Long-term characterization of MRI-morphologic alterations after active motion-compensated liver SBRT: a multi-institutional pooled analysis

Authors

  • Constantin Dreher a Department of Radiation Oncology, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany; b DKFZ-Hector Cancer Institute, University Medical Center Mannheim, Mannheim, Germany
  • Gustavo R. Sarria c Department of Radiation Oncology, University Hospital Bonn, University of Bonn, Bonn, Germany
  • Georgia Miebach a Department of Radiation Oncology, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
  • Christel Weiss d Department of Medical Statistics and Biomathematics, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
  • Daniel Buergy a Department of Radiation Oncology, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany; b DKFZ-Hector Cancer Institute, University Medical Center Mannheim, Mannheim, Germany
  • Paulina Wojtal a Department of Radiation Oncology, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
  • Anoshirwan A. Tavakoli e Department of Radiology, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
  • David Krug f Department of Radiation Oncology, University Medical Center Schleswig-Holstein, Kiel, Germany; g Saphir Radiosurgery Center Northern Germany, Kiel, Germany
  • Hans Oppitz a Department of Radiation Oncology, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
  • Frank A. Giordano a Department of Radiation Oncology, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany; b DKFZ-Hector Cancer Institute, University Medical Center Mannheim, Mannheim, Germany
  • Marcus Both h Department of Radiology and Neuroradiology, University Medical Center Schleswig-Holstein, Kiel, Germany
  • Frank Lohr i Dipartimento di Oncologia, UO di Radioterapia, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
  • ürgen Dunst f Department of Radiation Oncology, University Medical Center Schleswig-Holstein, Kiel, Germany
  • Oliver Blanck f Department of Radiation Oncology, University Medical Center Schleswig-Holstein, Kiel, Germany; g Saphir Radiosurgery Center Northern Germany, Kiel, Germany
  • Judit Boda-Heggemann a Department of Radiation Oncology, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany; b DKFZ-Hector Cancer Institute, University Medical Center Mannheim, Mannheim, Germany

DOI:

https://doi.org/10.1080/0284186X.2023.2187707

Keywords:

SBRT, liver, metastases, healthy tissue response, MRI

Abstract

Background

Stereotactic body radiotherapy (SBRT) is an effective therapeutic approach in patients with liver metastases. However, long-term changes in hepatic normal tissue have to be taken into account in multimodal treatment regimes. Magnetic-resonance-imaging (MRI) based morphologic liver alterations (MMA) after liver SBRT have been analyzed longitudinally.

Material and methods

57 patients treated with gantry-based or robotic-based SBRT of 69 treatment volumes of liver metastases, who had long-term follow-up (FU) ≥6 months were included in this retrospective analysis. Post-SBRT MMAs were contoured on each contrast-enhanced-T1-weighted (T1w) MRI-sequence. Morphologic/volumetric data of the liver and MMAs were evaluated longitudinally, including the dependency on treatment-related factors of the planning target volume (PTV) and liver.

Results

The median FU time was 1 year [6–48 months]. 66 of 69 treatment volumes developed MMAs (mean 143.8 ± 135.1 ccm at first appearance). 31.8% of MMAs resolved completely during FU. Of the persisting MMAs 82.2%/13.3% decreased/increased in size until last available FU. Morphological characterization of the MMAs at first appearance included 75% hypointense and 25% hyperintense T1w-MRI-based appearances. Hypointense as compared to hyperintense appearance was significantly associated with a higher mean liver dose EQD2α/β=3 Gy (p = 0.0212) and non-significantly greater MMA size. Variance analysis demonstrated a significant reduction of MMA and total liver volume after SBRT (p < 0.0001). The volume reduction decelerated longitudinally for both MMA (p < 0.0001) and liver size (p = 0.0033). Radiation doses (PTV-BEDα/β=3 Gy and 10 Gy) were not significantly associated with MMA volume reduction. SBRT of liver metastases with mean liver dose EQD2α/β=3 Gy > 18 Gy were characterized by greater MMA volumes (p = 0.0826) and steeper MMA reduction gradients during FU than those with EQD2α/β=3 Gy ≤ 18 Gy (p < 0.0001).

Conclusion

Radiogenic MMAs either completely resolve or usually decrease in volume with pronounced reduction during short-term FU. This course was independent of the MMA’s morphological appearance. Further, increased mean liver dose was associated with greater MMA size and a greater gradient of MMA size reduction during FU.

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Published

2023-03-04

How to Cite

Dreher, C., Sarria, G. R., Miebach, G., Weiss, C., Buergy, D., Wojtal, P., … Boda-Heggemann, J. (2023). Long-term characterization of MRI-morphologic alterations after active motion-compensated liver SBRT: a multi-institutional pooled analysis. Acta Oncologica, 62(3), 281–289. https://doi.org/10.1080/0284186X.2023.2187707

Issue

Vol. 62 No. 3 (2023): Acta Oncologica

Section

Articles