Threshold Doses for Focal Liver Reaction After Stereotactic Ablative Body Radiation Therapy for Small Hepatocellular Carcinoma Depend on Liver Function: Evaluation on Magnetic Resonance Imaging With Gd-EOB-DTPA

Sanuki, Naoko; Takeda, Atsuya; Oku, Yohei; Eriguchi, Takahisa; Nishimura, Soraya; Aoki, Yosuke; Mizuno, Takahisa; Iwabuchi, Shogo; Kunieda, Etsuo

doi:10.1016/j.ijrobp.2013.10.045

Cited by 63 publications

(65 citation statements)

References 20 publications

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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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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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“…This effect is described as the focal liver reaction (FLR) [5–7], and is a useful marker for predicting liver parenchymal damage in radiotherapy. For this purpose, using the hepatobiliary phase of Gd-EOB-DTPA MRI, the threshold dose (TD) for the background liver has been analyzed in patients with metastatic liver tumors and HCC associated with chronic liver disease in SABR and brachytherapy [7,8]. In PBT, Yuan et al were the first to report on FLR and MRI-based dosimetric proton end-of-range verification for the liver [9], but they did not examine TD in their analysis.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of Focal Liver Reaction after Proton Beam Therapy for Hepatocellular Carcinoma Examined Using Gd-EOB-DTPA Enhanced Hepatic Magnetic Resonance Imaging

Takamatsu¹,

Yamamoto²,

Maeda³

et al. 2016

PLoS ONE

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BackgroundProton beam therapy (PBT) achieves good local control for hepatocellular carcinoma (HCC), and toxicity tends to be lower than for photon radiotherapy. Focal liver parenchymal damage in radiotherapy is described as the focal liver reaction (FLR); the threshold doses (TDs) for FLR in the background liver have been analyzed in stereotactic ablative body radiotherapy and brachytherapy. To develop a safer approach for PBT, both TD and liver volume changes are considered clinically important in predicting the extent of damage before treatment, and subsequently in reducing background liver damage. We investigated appearance time, TDs and volume changes regarding FLR after PBT for HCC.Material and MethodsPatients who were treated using PBT and were followed up using gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid-enhanced magnetic resonance imaging (Gd-EOB-DTPA MRI) after PBT were enrolled. Sixty-eight lesions in 58 patients were eligible for analysis. MRI was acquired at the end of treatment, and at 1, 2, 3 and 6 months after PBT. We defined the FLR as a clearly depicted hypointense area on the hepatobiliary phase of Gd-EOB-DTPA MRI, and we monitored TDs and volume changes in the FLR area and the residual liver outside of the FLR area.ResultsFLR was depicted in all lesions at 3 months after PBT. In FLR expressed as the 2-Gy equivalent dose (α/β = 3 Gy), TDs did not differ significantly (27.0±6.4 CGE [10 fractions [Fr] vs. 30.5±7.3 CGE [20 Fr]). There were also no correlations between the TDs and clinical factors, and no significant differences between Child-Pugh A and B scores. The volume of the FLR area decreased and the residual liver volume increased, particularly during the initial 3 months.ConclusionThis study established the FLR dose for liver with HCC, which might be useful in the prediction of remnant liver volume for PBT.

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“…29,31 The comparison of studies should take into account the treatment duration and the doses per fraction according to the quadratic linear model. 31,[35][36][37] The alpha/beta ratio for healthy liver is quite low, from 1.5 13 to 3 38 . Murphy et al 33 postulates that the risk of hepatic toxicity for hypofractionated irradiation is overestimated in clinical practice when biological normalization is omitted.…”

Section: Hepatic Functions and Tumor Type Classical Data Showmentioning

confidence: 98%

Dose to organ at risk and dose prescription in liver SBRT

Rives

Izar

Parent

et al. 2017

Reports of Practical Oncology & Radiotherapy

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Concerning liver metastasis, SBRT can be safely delivered using one to five fractions. An excellent local control is obtained with doses from 20 to 60 Gy. For primary hepatic tumors, results are also good, but the risk of hepatic toxicity related to liver pre-existent pathology must be taken into account. Radiation induced liver disease (RILD) is not frequent in its classical presentation, but modifications of liver enzymes are often observed. Other toxicities of SBRT on the duodenum, small bowel and biliary tract are also described. With respect to contraindications and dose limitations on surrounding structures, SBRT is well tolerated and takes place among curative treatment of liver tumors, as surgery, radiofrequency and embolization.

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Threshold Doses for Focal Liver Reaction After Stereotactic Ablative Body Radiation Therapy for Small Hepatocellular Carcinoma Depend on Liver Function: Evaluation on Magnetic Resonance Imaging With Gd-EOB-DTPA

Cited by 63 publications

References 20 publications

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

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

Evaluation of Focal Liver Reaction after Proton Beam Therapy for Hepatocellular Carcinoma Examined Using Gd-EOB-DTPA Enhanced Hepatic Magnetic Resonance Imaging

Dose to organ at risk and dose prescription in liver SBRT

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