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Purpose Magnetic resonance (MR)-guided SABR was performed for patients with lung tumors in whom treatment delivery was challenging owing to tumor location, motion, or pulmonary comorbidity. Because stereotactic MR-guided adaptive radiation therapy (SMART) is a novel approach, we studied clinical outcomes in these high-risk lung tumors. Methods and Materials Fifty consecutive patients (54 lung tumors) underwent SMART between 2016 and 2018 for either a primary lung cancer (29 patients) or for lung metastases (21 patients). Eligible patients had risk factors that could predispose them to toxicity, including a central tumor location (n = 30), previous thoracic radiation therapy (n = 17), and interstitial lung disease (n = 7). A daily 17-second breath-hold MR scan was acquired in treatment position, and on-table plan adaptation was performed using the anatomy of the day. Gated SABR was delivered during repeated breath-holds under continuous MR guidance. Results All but 1 patient completed the planned SMART schedule. With daily plan adaptation, a biologically effective dose ≥100 Gy to 95% of the planning target volume was delivered in 50 tumors (93%). Median follow-up was 21.7 months (95% confidence interval, 19.9-28.1). Local control and overall and disease-free survival rates at 12 months were 95.6%, 88.0%, and 63.6%, respectively. Local failures developed in 4 patients: in 2 after reirradiation for a recurrent lung cancer and in 2 patients with a colorectal metastasis. Overall rates of any grade ≥2 and ≥3 toxicity were 30% and 8%, respectively. Commonest toxicities were grade ≥2 radiation pneumonitis (12%) and chest wall pain (8%). No grade 4 or 5 toxicities were observed. Conclusions Use of MR-guided SABR resulted in low rates of high-grade toxicity and encouraging early local control in a cohort of high-risk lung tumors. Additional studies are needed to identify patients who are most likely to benefit from the SMART approach.

Contains fulltext : 57338.pdf (author's version ) (Closed access) A central problem in motor control relates to the coordination of the arm's many degrees of freedom. This problem concerns the many arm postures (kinematics) that correspond to the same hand position in space and the movement trajectories between begin and end position (dynamics) that result in the same arm postures. The aim of this study was to compare the predictions for arm kinematics by various models on human motor control with experimental data and to study the relation between kinematics and dynamics. Goal-directed arm movements were measured in 3-D space toward far and near targets. The results demonstrate that arm postures for a particular target depend on previous arm postures, contradicting Donders's law. The minimum-work and minimum-torque-change models, on the other hand, predict a much larger effect of initial posture than observed. These data suggest that both kinematics and dynamics affect postures and that their relative contribution might depend on instruction and task complexity.