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

Judit Boda-heggemann; Anika Jahnke; Mark K. H. Chan; Leila S. Ghaderi Ardekani; Peter Hunold; Jost Philipp Schäfer; Stefan Huttenlocher; Stefan Wurster; Dirk Rades; Guido Hildebrandt; Frank Lohr; Jürgen Dunst; Frederik Wenz; Oliver Blanck

doi:10.1007/s00066-018-1271-9

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

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

Department of Clinical Medicine

11 Citations (Scopus)

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.

Original language	English
Journal	Strahlentherapie und Onkologie
Volume	194
Issue number	5
Pages (from-to)	414-424
Number of pages	11
ISSN	0179-7158
DOIs	https://doi.org/10.1007/s00066-018-1271-9
Publication status	Published - 1 May 2018

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Boda-heggemann, J., Jahnke, A., Chan, M. K. H., Ghaderi Ardekani, L. S., Hunold, P., Schäfer, J. P., Huttenlocher, S., Wurster, S., Rades, D., Hildebrandt, G., Lohr, F., Dunst, J., Wenz, F., & Blanck, O. (2018). Direct dose correlation of MRI morphologic alterations of healthy liver tissue after robotic liver SBRT. Strahlentherapie und Onkologie, 194(5), 414-424. https://doi.org/10.1007/s00066-018-1271-9

Boda-heggemann, J, Jahnke, A, Chan, MKH, Ghaderi Ardekani, LS, Hunold, P, Schäfer, JP, Huttenlocher, S, Wurster, S, Rades, D, Hildebrandt, G, Lohr, F, Dunst, J, Wenz, F & Blanck, O 2018, 'Direct dose correlation of MRI morphologic alterations of healthy liver tissue after robotic liver SBRT', Strahlentherapie und Onkologie, vol. 194, no. 5, pp. 414-424. https://doi.org/10.1007/s00066-018-1271-9

@article{874fc0ba48644387a832687ba839a565,

title = "Direct dose correlation of MRI morphologic alterations of healthy liver tissue after robotic liver SBRT",

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.",

author = "Judit Boda-heggemann and Anika Jahnke and Chan, {Mark K. H.} and {Ghaderi Ardekani}, {Leila S.} and Peter Hunold and Sch{\"a}fer, {Jost Philipp} and Stefan Huttenlocher and Stefan Wurster and Dirk Rades and Guido Hildebrandt and Frank Lohr and J{\"u}rgen Dunst and Frederik Wenz and Oliver Blanck",

year = "2018",

month = may,

day = "1",

doi = "10.1007/s00066-018-1271-9",

language = "English",

volume = "194",

pages = "414--424",

journal = "Strahlentherapie",

issn = "0931-2447",

publisher = "Springer Medizin",

number = "5",

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T1 - Direct dose correlation of MRI morphologic alterations of healthy liver tissue after robotic liver SBRT

AU - Boda-heggemann, Judit

AU - Jahnke, Anika

AU - Chan, Mark K. H.

AU - Ghaderi Ardekani, Leila S.

AU - Hunold, Peter

AU - Schäfer, Jost Philipp

AU - Huttenlocher, Stefan

AU - Wurster, Stefan

AU - Rades, Dirk

AU - Hildebrandt, Guido

AU - Lohr, Frank

AU - Dunst, Jürgen

AU - Wenz, Frederik

AU - Blanck, Oliver

PY - 2018/5/1

Y1 - 2018/5/1

N2 - 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.

AB - 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.

U2 - 10.1007/s00066-018-1271-9

DO - 10.1007/s00066-018-1271-9

M3 - Journal article

C2 - 29404626

SN - 0931-2447

VL - 194

SP - 414

EP - 424

JO - Strahlentherapie

JF - Strahlentherapie

IS - 5

ER -

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

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