Richter Christian, Andronesi Ovidiu C, Borra Ronald J H, Voigt Felix, Löck Steffen, Duda Dan G, Guimaraes Alexander R, Hong Theodore S, Bortfeld Thomas R, Seco Joao
Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
OncoRay - National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.
Clin Transl Radiat Oncol. 2019 Apr 26;18:113-119. doi: 10.1016/j.ctro.2019.04.013. eCollection 2019 Sep.
Previous MRI studies have shown a substantial decrease in normal-tissue uptake of a hepatobiliary-directed contrast agent 6-9 weeks after liver irradiation. In this prospective clinical study, we investigated whether this effect is detectable during the course of proton therapy.
Gd-EOB-DTPA enhanced MRI was performed twice during hypo-fractionated proton therapy of liver lesions in 9 patients (plus two patients with only one scan available). Dose-correlated signal changes were qualitatively scored based on difference images from the two scans. We evaluated the correlation between the MRI signal change with the planned dose map. The GTV was excluded from all analyses. In addition, were examined timing, irradiated liver volume, changes in liver function parameters as well as circulating biomarkers of inflammation.
Strong, moderate or no dose-correlated signal changes were detected for 2, 3 and 5 patients, respectively. Qualitative scoring was consistent with the quantitative dose to signal change correlation. In an exploratory analysis, the strongest correlation was found between the qualitative scoring and pretreatment IL-6 concentration. For all patients, a clear dose-correlated signal decrease was seen in late follow-up scans.
Radiation-induced effects can be detected with Gd-EOB-DTPA enhanced MRI in a subgroup of patients within a few days after proton irradiation. The reason for the large inter-patient variations is not yet understood and will require validation in larger studies.
先前的MRI研究表明，肝脏放疗后6 - 9周，肝胆靶向造影剂在正常组织中的摄取显著降低。在这项前瞻性临床研究中，我们调查了在质子治疗过程中这种效应是否可被检测到。
对9例肝脏病变患者在进行低分割质子治疗期间进行了两次钆塞酸二钠增强MRI检查（另外有2例患者仅进行了一次扫描）。基于两次扫描的差异图像对与剂量相关的信号变化进行定性评分。我们评估了MRI信号变化与计划剂量图之间的相关性。所有分析均排除了大体肿瘤体积（GTV）。此外，还检查了时间、受照射肝脏体积、肝功能参数变化以及循环炎症生物标志物。
分别在2例、3例和5例患者中检测到了强、中或无剂量相关信号变化。定性评分与信号变化的定量剂量相关性一致。在探索性分析中，定性评分与治疗前白细胞介素-6浓度之间的相关性最强。对于所有患者，在后期随访扫描中均可见明显的剂量相关信号降低。
在质子照射后的几天内，钆塞酸二钠增强MRI能够在部分患者亚组中检测到辐射诱导效应。患者间差异较大的原因尚不清楚，需要在更大规模的研究中进行验证。
