Threshold doses and prediction of visually apparent liver dysfunction after stereotactic body radiation therapy in cirrhotic and normal livers using magnetic resonance imaging

Doi, Hiroshi; Shiomi, Hiroya; Masai, Norihisa; Tatsumi, Daisaku; Igura, Takumi; Imai, Yumiko; Oh, Ryoong‐Jin

doi:10.1093/jrr/rrw008

Cited by 28 publications

(39 citation statements)

References 26 publications

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“…The linear-quadratic (LQ) model has been widely used to compare differentially fractionated radiotherapeutic regimens, despite several limitations (35). Our previous studies have described a prescription using IMRT based on the LQ model (23,36,37). Hypofractionated radiotherapy at higher doses per fraction may increase radiation-induced damages due to direct cytotoxicity, and may lead to microvascular disruption (38)(39)(40)(41).…”

Section: Discussionmentioning

confidence: 99%

“…In the present study, adding margins >8 mm to the ITV led to improved outcomes, although the differences were not significant. When performing SBRT for liver tumors, no margins are usually added to the ITV (12)(13)(14)(16)(17)(18)(19)(20)(21)23). However, only a few studies have demonstrated how many GTV-to-CTV expansions are required in order to reach the gross and microscopic diseases in liver metastasis (41,42).…”

Section: Discussionmentioning

confidence: 99%

“…Radiotherapy for liver tumors was performed as previously described (23). Briefly, CT and MRI scans for treatment planning were obtained using a 4-slice BrightSpeed ExcelÔ (GE Healthcare Bio-Sciences, Pittsburgh, PA, USA) between November 2007 and June 2014, and a 64-slice SOMATOM Definition AS Open RT Pro edition (Siemens AG, Munich, Germany) from July 2014 onward, as well as the SIGNA EXCITE HDx 1.5T (GE Healthcare Bio-Sciences), respectively.…”

Section: Methodsmentioning

confidence: 99%

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Effect of primary tumor location and tumor size on the response to radiotherapy for liver metastases from colorectal cancer

et al. 2017

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Abstract. Metastatic liver tumors (MLTs) from colorectal cancer (CRC) are often treated with stereotactic body radiation therapy (SBRT). The present study aimed to examine the predictive factors for response of MLTs to SBRT. A total of 39 MLTs from 24 patients with CRC were retrospectively analyzed. Radiotherapy for MLT was typically performed with a prescribed dose equivalent to a biologically effective dose (BED) 10 of 100 Gy. The median follow-up period was 16 months (range, 5-64 months). The median prescribed dose and total BED 10 were 56 Gy (range, 45-72 Gy) and 97.5 Gy (range, 71.7-115.5 Gy), respectively, in a median of 8 fractions (range, 4-33 fractions). The 1-and 2-year local control rates were 67.2 and 35.9%, respectively. For patients with MLT treated with ablative SBRT (BED 10 ≥100 Gy in ≤5 fractions), the 1-and 2-year local control rates were 83.3 and 62.5%, respectively. Univariate analysis showed that primary tumor location (left-sided colon), maximum tumor diameter (≤30 mm) and ablative SBRT (BED 10 ≥100 Gy in ≤5 fractions) were significantly associated with improved local control (P=0.0058, P=0.0059 and P=0.0268, respectively). Multivariate analysis showed that tumor diameter was significantly associated with improved local control (P=0.0314). In addition, patients who received ablative SBRT had significantly prolonged overall survival times compared with those treated with non-ablative SBRT (P= 0.0261). To conclude, tumors ≤30 mm that can be treated with ablative SBRT are associated with good local control rates. The primary tumor location may affect the radiosensitivity of MLTs. IntroductionPatients with colorectal cancer (CRC) often have metastases at initial presentation or during follow-up (1,2). The liver is one of the most frequent sites of metastasis (1,2). Newly developed chemotherapeutic agents, including targeted therapies, have improved the progression-free and overall survival times of patients with metastatic CRC (3,4). There is also evidence supporting the benefit of surgery to treat metastases from CRCs, with surgery improving overall survival time (5-7). The prolonged survival times of patients have highlighted the importance of local therapy for CRC and limited metastatic disease. In patients who are unfit for surgery, alternative local therapeutic approaches, including radiofrequency ablation (RFA), are available to treat liver metastases; these approaches are minimally invasive and can achieve good local control (8,9). However, their indication is currently limited to relatively small tumors that are located far away from critical structures (8,9).Modern radiotherapeutic techniques, including intensity-modulated radiation therapy (IMRT) and stereotactic body radiation therapy (SBRT), have recently become more frequently utilized to curatively treat limited metastatic tumors (10-14). SBRT, also termed stereotactic ablative radiation therapy, is a proven curative treatment for medically inoperable small tumors in the lung and liver; it delivers highly conformal radiation in a ...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Effect of primary tumor location and tumor size on the response to radiotherapy for liver metastases from colorectal cancer

et al. 2017

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“…However, no formula calculates the residual liver volume after radiotherapy. If the focal hepatic changes in CT or MRI accurately shows damaged liver as a loss of functional area, determining the threshold doses of these changes may be clinically important for calculating residual liver volume before radiation therapy to provide a preliminary estimate of residual liver volume before hepatectomy for HCC or liver metastases [2,[47][48][49][50].…”

Section: Likelihood Of Rild After Radiation Therapymentioning

confidence: 99%

Pathology and images of radiation-induced hepatitis: a review article

et al. 2018

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Recent advances in highly conformal radiotherapies greatly extend the indications for radiotherapy of liver tumors. However, because of poor tolerance to hepatic radiation, estimation of the intensity of irradiation of the liver is important, particularly for a cirrhotic liver. Knowledge of radiation-induced hepatitis is important for understanding how to optimize hepatic radiation therapy. Pathological changes of the irradiated liver, which include perivenular fibrosis, sinusoidal obstruction, and damage to Kupffer cells and hepatocytes, can be visualized using clinical imaging techniques. This review article discusses and illustrates the pathological and radiological changes of hepatic tumors and the surrounding parenchyma of the irradiated liver.

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“…Child‐Pugh score is often utilized in order to evaluate the liver dysfunction using several markers of liver injury including biochemical and clinical, however the use as a predictor for the risk of radiation‐induced liver damage is arbitrary and somewhat limited as it does not provide any regional‐volumetric information on compromised liver function. Gadolinium‐ethoxybenzyl‐diethylenetriamine pentaacetic acid (Gd‐EOB‐DTPA) is an MRI contrast agent also known as Primovist ® (Bayer Pharma AG, Berlin, Germany) that is taken up by hepatocytes, and as a result the assessment of the intensity of liver parenchyma can be correlated to the liver dysfunction . Following contrast administration, Primovist ® is distributed into the vascular space during arterial and portal venous phases; subsequently it is taken up by the hepatocytes during the hepatobiliary phase, where an enhancement can be observed on delayed images.…”

Section: Introductionmentioning

confidence: 99%

Structure guided deformable image registration for treatment planning CT and post stereotactic body radiation therapy (SBRT) Primovist^® (Gd‐EOB‐DTPA) enhanced MRI

Kuznetsova

Grendarova

Roy

et al. 2019

J Applied Clin Med Phys

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The purpose of this study was to assess the performance of structure‐guided deformable image registration (SG‐DIR) relative to rigid registration and DIR using TG‐132 recommendations. This assessment was performed for image registration of treatment planning computed tomography (CT) and magnetic resonance imaging (MRI) scans with Primovist® contrast agent acquired post stereotactic body radiation therapy (SBRT). SBRT treatment planning CT scans and posttreatment Primovist® MRI scans were obtained for 14 patients. The liver was delineated on both sets of images and matching anatomical landmarks were chosen by a radiation oncologist. Rigid registration, DIR, and two types of SG‐DIR (using liver contours only; and using liver structures along with anatomical landmarks) were performed for each set of scans. TG‐132 recommended metrics were estimated which included Dice Similarity Coefficient (DSC), Mean Distance to Agreement (MDA), Target Registration Error (TRE), and Jacobian determinant. Statistical analysis was performed using Wilcoxon Signed Rank test. The median (range) DSC for rigid registration was 0.88 (0.77–0.89), 0.89 (0.81–0.93) for DIR, and 0.90 (0.86–0.94) for both types of SG‐DIR tested in this study. The median MDA was 4.8 mm (3.7–6.8 mm) for rigid registration, 3.4 mm (2.4–8.7 mm) for DIR, 3.2 mm (2.0–5.2 mm) for SG‐DIR where liver structures were used to guide the registration, and 2.8 mm (2.1–4.2 mm) for the SG‐DIR where liver structures and anatomical landmarks were used to guide the registration. The median TRE for rigid registration was 7.2 mm (0.5–23 mm), 6.8 mm (0.7–30.7 mm) for DIR, 6.1 mm (1.1–20.5 mm) for the SG‐DIR guided by only the liver structures, and 4.1 mm (0.8–19.7 mm) for SG‐DIR guided by liver contours and anatomical landmarks. The SG‐DIR shows higher liver conformality as per TG‐132 metrics and lowest TRE compared to rigid registration and DIR in Velocity AI software for the purpose of registering treatment planning CT and post‐SBRT MRI for the liver region. It was found that TRE decreases when liver contours and corresponding anatomical landmarks guide SG‐DIR.

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Threshold doses and prediction of visually apparent liver dysfunction after stereotactic body radiation therapy in cirrhotic and normal livers using magnetic resonance imaging

Cited by 28 publications

References 26 publications

Effect of primary tumor location and tumor size on the response to radiotherapy for liver metastases from colorectal cancer

Effect of primary tumor location and tumor size on the response to radiotherapy for liver metastases from colorectal cancer

Pathology and images of radiation-induced hepatitis: a review article

Structure guided deformable image registration for treatment planning CT and post stereotactic body radiation therapy (SBRT) Primovist^® (Gd‐EOB‐DTPA) enhanced MRI

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Threshold doses and prediction of visually apparent liver dysfunction after stereotactic body radiation therapy in cirrhotic and normal livers using magnetic resonance imaging

Cited by 28 publications

References 26 publications

Effect of primary tumor location and tumor size on the response to radiotherapy for liver metastases from colorectal cancer

Effect of primary tumor location and tumor size on the response to radiotherapy for liver metastases from colorectal cancer

Pathology and images of radiation-induced hepatitis: a review article

Structure guided deformable image registration for treatment planning CT and post stereotactic body radiation therapy (SBRT) Primovist® (Gd‐EOB‐DTPA) enhanced MRI

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Product

Resources

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Structure guided deformable image registration for treatment planning CT and post stereotactic body radiation therapy (SBRT) Primovist^® (Gd‐EOB‐DTPA) enhanced MRI