Mullikin Trey C, Pepin Kay M, Evans Jaden E, Venkatesh Sudhakar K, Ehman Richard L, Merrell Kenneth W, Haddock Michael G, Harmsen William S, Herman Michael G, Hallemeier Christopher L
Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota.
Department of Radiation Oncology, Intermountain Health Care, Ogden, Utah.
Adv Radiat Oncol. 2021 Sep 9;6(6):100793. doi: 10.1016/j.adro.2021.100793. eCollection 2021 Nov-Dec.
Magnetic resonance (MR) elastography (E) is a noninvasive technique for quantifying liver stiffness (LS) for fibrosis. This study evaluates whether LS is associated with risk of developing radiation-induced liver disease (RILD) in patients receiving liver-directed radiation therapy (RT).
Based on prior studies, LS ≤3 kPa was considered normal and LS >3.0 kPa as representing fibrosis. RILD was defined as an increase in Child-Pugh (CP) score of ≥2 from baseline within 1 year of RT. Univariate and multivariate Cox models were used to assess correlation.
One hundred two patients, 51 with primary liver tumors and 51 with liver metastases, were identified with sufficient follow-up. In univariate models, pre-RT LS >3.0 kPa (hazard ratio [HR] 4.9; 95% confidence interval [CI], 1.6-14; = .004), body mass index (BMI), clinical cirrhosis, CP score, albumin-bilirubin (ALBI) grade 2, primary liver tumor, and mean liver dose were significantly associated with risk of post-RT RILD. In a multivariate analysis, LS >3.0 and mean liver dose both were significantly associated with RILD risk.
Elevated pre-RT LS is associated with an increased risk of RILD in patients receiving liver-directed RT.
磁共振（MR）弹性成像（E）是一种用于量化肝纤维化肝脏硬度（LS）的非侵入性技术。本研究评估在接受肝脏定向放射治疗（RT）的患者中，LS是否与发生放射性肝病（RILD）的风险相关。
根据先前的研究，LS≤3 kPa被认为正常，LS>3.0 kPa表示纤维化。RILD定义为RT后1年内Child-Pugh（CP）评分较基线增加≥2分。使用单变量和多变量Cox模型评估相关性。
确定了102例患者，其中51例为原发性肝癌，51例为肝转移瘤，均有足够的随访资料。在单变量模型中，RT前LS>3.0 kPa（风险比[HR] 4.9；95%置信区间[CI]，1.6 - 14；P = 0.004）、体重指数（BMI）、临床肝硬化、CP评分、白蛋白-胆红素（ALBI）2级、原发性肝癌和平均肝脏剂量与RT后RILD风险显著相关。在多变量分析中，LS>3.0和平均肝脏剂量均与RILD风险显著相关。
RT前LS升高与接受肝脏定向RT的患者发生RILD的风险增加相关。
