MRI对肝细胞癌SBRT的疗效评价及预测因素研究

Efficacy Evaluation and Predictive Factors of Stereotactic Body Radiation Therapy for Hepatocellular Carcinoma Using MRI

目的探讨对肝细胞癌(Hepatocellular Carcinoma,HCC)进行立体定向体部放疗(Stereotactic Body Radiation Therapy,SBRT)后,肿瘤缓解、局部控制及其预测因素与影像学特征的关系。方法回顾性选取25例接受SBRT治疗的32个HCC病灶。在3年随访中根据实体瘤反应评估标准(Response Evaluation Criteria in Solid Tumors,RECIST)和改良实体瘤反应评估标准(Modified RECIST,mRECIST)分别通过MRI评价肿瘤的缓解情况。结果mRECIST得到的局部缓解程度高于采用RECIST标准,其中两者肿瘤缓解率(Response Rate,RR)比较,差异具有统计学意义(P=0.002)。肿瘤基线直径小于22.5 mm是RECIST的独立预测因素(P=0.035)。结论SBRT是治疗无法手术的HCC的有效技术,治疗后MRI图像上产生的变化可能与肿瘤的进展密切相关。基线情况下的肿瘤大小及随访期的扩散加权强度是肿瘤RR的预测因素,可作为一种可靠的治疗效果预测方法。

Objective To explore the relationship between tumor response,local control,predictive factors and imaging features after stereotactic body radiation therapy(SBRT)for hepatocellular carcinoma(HCC).Methods A total of 25 patients with 32 HCC lesions treated with SBRT were included in this retrospective study.The assessment was made by using MRI,with determination of local and hepatic responses according to response evaluation criteria in solid tumors(RECIST)and modified RECIST(mRECIST)criteria during a three-year follow-up.Results The local response rate obtained by mRECIST was higher than that by RECIST,and the difference was statistically significant(P=0.002).A tumor diameter less than 22.5 mm at baseline was an independent predictive factor for RECIST responses(P=0.035).Conclusion SBRT is an effective technique for the treatment of inoperable HCC,and post-treatment changes on MRI images may be closely related to tumor progression.Tumor diameter at baseline and diffusion-weighted intensity at follow-up are predictive factors for tumor responses,which can be used as a reliable method to predict treatment effect.