The prediction of radiation-induced liver dysfunction using a local dose and regional venous perfusion model
The prediction of radiation-induced liver dysfunction using a local dose and regional venous perfusion model
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DOI：
10.1118/1.2431081
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发表时间：
2007-02-01
期刊：
影响因子：
3.8
通讯作者：
Lawrence, Theodore S.
中科院分区：
文献类型：
--
作者：
Cao, Yue;Platt, Joel F.;Lawrence, Theodore S.
我们已经证明，高剂量适形放疗联合化疗似乎可以延长不可切除的肝内癌患者的生存期。安全提供更高剂量的能力主要受限于以静脉闭塞为特征的辐射引起的肝脏疾病的发展。在这项研究中，我们探讨了放射治疗（RT）结束前门静脉灌注测量和剂量是否可以预测治疗后肝静脉灌注功能障碍。10例不可切除的肝癌患者参加了irb批准的计算机断层扫描（CT）灌注研究。通过动态增强CT和单室模型估计肝动脉和门静脉灌注分布。在四个时间点进行扫描：治疗前，1.5 Gy治疗的15和30次治疗后，以及RT完成后一个月。多变量线性回归用于确定前三个时间点测量加上剂量之间的协方差，以预测RT后测量。术后1个月局部静脉灌注减少的预测指标为局部累积剂量和30分相似后局部静脉灌注变化（F=90.6,p < 0.00001）。每Gy使静脉灌注减少约1.2%。这种局部剂量和静脉灌注模型有可能预测个体对辐射的敏感性。这是朝着开发一种方法迈出的第一步，该方法可以向可以安全接受更高剂量的患者提供更高和可能更具疗效的辐射剂量。(c) 2007年美国医学物理学家协会。
We have shown that high dose conformal radiation combined with chemotherapy appears to prolong the survival of patients with unresectable intrahepatic cancers. The ability to safely deliver higher doses is primarily limited by the development of radiation-induced liver disease, characterized by venous occlusion. In this study, we investigated whether portal venous perfusion measured prior to the end of radiation therapy (RT) together with dose could predict liver venous perfusion dysfunction after treatment. Ten patients with unresectable intrahepatic cancer participated in an IRB-approved computer tomography (CT) perfusion study. Hepatic arterial and portal vein perfusion distributions were estimated by using dynamic contrast enhanced CT and the single compartmental model. Scans were obtained at four time points: prior to treatment, after 15 and 30 fractions of 1.5 Gy treatments, and one month following the completion of RT. Multivariant linear regression was used to determine covariances among the first three time point measurements plus dose for prediction of the post RT measurement. The reduction in the regional venous perfusion one month following RT was predicted by the local accumulated dose and the change in the regional venous perfusion after similar to 30 fractions (F=90.6,p < 0.00001). Each Gy produced an approximately 1.2% of reduction in the venous perfusion. This local dose and venous perfusion model has the potential to predict individual sensitivity to radiation. This is the first step toward developing a method to deliver higher and potentially more curative radiation doses to the patients who can safely receive these higher doses. (c) 2007 American Association of Physicists in Medicine.