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

Abstract
Figure/Table
References(21)
Related Citation (15)
Read Tracking
Download Tracking

Download: PDF (0 KB) HTML (1 KB)
Export: BibTeX | EndNote (RIS) Supporting Info

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.

	Service

	E-mail this article
	Add to my bookshelf
	Add to citation manager
	E-mail Alert
	RSS
	Articles by authors
	Zong Yuan
	Men Kuo
	Wang Shulian
	Tang Yuan
	Jing Hao
	Tian Yuan
	Qin Shirui
	Liu Yueping
	Song Yongwen
	Fang Hui
	Qi Shunan
	Lu Ningning
	Li Ning
	Yang Zhuanbo
	Wan Bao
	Zhang Yanxin
	Li Yexiong
	Chen Bo

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

Received: 30 August 2021

Corresponding Authors: Chen Bo, Email:cbchinese@163.com

Cite this article:

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.

URL:

http://journal12.magtechjournal.com/Jweb_fszlx/EN/10.3760/cma.j.cn113030-20210830-00330 OR http://journal12.magtechjournal.com/Jweb_fszlx/EN/Y2022/V31/I1/1

[1] OHRI N, DAWSON LA, KRISHNAN S, et al. Radiotherapy for hepatocellular carcinoma:new indications and directions for future study[J]. J Natl Cancer Inst, 2016, 108(9):djw133. DOI:10.1093/jnci/djw133.
[2] CHOI SH, SEONG J. Strategic application of radiotherapy for hepatocellular carcinoma[J]. Clin Mol Hepatol, 2018, 24(2):114-134. DOI:10.3350/cmh.2017.0073.
[3] MAHADEVAN A, BLANCK O, LANCIANO R, et al. Stereotactic body radiotherapy (SBRT) for liver metastasis-clinical outcomes from the international multi-institutional RSSearch®patient registry[J]. Radiat Oncol, 2018, 13(1):26. DOI:10.1186/s13014-018-0969-2.
[4] WAHL DR, STENMARK MH, TAO Y, et al. Outcomes after stereotactic body radiotherapy or radiofrequency ablation for hepatocellular carcinoma[J]. J Clin Oncol, 2016, 34(5):452-459. DOI:10.1200/JCO.2015.61.4925.
[5] PARK JC, PARK SH, KIM JH, et al. Liver motion during cone beam computed tomography guided stereotactic body radiation therapy[J]. Med Phys, 2012, 39(10):6431-6442. DOI:10.1118/1.4754658.
[6] POLLARD JM, WEN Z, SADAGOPAN R, et al. The future of image-guided radiotherapy will be MR guided[J]. Br J Radiol, 2017, 90(1073):20160667. DOI:10.1259/bjr.20160667.
[7] LEE YJ, LEE JM, LEE JS, et al. Hepatocellular carcinoma:diagnostic performance of multidetector CT and MR imaging-a systematic review and meta-analysis[J]. Radiology, 2015, 275(1):97-109. DOI:10.1148/radiol.14140690.
[8] LEE JM, YOON JH, KIM KW. Diagnosis of hepatocellular carcinoma:newer radiological tools[J]. Semin Oncol, 2012, 39(4):399-409. DOI:10.1053/j.seminoncol.2012.05.010.
[9] 中国医师协会放射肿瘤治疗医师分会,中华医学会放射肿瘤治疗学分会,中国抗癌协会肿瘤放射治疗专业委员会. 中国原发性肝细胞癌放射治疗指南(2020年版)[J]. 国际肿瘤学杂志,2021, 48(1):1-10. DOI:10.3760/cma.j.cn371439-20201208-00001.
Radiotherapy Oncologist Branch of Chinese Medical Association,Society of Radiation Oncology, Chinese Medical Association,Tumor Radiotherapy Professional Committee of China Anti CancerAssociation. Radiotherapy guidelines for primary hepatocellular carcinoma in China (2020 Edition)[J]. J Int Oncol, 2021, 48(1):1-10. DOI:10.3760/cma.j.cn371439-20201208-00001.
[10] SUWINSKI R, WZIETEK I, TARNAWSKI R, et al. Moderately low alpha/beta ratio for rectal cancer may best explain the outcome of three fractionation schedules of preoperative radiotherapy[J]. Int J Radiat Oncol Biol Phys, 2007, 69(3):793-799. DOI:10.1016/j.ijrobp.2007.03.046.
[11] VAN LEEUWEN CM, OEI AL, CREZEE J, et al. The alfa and beta of tumours:a review of parameters of the linear-quadratic model, derived from clinical radiotherapy studies[J]. Radiat Oncol, 2018, 13(1):96. DOI:10.1186/s13014-018-1040-z.
[12] HANNA GG, MURRAY L, PATEL R, et al. UK consensus on normal tissue dose constraints for stereotactic radiotherapy[J]. Clin Oncol (R Coll Radiol), 2018, 30(1):5-14. DOI:10.1016/j.clon.2017.09.007.
[13] LENCIONI R, LLOVET JM. Modified RECIST (mRECIST) assessment for hepatocellular carcinoma[J]. Semin Liver Dis, 2010, 30(1):52-60. DOI:10.1055/s-0030-1247132.
[14] LUKOVIC J, HENKE L, GANI C, et al. MRI-Based upper abdominal organs-at-risk atlas for radiation oncology[J]. Int J Radiat Oncol Biol Phys, 2020, 106(4):743-753. DOI:10.1016/j.ijrobp.2019.12.003.
[15] BOLDRINI L, CORRADINI S, GANI C, et al. MR-guided radiotherapy for liver malignancies[J]. Front Oncol, 2021, 11:616027. DOI:10.3389/fonc.2021.616027.
[16] PAULSON ES, AHUNBAY E, CHEN X, et al.4D-MRI driven MR-guided online adaptive radiotherapy for abdominal stereotactic body radiation therapy on a high field MR-Linac:implementation and initial clinical experience[J]. Clin TranslRadiat Oncol, 2020, 23:72-79. DOI:10.1016/j.ctro.2020.05.002.
[17] HENKE L, KASHANI R, ROBINSON C, et al. Phase I trial of stereotactic MR-guided online adaptive radiation therapy (SMART) for the treatment of oligometastatic or unresectable primary malignancies of the abdomen[J]. Radiother Oncol, 2018, 126(3):519-526. DOI:10.1016/j.radonc.2017.11.032.
[18] FELDMAN AM, MODH A, GLIDE-HURST C, et al. Real-time magnetic resonance-guided liver stereotactic body radiation therapy:an institutional report using a magnetic resonance-Linac system[J]. Cureus, 2019, 11(9):e5774. DOI:10.7759/cureus.5774.
[19] ROSENBERG SA, HENKE LE, SHAVERDIAN N, et al. A multi-institutional experience of MR-guided liver stereotactic body radiation therapy[J]. Adv Radiat Oncol, 2019, 4(1):142-149. DOI:10.1016/j.adro.2018.08.005.
[20] BOLDRINI L, ROMANO A, MARIANI S, et al. MRI-guided stereotactic radiation therapy for hepatocellular carcinoma:a feasible and safe innovative treatment approach[J]. J Cancer Res Clin Oncol, 2021, 147(7):2057-2068. DOI:10.1007/s00432-020-03480-8.
[21] WEYKAMP F, HOEGEN P, KLüTER S, et al. Magnetic resonance-guided stereotactic body radiotherapy of liver tumors:initial clinical experience and patient-reported outcomes[J]. Front Oncol, 2021, 11:610637. DOI:10.3389/fonc.2021.610637.