Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Int J Radiat Oncol Biol Phys. 2018 Nov 15;102(4):867-874. doi: 10.1016/j.ijrobp.2018.05.018. Epub 2018 May 14.
Stereotactic body radiation therapy (SBRT) for hepatocellular carcinoma (HCC) has emerged as an alternative treatment option when curative treatment modalities cannot be applied. Although excellent local tumor control has been achieved with SBRT, the targeting accuracy in real-life practice remains poorly understood. We proposed an in vivo assessment of targeting accuracy using hepatic parenchymal changes observed on gadolinium ethoxybenzyl diethylenetriaminepentaacetic acid (Gd-EOB-DTPA)-enhanced magnetic resonance (MR) images and applied this method to investigate the "real-life" targeting accuracy of image-guided SBRT.
We selected 29 patients with available follow-up MR images acquired 2 to 4 months after completion of SBRT. All patients were administered 45 Gy in 3 fractions. The treated HCC and the region of hepatic parenchymal changes in the hepatobiliary phase of MR images were delineated. We evaluated the discrepancies between the center of the HCC and that of the parenchymal change area (intercenter discrepancy [ICD]). We also analyzed the difference in ICDs between those who underwent SBRT with intrahepatic marker guidance and those with diaphragm guidance.
The median ICD in the 3-dimensional direction was 6.81 mm (interquartile range [IQR], 4.27-9.61 mm). Those for the craniocaudal, left-right, and anteroposterior components were 2.70 mm (IQR, 1.83-4.06 mm), 1.63 mm (IQR, 0.76-3.49), and 4.12 mm (IQR, 1.20-6.96 mm), respectively. The median ICD for patients who underwent treatment with intrahepatic marker guidance and those with diaphragm guidance was 7.53 mm (IQR, 6.63-10.86 mm) and 5.60 mm (IQR, 4.28-8.18 mm), respectively. There was no significant difference in ICD between those who underwent treatment with intrahepatic marker guidance and those with diaphragm guidance (P = .296).
The hepatic parenchymal changes observed on Gd-EOB-DTPA-enhanced MR images can be used to assess the targeting accuracy after SBRT for HCC.
当无法应用根治性治疗方法时，立体定向体部放射治疗（SBRT）已成为治疗肝细胞癌（HCC）的一种替代选择。尽管 SBRT 已实现了优异的局部肿瘤控制，但其实践中的靶向准确性仍了解甚少。我们提出了一种使用钆乙氧基苯甲基二乙三胺五乙酸（Gd-EOB-DTPA）增强磁共振（MR）图像上观察到的肝实质变化来评估靶向准确性的方法，并将该方法应用于研究图像引导 SBRT 的“真实”靶向准确性。
我们选择了 29 例有随访 MR 图像的患者，这些图像是在 SBRT 完成后 2 至 4 个月获得的。所有患者均接受 45Gy 的 3 个分割剂量。对治疗后的 HCC 和 MR 图像肝胆期的肝实质变化区域进行了勾画。我们评估了 HCC 中心与实质变化区域中心之间的差异（中心差异[ICD]）。我们还分析了接受肝内标记物引导与膈肌引导的 SBRT 患者之间 ICD 的差异。
在三维方向上，ICD 的中位数为 6.81mm（四分位距[IQR]，4.27-9.61mm）。头脚、左右和前后成分的中位数分别为 2.70mm（IQR，1.83-4.06mm）、1.63mm（IQR，0.76-3.49mm）和 4.12mm（IQR，1.20-6.96mm）。接受肝内标记物引导和膈肌引导治疗的患者的 ICD 中位数分别为 7.53mm（IQR，6.63-10.86mm）和 5.60mm（IQR，4.28-8.18mm）。接受肝内标记物引导和膈肌引导治疗的患者的 ICD 之间没有显著差异（P=.296）。
Gd-EOB-DTPA 增强 MR 图像上观察到的肝实质变化可用于评估 HCC 患者 SBRT 后的靶向准确性。
