Oldrini Guillaume, Huertas Andres, Renard-Oldrini Sophie, Taste-George Hélène, Vogin Guillaume, Laurent Valérie, Salleron Julia, Henrot Philippe
Service d'Imagerie, Institut de cancérologie de Lorraine, Vandoeuvre-lès-Nancy Cedex, France.
Service de radiothérapie, Institut de cancérologie de Lorraine, Vandoeuvre-lès-Nancy Cedex, France.
PLoS One. 2017 Apr 25;12(4):e0176118. doi: 10.1371/journal.pone.0176118. eCollection 2017.
To evaluate the MRI features of a tumor response, local control, and predictive factors of local control after stereotactic body radiation therapy (SBRT) for hepatocellular carcinoma (HCC).
Thirty-five consecutive patients with 48 HCCs who were treated by SBRT were included in this retrospective study. All patients provided written informed consent to be treated by SBRT, and prior to inclusion they authorized use of the treatment data for further studies. The assessment was made using MRI, with determination of local and hepatic responses according to Response Evaluation Criteria in Solid Tumors (RECIST) and modified RECIST (mRECIST) criteria during a two-year follow-up.
The local response rate according to mRECIST was higher than with RECIST. A tumor diameter less than 20 mm at baseline was an independent predictive factor for RECIST and mRECIST responses, as was diffusion-weighted signal for RECIST. During follow-up, a tumor diameter of <20 mm (p = 0.034) and absence of a high intensity on T2-weighted (p = 0.006) and diffusion-weighted images (p = 0.039) were associated with a better response according to RECIST. Post-treatment changes include peritumoral ring-like enhanced changes with high intensity on T2-weighted images.
SBRT is a promising technique for the treatment of inoperable HCC. Post-treatment changes on MRI images can resemble tumor progression and as such must be adequately distinguished. The regression of tumorous enhancement is variable over time, although diffusion-weighted and T2-weighted intensities are predictive factors for tumor RECIST responses on subsequent MRIs. They hence provide a way to reliably predict treatment responses.
评估立体定向体部放射治疗（SBRT）治疗肝细胞癌（HCC）后肿瘤反应、局部控制情况及局部控制的预测因素的MRI特征。
本回顾性研究纳入了35例连续接受SBRT治疗的48例HCC患者。所有患者均提供书面知情同意书接受SBRT治疗，在纳入研究前，他们授权使用治疗数据进行进一步研究。使用MRI进行评估，在两年随访期间根据实体瘤疗效评价标准（RECIST）和改良RECIST（mRECIST）标准确定局部和肝脏反应。
根据mRECIST的局部反应率高于RECIST。基线时肿瘤直径小于20 mm是RECIST和mRECIST反应的独立预测因素，RECIST的扩散加权信号也是如此。随访期间，根据RECIST，肿瘤直径<20 mm（p = 0.034）以及T2加权（p = 0.006）和扩散加权图像上无高强度信号（p = 0.039）与更好的反应相关。治疗后改变包括T2加权图像上肿瘤周围环状强化改变且呈高强度信号。
SBRT是治疗无法手术切除的HCC的一种有前景的技术。MRI图像上的治疗后改变可能类似于肿瘤进展，因此必须进行充分鉴别。肿瘤强化的消退随时间变化，尽管扩散加权和T2加权信号强度是后续MRI上肿瘤RECIST反应的预测因素。因此，它们提供了一种可靠预测治疗反应的方法。
