Maybody Majid, Soliman Mohamed M, Yamada Yoshiya, Tahour David, Hsu Meier, Moskowitz Chaya S, Katsoulakis Evangelia, Solomon Stephen B
Department of Radiology, Interventional Radiology Service, Memorial Sloan Kettering Cancer Center, New York, New York.
Department of Radiology, Interventional Radiology Service, Memorial Sloan Kettering Cancer Center, New York, New York.
J Vasc Interv Radiol. 2020 Oct;31(10):1578-1586. doi: 10.1016/j.jvir.2020.01.011. Epub 2020 Aug 27.
To demonstrate that temporary organ displacement (TOD) by drainage catheter placement and hydrodissection is feasible and reproducible for simulation (SIM) and stereotactic body radiation treatment (SBRT).
Between February 2010 and December 2018, 31 consecutive patients (20 men and 11 women; median age, 59 years; range 20-80 years) received both SIM and SBRT with TOD. The minimum required displacement was 10 mm between the gross tumor volume (GTV) and the organ at risk (OAR). Complete displacement was defined as the ability to displace the OAR from the GTV a minimum of 10 mm across the entire boundary. SIM was performed with hydrodissection on the same day. On the day of SBRT, displacement was reproduced by hydrodissection. Displacement was measured on computed tomography images of TOD, SIM, and SBRT. The drain was removed after SBRT.
TOD (hydrodissection) was significantly associated with successful displacement of the OAR from a GTV greater than 10 mm (median, 20 mm vs 4.1 mm, P < .001) and maintained displacement at SIM and SBRT (SIM: 29.4 mm vs 4.1 mm, P < .001; SBRT: 32.4 mm vs 4.1 mm, P < .001). The OAR-GTV boundary showed a median reduction of 35 mm (95% confidence interval, 27.5-37.5 mm) after TOD. TOD achieved complete displacement in 22 of 31 (71%) patients, and 25 of 31 (81%) patients were able to undergo single-fraction ablative SBRT. No patients developed procedure-related complications within 30 days. SIM and SBRT were successful without OAR toxicities within a median of 33 months (range, 3-92 months).
TOD with placement of drain and hydrodissection is technically feasible and safe and maintains displacement for SIM and SBRT.
证明通过放置引流导管和水分离法进行临时器官移位（TOD）对于模拟（SIM）和立体定向体部放射治疗（SBRT）是可行且可重复的。
2010年2月至2018年12月期间，31例连续患者（20例男性和11例女性；中位年龄59岁；范围20 - 80岁）接受了采用TOD的SIM和SBRT。大体肿瘤体积（GTV）与危及器官（OAR）之间所需的最小移位为10毫米。完全移位定义为能够在整个边界上将OAR从GTV移位至少10毫米。同一天进行水分离法的SIM。在SBRT当天，通过水分离法重现移位。在TOD、SIM和SBRT的计算机断层扫描图像上测量移位。SBRT后拔除引流管。
TOD（水分离法）与将OAR从大于10毫米的GTV成功移位显著相关（中位值，20毫米对4.1毫米，P <.001），并在SIM和SBRT时维持移位（SIM：29.4毫米对4.1毫米，P <.001；SBRT：32.4毫米对4.1毫米，P <.001）。TOD后OAR - GTV边界显示中位减少35毫米（95%置信区间，27.5 - 37.5毫米）。TOD在31例患者中的22例（71%）实现了完全移位，31例患者中的25例（81%）能够接受单次分割消融性SBRT。30天内无患者发生与操作相关的并发症。SIM和SBRT成功，中位33个月（范围，3 - 92个月）内无OAR毒性。
放置引流管和水分离法的TOD在技术上可行且安全，并能维持SIM和SBRT的移位。
