Since the predicted duodenum and/or stomach dose constraints would have been violated if original plan was used on each fraction due to interfraction anatomic changes, online adaptive replanning was utilized to ensure that all organ at risk constraints were met while optimizing target coverage by the ablative prescription dose. She did not experience acute or late grade 2+ higher toxicity and achieved a complete metabolic response.