文章：

立体定向放疗后肺癌脑转移瘤的瘤周水肿体积测量：PACS集成工具为基于RANO-BM标准的评估提供补充信息——一项初步研究

PACS-Integrated Tools for Peritumoral Edema Volumetrics Provide Additional Information to RANO-BM-Based Assessment of Lung Cancer Brain Metastases after Stereotactic Radiotherapy: A Pilot Study

原文发布日期：30 September 2023

DOI: 10.3390/cancers15194822

类型: Article

开放获取: 是

英文摘要：

Stereotactic radiotherapy (SRT) is the standard of care treatment for brain metastases (METS) today. Nevertheless, there is limited understanding of how posttreatment lesional volumetric changes may assist prediction of lesional outcome. This is partly due to the paucity of volumetric segmentation tools. Edema alone can cause significant clinical symptoms and, therefore, needs independent study along with standard measurements of contrast-enhancing tumors. In this study, we aimed to compare volumetric changes of edema to RANO-BM-based measurements of contrast-enhancing lesion size. Patients with NSCLC METS ≥10 mm on post-contrast T1-weighted image and treated with SRT had measurements for up to seven follow-up scans using a PACS-integrated tool segmenting the peritumoral FLAIR hyperintense volume. Two-dimensional contrast-enhancing and volumetric edema changes were compared by creating treatment response curves. Fifty NSCLC METS were included in the study. The initial median peritumoral edema volume post-SRT relative to pre-SRT baseline was 37% (IQR 8–114%). Most of the lesions with edema volume reduction post-SRT experienced no increase in edema during the study. In over 50% of METS, the pattern of edema volume change was different than the pattern of contrast-enhancing lesion change at different timepoints, which was defined as incongruent. Lesions demonstrating incongruence at the first follow-up were more likely to progress subsequently. Therefore, edema assessment of METS post-SRT provides critical additional information to RANO-BM.

摘要翻译： 

立体定向放射治疗（SRT）是目前脑转移瘤（METS）的标准治疗方案。然而，对于治疗后病灶体积变化如何有助于预测病灶转归，目前认识有限。这部分是由于缺乏体积分割工具。单纯水肿即可引起显著的临床症状，因此需要与对比增强肿瘤的标准测量方法一起进行独立研究。本研究旨在比较水肿体积变化与基于RANO-BM标准的对比增强病灶大小测量结果。纳入研究的患者为非小细胞肺癌脑转移瘤，在对比后T1加权图像上病灶≥10毫米，并接受SRT治疗。使用集成于PACS系统的工具对瘤周FLAIR高信号体积进行分割，对最多七次随访扫描进行测量。通过创建治疗反应曲线，比较二维对比增强病灶与水肿体积的变化。研究共纳入50个非小细胞肺癌脑转移瘤。SRT后初始瘤周水肿体积相对于SRT前基线的中位数为37%（四分位距8-114%）。大多数SRT后水肿体积减少的病灶在研究期间未出现水肿增加。超过50%的转移瘤在不同时间点的水肿体积变化模式与对比增强病灶变化模式不同，即定义为不一致。首次随访时表现出不一致的病灶更可能在后续进展。因此，对SRT后脑转移瘤的水肿评估为RANO-BM标准提供了重要的补充信息。

原文链接：

PACS-Integrated Tools for Peritumoral Edema Volumetrics Provide Additional Information to RANO-BM-Based Assessment of Lung Cancer Brain Metastases after Stereotactic Radiotherapy: A Pilot Study