MR加速器在肝脏肿瘤放疗中的临床应用

doi:10.3760/cma.j.cn113030-20210830-00330

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摘要目的初步探讨MR加速器在肝脏肿瘤中的应用流程、疗效及安全性。方法回顾性分析2019—2021年15例采用MR加速器治疗的肝脏肿瘤患者的临床数据,探讨肝脏肿瘤采用MR加速器治疗的流程,分析患者肿瘤的图像识别率、疗效及不良反应。结果全组15例患者中肝细胞癌6例、结直肠癌肝转移8例、乳腺癌肝转移1例;肝内1个病灶10例、2个病灶4例、3个病灶1例;中位肿瘤最长径2.4cm (0.8~9.8cm)。MR加速器大体肿瘤体积(GTV)识别率达13/15,2例患者GTV显示不清,采用肿瘤周边大血管或胆管识别辅助仍可达精准配准。全组患者均接受体部立体定向放疗。肝细胞癌患者中位分割次数9次(5~10次),GTV或计划靶体积(PGTV)中位单次剂量6Gy (5~10Gy),中位总剂量52Gy (50~54Gy),α/β=10的中位2Gy等效剂量(EQD2Gy)为72Gy (62.5~83.3Gy)。肝转移瘤患者中位分割次数10次(5~10次),GTV或PGTV的中位单次剂量5Gy (5~10Gy),中位总剂量50Gy (40~50Gy),α/β=5的中位EQD2Gy为71.4Gy (71.4~107.1Gy)。放疗后1个月野内总有效率8/13,疾病控制率13/13,放疗后3~6个月野内总有效率6/6。全组患者中位随访4.0个月(0.3~11.6个月),4个月局部无进展生存、无进展生存和总生存分别为15/15、11/15和15/15。放疗不良反应轻微,未见≥3级不良反应。结论 MR加速器对肝内肿瘤显示率高,且可通过周边大血管或胆管的显示辅助精准配准,在肝脏肿瘤的精准治疗上初步展现优势,局部疗效肯定,耐受性好。

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	宗源
	门阔
	王淑莲
	唐源
	景灏
	田源
	覃仕瑞
	刘跃平
	宋永文
	房辉
	亓姝楠
	卢宁宁
	李宁
	杨颛搏
	万宝
	张彦新
	李晔雄
	陈波

关键词 ：磁共振加速器, 肝肿瘤/体部立体定向放射疗法, 肿瘤,肝转移/体部立体定向放射疗法, 治疗结果

Abstract：Objective To investigate the workflow, efficacy and safety of MR-Linac in liver malignancies. Methods Clinical data of 15 patients with hepatocellular carcinomas (HCC) or liver metastases treated with MR-Linac between November 2019 and July 2021 were retrospectively analyzed. The workflow of MR-Linac was investigated and image identification rate was analyzed. Patients were followed up for response and toxicity assessment. Results Fifteen patients (6HCC, 8 liver metastases from colorectal cancer, 1 liver metastasis from breast cancer) were enrolled. A total of 21 lesions were treated, consisting of 10 patients with single lesion, 4 patients with double lesions and 1 patient with triple lesions. The median tumor size was 2.4cm (0.8-9.8cm). The identification rate for gross tumor volume (GTV) in MR-Linac was 13/15. Although GTV of two patients were unclearly displayed in MR-Linac images, the presence of adjacent blood vessel and bile duct assisted the precise registration. All the patients were treated with stereotactic body radiation therapy (SBRT). For HCC, the median fraction dose for GTV or planning gross tumor volume (PGTV) was 6Gy (5-10Gy) and the median number of fractions was 9(5-10). The median total dose was 52Gy (50-54Gy) and the median equivalent dose in 2Gy fraction (EQD2Gy) at α/β= 10 was 72Gy (62.5-83.3Gy). For liver metastases, the median fraction dose for GTV or PGTV was 5Gy (5-10Gy) and the median number of fractions was 10(5-10). The median total dose was 50Gy (40-50Gy) and the median EQD2Gy at α/β=5 was 71.4Gy (71.4-107.1Gy). At 1 month after SBRT, the in-field Objective response rate (ORR) was 8/13 and the disease control rate was 13/13. At 3-6 months after SBRT, the in-filed ORR was increased to 6/6. During the median follow-up of 4.0 months (0.3-11.6), 4-month local progression-free survival, progression-free survival and overall survival were 15/15, 11/15 and 15/15, respectively. Toxicities were mild and no grade 3 or higher toxicities were observed. Conclusions MR-Linac provides a platform with high identification rates of liver lesions. Besides, the presence of adjacent blood vessel and bile duct also assists the precise registration. It is especially suitable for liver malignancies with promising local control and well tolerance.

Key words： Magnetic resonance accelerator Hepatocellular neoplasm/stereotactic body radiation therapy Neoplasm, liver metastasis/stereotactic body radiation therapy Treatment outcome

收稿日期: 2021-08-30

通讯作者: 陈波, Email:cbchinese@163.com

引用本文:

宗源,门阔,王淑莲等. MR加速器在肝脏肿瘤放疗中的临床应用[J]. 中华放射肿瘤学杂志, 2022, 31(1): 1-7.

Zong Yuan,Men Kuo,Wang Shulian et al. Preliminary study of clinical application of magnetic resonance linear accelerator in liver malignancies[J]. Chinese Journal of Radiation Oncology, 2022, 31(1): 1-7.

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