Amar Kishan, MD, on implications of MIRAGE trial data

In this video, Amar U. Kishan, MD, highlights some of the implications of the MIRAGE trial (NCT04384770), which compared the use of aggressive margin reduction with MRI-guided SBRT to standard CT-guided SBRT. Kishan is a professor and executive vice chair of radiation oncology at the University of California, Los Angeles.

Video Transcript:

There's a couple of ways to think about how this could move forward. One is, now we have data right that going from 4 mm margins to 2 mm margins, strictly speaking—the MRI allowed us to do that—reduces both short-term toxicity and long-term toxicity. One implication would be if there is an uptake in MRI-guided radiation, that would allow a seamless move from larger margins to smaller margins. Thinking a little bit more broadly, perhaps there may be technological advances, even in the CT-guided, that allow us going from a 4 mm to 2 mm without MRI-guided; that's possible as well. Strictly speaking, it was a trial of reducing the margin. We just used the advanced technology to be able to do that. I would say both there could be an increase in MRI-guided [SBRT] and there may be increase in investigation into shrinking margins with CT-guided SBRT as well. MRI-guided radiation is great. It does require an expensive MRI-guided linear accelerator. CT-guided linear accelerators are, at this point, more common. There, I think, will be parallel streams of research there.

I think another implication is that it's important to note that dropping short-term toxicity did lead to less long-term toxicity, which is intuitive to most people, but it is a controversial point in the field whether short-term toxicity is meaningful in and of itself, because it gets better. These results are supportive, as well as some work that'll be coming out in a month or so, that there is a link between early toxicity and late toxicity. If we can do things to minimize the short-term toxicity, that may very well pan out later, and that's ultimately what we want to do. Ultimately, we aren't concerned about just short-term toxicity. We want to make sure that the whole survivorship, patient quality of life, many years down the line is improved.

This transcript was AI generated and edited by human editors for clarity.