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Title: 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

Abstract

Purpose: Focal liver reaction (FLR) appears on radiographic images after stereotactic ablative body radiation therapy (SABR) in patients with hepatocellular carcinoma (HCC) and chronic liver disease. We investigated the threshold dose (TD) of FLR and possible factors affecting the TD on gadoxetate acid (Gd-EOB-DTPA)-enhanced magnetic resonance imaging (MRI). Methods and Materials: In 50 patients who were treated with SABR for small HCC and followed up by MRI for >6 months, FLR, seen as a hypointense area, was evaluated on the hepatobiliary phase of Gd-EOB-DTPA-enhanced MRI. The follow-up MRI with the largest extent of FLR was fused to the planning computed tomography (CT) image, and patients with good image fusion concordance were eligible. After delineating the border of the FLR manually, a dose–volume histogram was used to identify the TD for the FLR. Clinical and volumetric factors were analyzed for correlation with the TD. Results: A total of 45 patients were eligible for analysis with a median image fusion concordance of 84.9% (range, 71.6-95.4%). The median duration between SABR and subsequent hepatobiliary phase MRI with the largest extent of FLR was 3 months (range, 1-6 months). The median TD for FLR was 28.0 Gy (range, 22.3-36.4 Gy). On univariate analysis, pre-treatmentmore » Child-Pugh (CP) score and platelet count were significantly correlated with the TD. On multiple linear regression analysis, CP score was the only parameter that predicted TD. Median TDs were 30.5 Gy (range, 26.2.3-36.4 Gy) and 25.2 Gy (range, 22.3-27.5 Gy) for patients with CP-A and CP-B disease, respectively. Conclusion: The TD was significantly correlated with baseline liver function. We propose 30 Gy for CP-A disease and 25 Gy for CP-B disease in 5 fractions as TDs for FLR after SABR for patients with HCC and chronic liver disease. Use of these TDs will help to predict potential loss of liver tissue after SABR.« less

Authors:
; ;  [1]; ; ;  [1];  [2];  [3];  [4]
  1. Radiation Oncology Center, Ofuna Chuo Hospital, Kanagawa (Japan)
  2. Department of Radiology, Ofuna Chuo Hospital, Kanagawa (Japan)
  3. Department of Hepatology and Gastroenterology, Ofuna Chuo Hospital, Kanagawa (Japan)
  4. Department of Radiation Oncology, Tokai University, Kanagawa (Japan)
Publication Date:
OSTI Identifier:
22283343
Resource Type:
Journal Article
Journal Name:
International Journal of Radiation Oncology, Biology and Physics
Additional Journal Information:
Journal Volume: 88; Journal Issue: 2; Other Information: Copyright (c) 2014 Elsevier Science B.V., Amsterdam, The Netherlands, All rights reserved.; Country of input: International Atomic Energy Agency (IAEA); Journal ID: ISSN 0360-3016
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; CAT SCANNING; DTPA; GY RANGE 10-100; HEPATOMAS; LIVER; NMR IMAGING; PATIENTS; RADIOTHERAPY; THRESHOLD DOSE

Citation Formats

Sanuki, Naoko, Takeda, Atsuya, Oku, Yohei, Department of Radiation Oncology, Tokai University, Kanagawa, Eriguchi, Takahisa, Nishimura, Shuichi, Aoki, Yosuke, Mizuno, Tomikazu, Iwabuchi, Shogo, and Kunieda, Etsuo. 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. United States: N. p., 2014. Web. doi:10.1016/J.IJROBP.2013.10.045.
Sanuki, Naoko, Takeda, Atsuya, Oku, Yohei, Department of Radiation Oncology, Tokai University, Kanagawa, Eriguchi, Takahisa, Nishimura, Shuichi, Aoki, Yosuke, Mizuno, Tomikazu, Iwabuchi, Shogo, & Kunieda, Etsuo. 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. United States. https://doi.org/10.1016/J.IJROBP.2013.10.045
Sanuki, Naoko, Takeda, Atsuya, Oku, Yohei, Department of Radiation Oncology, Tokai University, Kanagawa, Eriguchi, Takahisa, Nishimura, Shuichi, Aoki, Yosuke, Mizuno, Tomikazu, Iwabuchi, Shogo, and Kunieda, Etsuo. 2014. "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". United States. https://doi.org/10.1016/J.IJROBP.2013.10.045.
@article{osti_22283343,
title = {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},
author = {Sanuki, Naoko and Takeda, Atsuya and Oku, Yohei and Department of Radiation Oncology, Tokai University, Kanagawa and Eriguchi, Takahisa and Nishimura, Shuichi and Aoki, Yosuke and Mizuno, Tomikazu and Iwabuchi, Shogo and Kunieda, Etsuo},
abstractNote = {Purpose: Focal liver reaction (FLR) appears on radiographic images after stereotactic ablative body radiation therapy (SABR) in patients with hepatocellular carcinoma (HCC) and chronic liver disease. We investigated the threshold dose (TD) of FLR and possible factors affecting the TD on gadoxetate acid (Gd-EOB-DTPA)-enhanced magnetic resonance imaging (MRI). Methods and Materials: In 50 patients who were treated with SABR for small HCC and followed up by MRI for >6 months, FLR, seen as a hypointense area, was evaluated on the hepatobiliary phase of Gd-EOB-DTPA-enhanced MRI. The follow-up MRI with the largest extent of FLR was fused to the planning computed tomography (CT) image, and patients with good image fusion concordance were eligible. After delineating the border of the FLR manually, a dose–volume histogram was used to identify the TD for the FLR. Clinical and volumetric factors were analyzed for correlation with the TD. Results: A total of 45 patients were eligible for analysis with a median image fusion concordance of 84.9% (range, 71.6-95.4%). The median duration between SABR and subsequent hepatobiliary phase MRI with the largest extent of FLR was 3 months (range, 1-6 months). The median TD for FLR was 28.0 Gy (range, 22.3-36.4 Gy). On univariate analysis, pre-treatment Child-Pugh (CP) score and platelet count were significantly correlated with the TD. On multiple linear regression analysis, CP score was the only parameter that predicted TD. Median TDs were 30.5 Gy (range, 26.2.3-36.4 Gy) and 25.2 Gy (range, 22.3-27.5 Gy) for patients with CP-A and CP-B disease, respectively. Conclusion: The TD was significantly correlated with baseline liver function. We propose 30 Gy for CP-A disease and 25 Gy for CP-B disease in 5 fractions as TDs for FLR after SABR for patients with HCC and chronic liver disease. Use of these TDs will help to predict potential loss of liver tissue after SABR.},
doi = {10.1016/J.IJROBP.2013.10.045},
url = {https://www.osti.gov/biblio/22283343}, journal = {International Journal of Radiation Oncology, Biology and Physics},
issn = {0360-3016},
number = 2,
volume = 88,
place = {United States},
year = {Sat Feb 01 00:00:00 EST 2014},
month = {Sat Feb 01 00:00:00 EST 2014}
}