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Strahlentherapie und Onkologie
Published in: Strahlentherapie und Onkologie 5/2018

01-05-2018 | Original Article

Direct dose correlation of MRI morphologic alterations of healthy liver tissue after robotic liver SBRT

Authors: Judit Boda-Heggemann, MD, Anika Jahnke, PhD, Mark K. H. Chan, PhD, Leila S. Ghaderi Ardekani, MSc, Peter Hunold, MD, Jost Philipp Schäfer, MD, Stefan Huttenlocher, MD, Stefan Wurster, MD, Dirk Rades, MD, Guido Hildebrandt, MD, Frank Lohr, MD, Jürgen Dunst, MD, Frederik Wenz, MD, Oliver Blanck, PhD

Published in: Strahlentherapie und Onkologie | Issue 5/2018

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Abstract

Purpose

For assessing healthy liver reactions after robotic SBRT (stereotactic body radiotherapy), we investigated early morphologic alterations on MRI (magnetic resonance imaging) with respect to patient and treatment plan parameters.

Patients and methods

MRI data at 6–17 weeks post-treatment from 22 patients with 42 liver metastases were analyzed retrospectively. Median prescription dose was 40 Gy delivered in 3–5 fractions. T2- and T1-weighted MRI were registered to the treatment plan. Absolute doses were converted to EQD2 (Equivalent dose in 2Gy fractions) with α/β-ratios of 2 and 3 Gy for healthy, and 8 Gy for modelling pre-damaged liver tissue.

Results

Sharply defined, centroid-shaped morphologic alterations were observed outside the high-dose volume surrounding the GTV. On T2-w MRI, hyperintensity at EQD2 isodoses of 113.3 ± 66.1 Gy2, 97.5 ± 54.7 Gy3, and 66.5 ± 32.0 Gy8 significantly depended on PTV dimension (p = 0.02) and healthy liver EQD2 (p = 0.05). On T1-w non-contrast MRI, hypointensity at EQD2 isodoses of 113.3 ± 49.3 Gy2, 97.4 ± 41.0 Gy3, and 65.7 ± 24.2 Gy8 significantly depended on prior chemotherapy (p = 0.01) and total liver volume (p = 0.05). On T1-w gadolinium-contrast delayed MRI, hypointensity at EQD2 isodoses of 90.6 ± 42.5 Gy2, 79.3 ± 35.3 Gy3, and 56.6 ± 20.9 Gy8 significantly depended on total (p = 0.04) and healthy (p = 0.01) liver EQD2.

Conclusions

Early post-treatment changes in healthy liver tissue after robotic SBRT could spatially be correlated to respective isodoses. Median nominal doses of 10.1–11.3 Gy per fraction (EQD2 79–97 Gy3) induce characteristic morphologic alterations surrounding the lesions, potentially allowing for dosimetric in-vivo accuracy assessments. Comparison to other techniques and investigations of the short- and long-term clinical impact require further research.
Literature
1.
Sterzing F, Brunner TB, Ernst I et al (2014) Stereotactic body radiotherapy for liver tumors: principles and practical guidelines of the DEGRO Working Group on Stereotactic Radiotherapy. Strahlenther Onkol 190(10):872–881CrossRefPubMed
2.
Boda-Heggemann J, Dinter D, Weiss C et al (2012) Hypofractionated image-guided breath-hold SABR (stereotactic ablative body radiotherapy) of liver metastases—clinical results. Radiat Oncol 7:92CrossRefPubMedPubMedCentral
3.
Andratschke N, Parys A, Stadtfeld S et al (2016) Clinical results of mean GTV dose optimized robotic guided SBRT for liver metastases. Radiat Oncol 11:74CrossRefPubMedPubMedCentral
4.
Klement RJ, Guckenberger M, Alheid H et al (2017) Stereotactic body radiotherapy for oligo-metastatic liver disease – influence of pre-treatment chemotherapy and histology on local tumor control. Radiother Oncol 123(2):227–233CrossRefPubMed
5.
Osmundson EC, Wu Y, Luxton G et al (2015) Predictors of toxicity associated with stereotactic body radiation therapy to the central hepatobiliary tract. Int J Radiat Oncol Biol Phys 91(5):986–994CrossRefPubMed
6.
Toesca DAS, Osmundson EC, von Eyben R et al (2017) Assessment of hepatic function decline after stereotactic body radiation therapy for primary liver cancer. Pract Radiat Oncol 7(3):173–182CrossRefPubMed
7.
Grimm J, LaCouture T, Croce R et al (2011) Dose tolerance limits and dose volume histogram evaluation for stereotactic body radiotherapy. J Appl Clin Med Phys 12(2):3368CrossRefPubMed
8.
LaCouture TA, Xue J, Subedi G et al (2016) Small bowel dose tolerance for stereotactic body radiation therapy. Semin Radiat Oncol 26(2):157–164CrossRefPubMed
9.
Goldsmith C, Price P, Cross T et al (2016) Dose-volume histogram analysis of stereotactic body radiotherapy treatment of pancreatic cancer: a focus on duodenal dose constraints. Semin Radiat Oncol 26(2):149–156CrossRefPubMed
10.
Pan CC, Kavanagh BD, Dawson LA et al (2010) Radiation-associated liver injury. Int J Radiat Oncol Biol Phys 76(3):94–100CrossRef
11.
Jung J, Yoon SM, Kim SY et al (2013) Radiation-induced liver disease after stereotactic body radiotherapy for small hepatocellular carcinoma: clinical and dose-volumetric parameters. Radiat Oncol 8:249CrossRefPubMedPubMedCentral
12.
Dreher C, Hoyer KI, Fode MM et al (2016) Metabolic liver function after stereotactic body radiation therapy for hepatocellular carcinoma. Acta Oncol 55(7):886–891CrossRefPubMed
13.
14.
Herfarth KK, Hof H, Bahner ML et al (2003) Assessment of focal liver reaction by multiphasic CT after stereotactic single-dose radiotherapy of liver tumors. Int J Radiat Oncol Biol Phys 57:444–451CrossRefPubMed
15.
Seidensticker M, Seidensticker R, Mohnike K et al (2011) Quantitative in vivo assessment of radiation injury of the liver using Gd-EOB-DTPA enhanced MRI: tolerance dose of small liver volumes. Radiat Oncol 6:40CrossRefPubMedPubMedCentral
16.
Seidensticker M, Burak M, Kalinski T et al (2015) Radiation-induced liver damage: correlation of histopathology with hepatobiliary magnetic resonance imaging, a feasibility study. Cardiovasc Intervent Radiol 38:213–221CrossRefPubMed
17.
Seidensticker M, Seidensticker R, Damm R et al (2014) Prospective randomized trial of enoxaparin, pentoxifylline and ursodeoxycholic acid for prevention of radiation-induced liver toxicity. PLoS ONE 9:e112731CrossRefPubMedPubMedCentral
18.
Boda-Heggemann J, Attenberger U, Budjan J et al (2016) MRI morphologic alterations after liver SBRT: direct dose correlation with intermodal matching. Strahlenther Onkol 192(9):641–648CrossRefPubMed
19.
Sanuki-Fujimoto N, Takeda A, Ohashi T et al (2010) CT evaluations of focal liver reactions following stereotactic body radiotherapy for small hepatocellular carcinoma with cirrhosis: relationship between imaging appearance and baseline liver function. Br J Radiol 83:1063–1071CrossRefPubMedPubMedCentral
20.
Lo SS, Teh BS, Wang JZ et al (2011) Imaging changes after stereotactic body radiation therapy for lung and liver tumors. Expert Rev Anticancer Ther 11:613–620CrossRefPubMed
21.
Howells CC, Stinauer MA, Diot Q et al (2012) Normal liver tissue density dose response in patients treated with stereotactic body radiation therapy for liver metastases. Int J Radiat Oncol Biol Phys 84:e441–446CrossRefPubMed
22.
Jarraya H, Mirabel X, Taieb S et al (2013) Image-based response assessment of liver metastases following stereotactic body radiotherapy with respiratory tracking. Radiat Oncol 8:24CrossRefPubMedPubMedCentral
23.
Richter C, Seco J, Hong TS et al (2014) Radiation-induced changes in hepatocyte-specific Gd-EOB-DTPA enhanced MRI: potential mechanism. Med Hypotheses 83:477–481CrossRefPubMed
24.
Sanuki N, Takeda A, Oku Y et al (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. Int J Radiat Oncol Biol Phys 88:306–311CrossRefPubMed
25.
Schmid-Tannwald C, Strobl FF, Theisen D et al (2015) Diffusion-weighted MRI before and after robotic radiosurgery (Cyberknife(R)) in primary and secondary liver malignancies: a pilot study. Technol Cancer Res Treat 14:191–199CrossRefPubMed
26.
Lall C, Bhargava P, Sandrasegaran K et al (2015) Three-dimensional conformal radiation therapy in the liver: MRI findings along a time continuum. J Comput Assist Tomogr 39:356–364PubMed
27.
Haddad MM, Merrell KW, Hallemeier CL et al (2016) Stereotactic body radiation therapy of liver tumors: post-treatment appearances and evaluation of treatment response: a pictorial review. Abdom Radiol (NY) 41(10):2061–2077CrossRef
28.
Doi H, Shiomi H, Masai N et al (2016) Threshold doses and prediction of visually apparent liver dysfunction after stereotactic body radiation therapy in cirrhotic and normal livers using magnetic resonance imaging. J Radiat Res 57(3):294–300CrossRefPubMedPubMedCentral
29.
Fukugawa Y, Namimoto T, Toya R et al (2017) Radiation-induced liver injury after 3D-conformal radiotherapy for hepatocellular carcinoma: quantitative assessment using Gd-EOB-DTPA-enhanced MRI. Acta Med Okayama 71(1):25–29PubMed
30.
Olsen CC, Welsh J, Kavanagh BD et al (2009) Microscopic and macroscopic tumor and parenchymal effects of liver stereotactic body radiotherapy. Int J Radiat Oncol Biol Phys 73:1414–1424CrossRefPubMed
31.
Kilby W, Dooley JR, Kuduvalli G et al (2010) The CyberKnife Robotic Radiosurgery System in 2010. Technol Cancer Res Treat 9(5):433–452CrossRefPubMed
32.
Vautravers-Dewas C, Dewas S, Bonodeau F et al (2011) Image-guided robotic stereotactic body radiation therapy for liver metastases: is there a dose response relationship? Int J Radiat Oncol Biol Phys 81(3):e39–47CrossRefPubMed
33.
Méndez Romero A, Verheij J, Dwarkasing RS et al (2012) Comparison of macroscopic pathology measurements with magnetic resonance imaging and assessment of microscopic pathology extension for colorectal liver metastases. Int J Radiat Oncol Biol Phys 82(1):159–166CrossRefPubMed
34.
Chan M, Grehn M, Cremers F et al (2017) Dosimetric implications of residual tracking errors during robotic SBRT of liver metastases. Int J Radiat Oncol Biol Phys 97(4):839–848CrossRefPubMed
35.
Blanck O, Wang L, Baus W et al (2016) Inverse treatment planning for spinal robotic radiosurgery: an international multi-institutional benchmark trial. J Appl Clin Med Phys 17(3):313–330CrossRefPubMedPubMedCentral
36.
Malinowski K, McAvoy TJ, George R et al (2013) Maintaining tumor targeting accuracy in real-time motion compensation systems for respiration-induced tumor motion. Med Phys 40(7):71709CrossRefPubMedPubMedCentral
37.
Michaely HJ, Morelli JN, Budjan J et al (2013) CAIPIRINHA-Dixon-TWIST (CDT)-volume-interpolated breath-hold examination (VIBE): a new technique for fast time-resolved dynamic 3‑dimensional imaging of the abdomen with high spatial resolution. Invest Radiol 48:590–597CrossRefPubMed
38.
Morelli JN, Michaely HJ, Meyer MM et al (2013) Comparison of dynamic and liver-specific gadoxetic acid contrast-enhanced MRI versus apparent diffusion coefficients. PLoS ONE 8:e61898CrossRefPubMedPubMedCentral
39.
Kanai T, Kadoya N, Ito K et al (2014) Evaluation of accuracy of B‑spline transformation-based deformable image registration with different parameter settings for thoracic images. J Radiat Res 55:1163–1170CrossRefPubMedPubMedCentral
40.
41.
Fukumitsu N, Nitta K, Terunuma T et al (2017) Registration error of the liver CT using deformable image registration of MIM Maestro and Velocity AI. Bmc Med Imaging 17(1):30CrossRefPubMedPubMedCentral
42.
43.
Dawson LA, Ten Haken RK (2005) Partial volume tolerance of the liver to radiation. Semin Radiat Oncol 15:279–283CrossRefPubMed
44.
Son SH, Jang HS, Lee H et al (2013) Determination of the alpha/beta ratio for the normal liver on the basis of radiation-induced hepatic toxicities in patients with hepatocellular carcinoma. Radiat Oncol 8:61CrossRefPubMedPubMedCentral
45.
46.
Dollinger M, Jung EM, Beyer L et al (2014) Irreversible electroporation ablation of malignant hepatic tumors: subacute and follow-up CT appearance of ablation zones. J Vasc Interv Radiol 25(10):1589–1594CrossRefPubMed
47.
Cheng W, Xiao L, Ainiwaer A et al (2015) Molecular responses of radiation-induced liver damage in rats. Mol Med Rep 11(4):2592–2600CrossRefPubMed
48.
Tetreau R, Llacer C, Riou O et al (2017) Evaluation of response after SBRT for liver tumors. Rep Pract Oncol Radiother 22:170–175CrossRefPubMed
49.
Yuan Y, Andronesi OC, Bortfeld TR et al (2013) Feasibility study of in vivo MRI based dosimetric verification of proton end-of-range for liver cancer patients. Radiother Oncol 106:378–382CrossRefPubMed
50.
Pollom EL, Chin AL, Diehn M et al (2017) Normal tissue constraints for abdominal and thoracic stereotactic body radiotherapy. Semin Radiat Oncol 27(3):197–208CrossRefPubMed
Metadata
Title
Direct dose correlation of MRI morphologic alterations of healthy liver tissue after robotic liver SBRT
Authors
Judit Boda-Heggemann, MD
Anika Jahnke, PhD
Mark K. H. Chan, PhD
Leila S. Ghaderi Ardekani, MSc
Peter Hunold, MD
Jost Philipp Schäfer, MD
Stefan Huttenlocher, MD
Stefan Wurster, MD
Dirk Rades, MD
Guido Hildebrandt, MD
Frank Lohr, MD
Jürgen Dunst, MD
Frederik Wenz, MD
Oliver Blanck, PhD
Publication date
01-05-2018
Publisher
Springer Berlin Heidelberg
Published in
Strahlentherapie und Onkologie / Issue 5/2018
Print ISSN: 0179-7158
Electronic ISSN: 1439-099X
DOI
https://doi.org/10.1007/s00066-018-1271-9

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