A Pilot Study Evaluating the Use of Dynamic Contrast-Enhanced Perfusion MRI to Predict Local Recurrence After Radiosurgery on Spinal Metastases

被引:30
作者
Kumar, Kiran A. [1 ]
Peck, Kyung K. [2 ,3 ]
Karimi, Sasan [2 ]
Lis, Eric [2 ]
Holodny, Andrei I. [2 ]
Bilsky, Mark H. [4 ]
Yamada, Yoshiya [5 ]
机构
[1] Stanford Univ, Dept Radiat Oncol, Stanford, CA 94305 USA
[2] Mem Sloan Kettering Canc Ctr, Dept Radiol, New York, NY 10065 USA
[3] Mem Sloan Kettering Canc Ctr, Dept Med Phys, New York, NY 10065 USA
[4] Mem Sloan Kettering Canc Ctr, Dept Neurosurg, New York, NY 10065 USA
[5] Mem Sloan Kettering Canc Ctr, Dept Radiat Oncol, 1275 York Ave, New York, NY 10065 USA
关键词
spine metastases; SBRT; SRS; DCE-MRI; tumor recurrence; high-dose RT; RADIATION-THERAPY; TUMOR-RESPONSE; BONE-MARROW; RADIOTHERAPY; DIFFERENTIATION; INTENSITY; DISEASE; CANCER;
D O I
10.1177/1533034617705715
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
Purpose: Dynamic contrast-enhanced magnetic resonance imaging offers noninvasive characterization of the vascular microenvironment and hemodynamics. Stereotactic radiosurgery, or stereotactic body radiation therapy, engages a vascular component of the tumor response which may be detectable using dynamic contrast-enhanced magnetic resonance imaging. The purpose of this study is to examine whether dynamic contrast-enhanced magnetic resonance imaging can be used to predict local tumor recurrence in patients with spinal bone metastases who undergo high-dose radiotherapy with stereotactic radiosurgery. Materials and Methods: We conducted a study of 30 patients with spinal metastases who underwent dynamic contrast-enhanced magnetic resonance imaging before and after radiotherapy. Twenty patients received single-fraction stereotactic radiosurgery (24 Gy), while 10 received hypofractionated stereotactic radiosurgery (3-5 fractions, 27-30 Gy total). Kaplan-Meier analysis was used to estimate the actuarial local recurrence rates. Two perfusion parameters (K-trans: permeability and V-p: plasma volume) were measured for each metastasis. Percentage change in parameter values from pre- to posttreatment was calculated and compared. Results: At 20-month median follow-up, 5 of the 30 patients had pathological evidence of local recurrence. One- and 3-year actuarial local recurrence rates were 24% and 44% for the hypofractionated stereotactic radiosurgery cohort versus 5% and 16% for the single-fraction stereotactic radiosurgery cohort (P = .20). The average change in V-p and K-trans for patients without local recurrence versus those with local recurrence was -76% and -66% versus +28% and -14% (P < .01 for both). With a cutoff point of -20%, V-p had a sensitivity, specificity, positive predictive value, and negative predictive value of 100%, 98%, 91%, and 100%, respectively, for the detection of local recurrence following high-dose radiotherapy. Using this definition, dynamic contrast-enhanced magnetic resonance imaging identified local recurrence up to 18 months (mean [standard deviation], 6.6 [6.8] months) earlier than standard magnetic resonance imaging. Conclusions: We demonstrated that changes in perfusion parameters, particularly V-p, after high-dose radiotherapy to spinal bone metastases were predictive of local tumor recurrence. These changes predicted local recurrence on average >6 months earlier than standard imaging did.
引用
收藏
页码:857 / 865
页数:9
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