脑转移瘤立体定向放疗后近期MRI变化及疗效评价  

Changes and Efficacy Evaluation of Recent MRI Chemotherapy After Stereotactic Radiotherapy for Brain Metastases

作　　者：汤子茜 林州 欧阳苗 赵奇[1] TANG Zi-qian;LIN Zhou;OUYANG Miao;ZHAO Qi(Department of Oncology and Radiotherapy,The First Affiliated Hospital of Soochow University,Suzhou,Jiangsu,215006,China)

机构地区：[1]苏州大学附属第一医院肿瘤放疗科,江苏苏州215006

出　　处：《中国血液流变学杂志》2021年第4期524-528,共5页Chinese Journal of Hemorheology

摘　　要：目的分析脑转移瘤立体定向放疗(SBRT)后近期MRI变化特点及其与RECIST 1.1实体瘤疗效评价标准的相关性。方法回顾分析行SBRT的17例脑转移癌患者的20个病灶,治疗后1~3个月内行MRI检查评估疗效,按照RECIST 1.1标准进行疗效评估,测量转移灶实质区治疗前后表观弥散系数(ADC)及相对表观弥散系数(rADC)。结果20个病灶SBRT后疗效评估结果如下:(1)完全缓解(CR)1例,部分缓解(PR)6例,稳定(SD)10例,进展(PD)3例,客观缓解率(CR+PR)35%;(2)MRI评价:病灶体积明显缩小10例,其中水肿减轻或强化减弱4例,水肿或强化无明显变化5例,水肿增多或强化增强1例。病灶体积无明显变化7例,其中水肿减轻或强化减弱1例,水肿或强化无明显变化4例,水肿增多或强化增强2例。病灶增大3例。(3)RECIST 1.1实体瘤疗效评价7例CR+PR病灶SBRT后的ADC[(1.06±0.24)×10^(-3)mm^(2)/s]高于SBRT前的ADC[(0.90±0.15)×10^(-3)mm^(2)/s],差异具有统计学意义(P=0.021);SBRT后的rADC[(1.55±0.31)]高于SBRT前的rADC[(1.32±0.14)],差异具有统计学意义(P=0.044);SBRT后的肿瘤最大直径[(7.96±4.88)mm]低于SBRT前的肿瘤最大直径[(16.59±5.83)mm],差异具有统计学意义(P=0.008)。10例SD病灶SBRT后的ADC[(1.16±0.26)×10^(-3)mm^(2)/s]高于SBRT前的ADC[(0.91±0.13)×10^(-3)mm^(2)/s],差异具有统计学意义(P=0.003);SBRT后的rADC[(1.73±0.53)]高于SBRT前的rADC[(1.27±0.20)],差异具有统计学意义(P=0.020)。3例PD病灶SBRT后其ADC及rADC值降低。结论脑转移癌SBRT后MRI表现多样,部分病灶难以根据MRI判断性质,ADC值可辅助评估疗效,RECIST 1.1标准可能低估近期疗效。Objective To analyze the characteristics of recent MRI changes in brain metastases after stereotactic radiotherapy(SBRT)and its correlation with RECIST 1.1 solid tumor efficacy evaluation criteria.Methods 20 lesions of 17 patients with brain metastases who underwent SBRT were retrospectively analyzed.MRI examination was performed within 1-3 months after treatment to evaluate the efficacy.The efficacy was evaluated according to RECIST 1.1 criteria,and the apparent diffusion coefficient(ADC)and relative apparent diffusion coefficient(rADC)of the metastatic parenchyma before and after treatment were measured.Results The efficacy evaluation results of 20 lesions after SBRT were as follows:(1)Complete response(CR)in 1 case,partial response(PR)in 6 cases,stable response(SD)in 10 cases,and progressive response(PD)in 3 cases.The objective response rate(CR+PR)was 35%.(2)MRI evaluation:the lesion volume decreased significantly in 10 cases,including 4 cases with reduced or enhanced edema,and 5 cases with no significant change in edema or enhancement,and 1 case with increased or enhanced edema.There was no significant change in the volume of lesions in 7 cases,including 1 case with reduced or enhanced edema,4 cases with no significant change in edema or enhancement,and 2 cases with increased or enhanced edema.Lesion enlargement was in 3 cases.(3)Evaluation of the efficacy of RECIST 1.1 solid tumor in 7 CR+PR patients,the ADC[(1.06±0.24)×10^(-3)mm^(2)/s]after SBRT was higher than that before SBRT[(0.90±0.15)×10^(-3)mm^(2)/s],and the difference was statistically significant(P=0.021).The rADC after SBRT[(1.55±0.31)]was higher than that before SBRT[(1.32±0.14)],and the difference was statistically significant(P=0.044).The maximum tumor diameter after SBRT[(7.96±4.88)mm]was lower than that before SBRT[(16.59±5.83)mm],and the difference was statistically significant(P=0.008).The ADC of 10 SD lesions after SBRT[(1.16±0.26)×10^(-3)mm^(2)/s]was higher than that before SBRT[(0.91±0.13)×10^(-3)mm^(2)/s],and the difference w

关 键 词：脑转移瘤 立体定向放疗 磁共振 表观弥散系数 

分 类 号：R739.41[医药卫生—肿瘤] R730.55[医药卫生—临床医学]