Witzmann Katharina, Raschke Felix, Löck Steffen, Wesemann Tim, Krause Mechthild, Linn Jennifer, Troost Esther G C
Helmholtz-Zentrum Dresden-Rossendorf, Institute of Radiooncology - OncoRay, Dresden, Germany.
OncoRay - National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden-Rossendorf, Dresden, Germany.
Acta Oncol. 2023 Feb;62(2):141-149. doi: 10.1080/0284186X.2023.2176254. Epub 2023 Feb 21.
Radio(chemo)therapy is used as a standard treatment for glioma patients. The surrounding normal tissue is inevitably affected by the irradiation. The aim of this longitudinal study was to investigate perfusion alterations in the normal-appearing tissue after proton irradiation and assess the dose sensitivity of the normal tissue perfusion.
In 14 glioma patients, a sub-cohort of a prospective clinical trial (NCT02824731), perfusion changes in normal-appearing white matter (WM), grey matter (GM) and subcortical GM structures, i.e. caudate nucleus, hippocampus, amygdala, putamen, pallidum and thalamus, were evaluated before treatment and at three-monthly intervals after proton beam irradiation. The relative cerebral blood volume (rCBV) was assessed with dynamic susceptibility contrast MRI and analysed as the percentage ratio between follow-up and baseline image (ΔrCBV). Radiation-induced alterations were evaluated using Wilcoxon signed rank test. Dose and time correlations were investigated with univariate and multivariate linear regression models.
No significant ΔrCBV changes were found in any normal-appearing WM and GM region after proton beam irradiation. A positive correlation with radiation dose was observed in the multivariate regression model applied to the combined ΔrCBV values of low (1-20 Gy), intermediate (21-40 Gy) and high (41-60 Gy) dose regions of GM ( < 0.001), while no time dependency was detected in any normal-appearing area.
The perfusion in normal-appearing brain tissue remained unaltered after proton beam therapy. In further studies, a direct comparison with changes after photon therapy is recommended to confirm the different effect of proton therapy on the normal-appearing tissue.
放射（化学）疗法被用作胶质瘤患者的标准治疗方法。周围正常组织不可避免地会受到辐射影响。这项纵向研究的目的是调查质子照射后正常外观组织中的灌注变化，并评估正常组织灌注的剂量敏感性。
在一项前瞻性临床试验（NCT02824731）的14名胶质瘤患者亚组中，在治疗前以及质子束照射后的每三个月评估正常外观的白质（WM）、灰质（GM）和皮质下GM结构（即尾状核、海马体、杏仁核、壳核、苍白球和丘脑）的灌注变化。使用动态磁敏感对比MRI评估相对脑血容量（rCBV），并将其分析为随访图像与基线图像之间的百分比比值（ΔrCBV）。使用Wilcoxon符号秩检验评估辐射引起的变化。通过单变量和多变量线性回归模型研究剂量和时间相关性。
质子束照射后，在任何正常外观的WM和GM区域均未发现明显的ΔrCBV变化。在应用于GM低剂量（1 - 20 Gy）、中等剂量（21 - 40 Gy）和高剂量（41 - 60 Gy）区域组合的ΔrCBV值的多变量回归模型中，观察到与辐射剂量呈正相关（<0.001），而在任何正常外观区域均未检测到时间依赖性。
质子束治疗后，正常外观脑组织中的灌注保持不变。在进一步的研究中，建议与光子治疗后的变化进行直接比较，以确认质子治疗对正常外观组织的不同影响。
