Radiation Oncology Center, Ofuna Chuo Hospital, Kanagawa, Japan; Department of Radiation Oncology, Tokai University, Kanagawa, Japan.
Radiation Oncology Center, Ofuna Chuo Hospital, Kanagawa, Japan.
Int J Radiat Oncol Biol Phys. 2014 Feb 1;88(2):306-11. doi: 10.1016/j.ijrobp.2013.10.045.
Focal liver reaction (FLR) appears on radiographic images after stereotactic ablative body radiation therapy (SABR) in patients with hepatocellular carcinoma (HCC) and chronic liver disease. We investigated the threshold dose (TD) of FLR and possible factors affecting the TD on gadoxetate acid (Gd-EOB-DTPA)-enhanced magnetic resonance imaging (MRI).
In 50 patients who were treated with SABR for small HCC and followed up by MRI for >6 months, FLR, seen as a hypointense area, was evaluated on the hepatobiliary phase of Gd-EOB-DTPA-enhanced MRI. The follow-up MRI with the largest extent of FLR was fused to the planning computed tomography (CT) image, and patients with good image fusion concordance were eligible. After delineating the border of the FLR manually, a dose-volume histogram was used to identify the TD for the FLR. Clinical and volumetric factors were analyzed for correlation with the TD.
A total of 45 patients were eligible for analysis with a median image fusion concordance of 84.9% (range, 71.6-95.4%). The median duration between SABR and subsequent hepatobiliary phase MRI with the largest extent of FLR was 3 months (range, 1-6 months). The median TD for FLR was 28.0 Gy (range, 22.3-36.4 Gy). On univariate analysis, pre-treatment Child-Pugh (CP) score and platelet count were significantly correlated with the TD. On multiple linear regression analysis, CP score was the only parameter that predicted TD. Median TDs were 30.5 Gy (range, 26.2.3-36.4 Gy) and 25.2 Gy (range, 22.3-27.5 Gy) for patients with CP-A and CP-B disease, respectively.
The TD was significantly correlated with baseline liver function. We propose 30 Gy for CP-A disease and 25 Gy for CP-B disease in 5 fractions as TDs for FLR after SABR for patients with HCC and chronic liver disease. Use of these TDs will help to predict potential loss of liver tissue after SABR.
在接受肝癌（HCC）和慢性肝病患者立体定向消融放射治疗（SABR）后，放射性肝反应（FLR）会出现在放射性图像上。我们研究了钆塞酸（Gd-EOB-DTPA）增强磁共振成像（MRI）上 FLR 的阈值剂量（TD）和可能影响 TD 的因素。
在 50 名接受 SABR 治疗小 HCC 并通过 MRI 随访超过 6 个月的患者中，在 Gd-EOB-DTPA 增强 MRI 的肝胆期评估 FLR，表现为低信号区域。将具有最大 FLR 范围的随访 MRI 与计划 CT 图像融合，并且具有良好图像融合一致性的患者符合条件。手动描绘 FLR 边界后，使用剂量-体积直方图确定 FLR 的 TD。分析临床和体积因素与 TD 的相关性。
共有 45 名患者符合分析条件，图像融合一致性中位数为 84.9%（范围，71.6-95.4%）。SABR 与具有最大 FLR 范围的后续肝胆期 MRI 之间的中位时间为 3 个月（范围，1-6 个月）。FLR 的中位 TD 为 28.0Gy（范围，22.3-36.4Gy）。在单变量分析中，治疗前的 Child-Pugh（CP）评分和血小板计数与 TD 显著相关。在多元线性回归分析中，CP 评分是唯一预测 TD 的参数。CP-A 疾病患者的中位 TD 分别为 30.5Gy（范围，26.2-36.4Gy）和 25.2Gy（范围，22.3-27.5Gy），CP-B 疾病患者的中位 TD 分别为 30.5Gy（范围，26.2-36.4Gy）和 25.2Gy（范围，22.3-27.5Gy）。
TD 与基线肝功能显著相关。我们建议对于 HCC 和慢性肝病患者，CP-A 疾病患者的 SABR 后 FLR 的 TD 为 30Gy，CP-B 疾病患者的 TD 为 25Gy，共 5 个剂量。使用这些 TD 将有助于预测 SABR 后潜在的肝组织丢失。
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