Arterial perfusion imaging-defined subvolume of intrahepatic cancer.

Abstract

PURPOSE:

To assess whether an increase in a subvolume of intrahepatic tumor with elevated arterial perfusion during radiation therapy (RT) predicts tumor progression after RT.

METHODS AND MATERIALS:

Twenty patients with unresectable intrahepatic cancers undergoing RT were enrolled in a prospective, institutional review board-approved study. Dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) was performed before RT (pre-RT), after delivering ∼60% of the planned dose (mid-RT) and 1 month after completion of RT to quantify hepatic arterial perfusion. The arterial perfusions of the tumors at pre-RT were clustered into low-normal and elevated perfusion by a fuzzy clustering-based method, and the tumor subvolumes with elevated arterial perfusion were extracted from the hepatic arterial perfusion images. The percentage changes in the tumor subvolumes and means of arterial perfusion over the tumors from pre-RT to mid-RT were evaluated for predicting tumor progression post-RT.

RESULTS:

Of the 24 tumors, 6 tumors in 5 patients progressed 5 to 21 months after RT completion. Neither tumor volumes nor means of tumor arterial perfusion at pre-RT were predictive of treatment outcome. The mean arterial perfusion over the tumors increased significantly at mid-RT in progressive tumors compared with the responsive tumors (P=.006). From pre-RT to mid-RT, the responsive tumors had a decrease in the tumor subvolumes with elevated arterial perfusion (median, -14%; range, -75% to 65%), whereas the progressive tumors had an increase of the subvolumes (median, 57%; range, -7% to 165%) (P=.003). Receiver operating characteristic analysis of the percentage change in the subvolume for predicting tumor progression post-RT had an area under the curve of 0.90.

CONCLUSION:

The increase in the subvolume of the intrahepatic tumor with elevated arterial perfusion during RT has the potential to be a predictor for tumor progression post-RT. The tumor subvolume could be a radiation boost candidate for response-driven adaptive RT.

• Authors: Hesheng Wang, Reza Farjam, Mary Feng, Hero Hussain, Randall K Ten Haken, Theodore S Lawrence, Yue Cao
• Journal: International journal of radiation oncology, biology, physics (Int J Radiat Oncol Biol Phys) Vol. 89 Issue 1 Pg. 167-74 (May 01 2014) ISSN: 1879-355X [Electronic] United States
• PMID: 24613814 (Publication Type: Journal Article, Research Support, N.I.H., Extramural)
• Copyright: Published by Elsevier Inc.

Chemical References

• Contrast Media

Topics

• Adult
• Aged
• Aged, 80 and over
• Area Under Curve
• Bile Duct Neoplasms (blood supply, pathology, radiotherapy, surgery)
• Bile Ducts, Intrahepatic
• Carcinoma, Hepatocellular (blood supply, pathology, radiotherapy, surgery)
• Cholangiocarcinoma (blood supply, pathology, radiotherapy, surgery)
• Contrast Media
• Disease Progression
• Female
• Hepatic Artery (physiopathology)
• Humans
• Liver Neoplasms (blood supply, pathology, radiotherapy, secondary, surgery)
• Magnetic Resonance Imaging (methods)
• Male
• Middle Aged
• Perfusion Imaging (methods)
• Prospective Studies
• ROC Curve
• Radiosurgery
• Radiotherapy, Conformal