MR-linac could offer several advantages for radical radiochemotherapy (RCHT) in oropharyngeal squamous cell carcinoma (OPSCC) patients. Currently, only a few case series have been published and no comparison with other techniques have been performed. Data of 34 consecutive patients treated from September 2022 to May 2024 at a single Institution with RCHT on Unity® MR-linac for OPSCC with daily adaptive radiotherapy (RT) according to the adapt-to-shape (ATS) workflow were prospectively analyzed. A comparative cohort of 34 patients with similar characteristics treated with helical treatment on Radixact® was retrieved. Characteristics were well balanced across the two groups. Maximal toxicity grade ≥2 rate was borderline higher at RT end in MRI-linac group (p 0.049), but lower one month after RT (76.5 % vs 91.2 %; p = 0.257).Non-significantly lower rates of grade ≥2 xerostomia and dysgeusia were reported in Unity® group one and three months after RT. Higher rates of hospitalizations were reported in Radixact group at 20 fractions and at RT end (64.1 % vs 35.3 %; p = 0.015). Mean Karnofsky performance status (KPS) was higher in Unity group three months after RT (87.67 vs 83.87; p = 0.038).After a median follow up of 361.5 days, local complete response was reported for 93.6 % of patients treated with Unity® and 96.8 % of patients treated with Radixact®. Results of this analysis support the feasibility of an ATS MR-linac workflow for RCHT in OPSCC. Compared with tomotherapy, treatment with Unity® resulted in significantly lower rates of hospitalization and higher KPS three months after RT. Grade 2 xerostomia and dysgeusia rates were non-significantly lower in Unity group. Optimal results in terms of local control were reported for both techniques.

Purpose: Lymphomas are generally radiosensitive; therefore, disease volume tends to shrink during radiotherapy courses. As MRI-linac provides excellent soft tissue definition and allows daily re-contouring of gross tumor volume and clinical target volume, its adoption could be beneficial for the treatment of lymphomas. Nonetheless, at this time there is a lack of literature regarding the use of MR-linac in this context. Methods: A prospective observational study was conducted on patients affected by non-Hodgkin lymphoma (NHL) involving head and neck (H&N) sites and treated with Elekta Unity^® MR-Linac. The clinical and dosimetric data of the first eight patients were collected and integrated with relevant data from medical records. Results: Seven patients had B-cell lymphoma (three DLBCL, two MALT, one follicular, and one mantle-cell) and one T-cell/NK lymphoma. The intent of RT was radical for four patients, salvage treatment for three, and CAR-T bridging for one. Two patients presented orbital localizations and six cervical lymphonodal sites. Median GTV was 5.74 cc, median CTV 127.01 cc, and median PTV 210.37 cc. The prescribed dose was 24–50 Gy in 2 Gy fractions for seven patients and 24 Gy in 3 Gy fractions for one patient. All the patients experienced acute toxicity, the maximum grade was G1 for five patients and G2 for three at the end of RT. One month after radiotherapy seven patients still experienced G1 toxicity, but no toxicity grade ≥ 2 was reported. First radiological assessment was performed for all the patients after a median of 101.5 days, reporting complete response in all the cases. After a median follow up of 330 days, no patient experienced local disease progression, while one patient developed distant progression. Conclusions: radiotherapy for NHL with H&N localization using a 1.5 T MR-linac was feasible, with no >G2 toxicity and optimal response rate and disease control.

Background: By integrating an MRI scanner and a linear accelerator, MR-linac systems provide superior soft tissue imaging and allow to perform adaptive radiotherapy adjusted on daily anatomical changes. The advent of this technology represents a revolution in radiation oncology and could improve treatment accuracy and clinical outcomes. We performed a comprehensive bibliometric analysis with the aim of displaying the available scientific literature and trends regarding MR-linac. Methods: Scopus database was investigated, considering documents published up to 6 April 2025. Keywords encompassed terms related to “MR-linac” or “MRI-linac” and possible combinations and acronyms. BibTeX data file was imported into Biblioshiny (Bibliometrix package—v. 4.1.4) and analysis was conducted using R code (R version 4.3.2) and the Bibliometrix package (version 4.1.4). Results: A total of 1624 articles on MR-linac were identified. The number of annual publications gradually increased from 21 in 2008, peaking at 211 in 2022 and then remaining substantially stable in subsequent years. Most of the papers were original articles (79.2%) and the majority was published by the 10 journals with the largest output. Remarkably, of 6385 identified authors, over 85% were from one of the 10 most represented countries (including European, North American and Asian nations). Consistently, the 10 institutions with the larger output were North American, Australian or European and provided over 60% of the articles. International co-authorship was found in only 23.6% of the articles. Keyword and co-occurrence analyses identified MR-guided radiotherapy, SBRT, dosimetry, and adaptive strategies as core themes, with emerging trends in radiomics, diffusion metrics, and deep learning. Conclusions: Bibliometric analysis identified trends and patterns of scientific publications regarding MR-linac, highlighting a growing interest in the topic. Nonetheless, it should be considered that the majority of the papers were published by a few journals and over 85% of authors were from 10 countries, demonstrating an evident disparity across nations. Multicentric international research protocols and common frameworks could foster the transition towards collaborative practice-changing studies.