Name: treatment of liver metastases using an internal target volume method for stereotactic body radiotherapy
Uploaded: 2018-05-08T13:30:00
Description: Watch this Scientific Journal Video about Treatment of Liver Metastases Using an Internal Target Volume Method for Stereotactic Body Radiotherapy at JoVE.com

这项研究得到台北医科大学医院 (106 tmuh-02) 的支持。

本研究获得台北医科大学联合机构评审委员会批准。
1. SBRT 咨询
<ol><li>通过咨询多学科肿瘤委员会, 评估 SBRT 治疗肝转移瘤患者的资格。 注意: 需要进行局部消融以及手术和其他治疗选择必须由肿瘤委员会评估。我们的选择标准如下: 1) 具有良好表现状态的成年患者 (东方合作肿瘤组 0-1), 2) 通过抗癌药物控制癌症状态, 仅在肝脏 oligometastases, 3) 肝损害数≤3和最大的肿瘤≤6?...

<ol>
	<li>Mountain, C. F., McMurtrey, M. J., Hermes, K. E. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Surgery+for+pulmonary+metastasis:+a+20-year+experience.">Surgery for pulmonary metastasis: a 20-year experience.</a> Ann Thorac Surg. 38 (4), 323-330 (1984).</li><li>Hellman, S., Weichselbaum, R. R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Oligometastases.">Oligometastases.</a> J Clin Oncol. 13 (1), 8-10 (1995).</li><li>Weichselbaum, R. R., Hellman, S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Oligometastases+revisited.">Oligometastases revisited.</a> Na. 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A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=SIRFLOX:+Randomized+Phase+III+Trial+Comparing+First-Line+mFOLFOX6+(Plus+or+Minus+Bevacizumab)+Versus+mFOLFOX6+(Plus+or+Minus+Bevacizumab)+Plus+Selective+Internal+Radiation+Therapy+in+Patients+With+Metastatic+Colorectal+Cancer.">SIRFLOX: Randomized Phase III Trial Comparing First-Line mFOLFOX6 (Plus or Minus Bevacizumab) Versus mFOLFOX6 (Plus or Minus Bevacizumab) Plus Selective Internal Radiation Therapy in Patients With Metastatic Colorectal Cancer.</a> J Clin Oncol. 34 (15), 1723-1731 (2016).</li><li>Salama, J. K., Milano, M. T. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Radical+irradiation+of+extracranial+oligometastases.">Radical irradiation of extracranial oligometastases.</a> J Clin Oncol. 32 (26), 2902-2912 (2014).</li><li>Rusthoven, K. E., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Multi-institutional+phase+I/II+trial+of+stereotactic+body+radiation+therapy+for+liver+metastases.">Multi-institutional phase I/II trial of stereotactic body radiation therapy for liver metastases.</a> J Clin Oncol. 27 (10), 1572-1578 (2009).</li><li>Ricardi, U., Badellino, S., Filippi, A. R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Clinical+applications+of+stereotactic+radiation+therapy+for+oligometastatic+cancer+patients:+a+disease-oriented+approach.">Clinical applications of stereotactic radiation therapy for oligometastatic cancer patients: a disease-oriented approach.</a> J Radiat Res. 57 (Suppl 1), i58-i68 (2016).</li><li>Wild, A. T., Yamada, Y. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Treatment+Options+in+Oligometastatic+Disease:+Stereotactic+Body+Radiation+Therapy+-+Focus+on+Colorectal+Cancer.">Treatment Options in Oligometastatic Disease: Stereotactic Body Radiation Therapy - Focus on Colorectal Cancer.</a> Visc Med. 33 (1), 54-61 (2017).</li><li>Gill, S., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Patient-reported+complications+from+fiducial+marker+implantation+for+prostate+image-guided+radiotherapy.">Patient-reported complications from fiducial marker implantation for prostate image-guided radiotherapy.</a> Br J Radiol. 85 (1015), 1011-1017 (2012).</li><li>Eldredge-Hindy, H., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Active+Breathing+Coordinator+Reduces+Radiation+Dose+to+the+Heart+and+Preserves+Local+Control+in+Patients+with+Left+Breast+Cancer:+Report+of+a+Prospective+Trial.">Active Breathing Coordinator Reduces Radiation Dose to the Heart and Preserves Local Control in Patients with Left Breast Cancer: Report of a Prospective Trial.</a> Pract Radiat Oncol. 5 (1), 4-10 (2015).</li><li>Swanson, T., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Six-year+experience+routinely+using+moderate+deep+inspiration+breath-hold+for+the+reduction+of+cardiac+dose+in+left-sided+breast+irradiation+for+patients+with+early-stage+or+locally+advanced+breast+cancer.">Six-year experience routinely using moderate deep inspiration breath-hold for the reduction of cardiac dose in left-sided breast irradiation for patients with early-stage or locally advanced breast cancer.</a> Am J Clin Oncol. 36 (1), 24-30 (2013).</li><li>Sweeney, R. A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Accuracy+and+inter-observer+variability+of+3D+versus+4D+cone-beam+CT+based+image-guidance+in+SBRT+for+lung+tumors.">Accuracy and inter-observer variability of 3D versus 4D cone-beam CT based image-guidance in SBRT for lung tumors.</a> Radiat Oncol. 7, 81 (2012).</li><li>Takahashi, W., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Verification+of+Planning+Target+Volume+Settings+in+Volumetric+Modulated+Arc+Therapy+for+Stereotactic+Body+Radiation+Therapy+by+Using+In-Treatment+4-Dimensional+Cone+Beam+Computed+Tomography.">Verification of Planning Target Volume Settings in Volumetric Modulated Arc Therapy for Stereotactic Body Radiation Therapy by Using In-Treatment 4-Dimensional Cone Beam Computed Tomography.</a> Int J Radiat Oncol Biol Phys. 86 (3), 426-431 (2013).</li><li>Yeo, U. A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Evaluation+of+dosimetric+misrepresentations+from+3D+conventional+planning+of+liver+SBRT+using+4D+deformable+dose+integration.">Evaluation of dosimetric misrepresentations from 3D conventional planning of liver SBRT using 4D deformable dose integration.</a> J Appl Clin Med Phys. 15 (6), 4978 (2014).</li><li>Shinmohigashi, Y., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Tumor+motion+changes+in+stereotactic+body+radiotherapy+for+liver+tumors:+an+evaluation+based+on+four-dimensional+cone-beam+computed+tomography+and+fiducial+markers.">Tumor motion changes in stereotactic body radiotherapy for liver tumors: an evaluation based on four-dimensional cone-beam computed tomography and fiducial markers.</a> Radiat Oncol. 12, 61 (2017).</li><li>Goodman, B. D., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Long-term+safety+and+efficacy+of+stereotactic+body+radiation+therapy+for+hepatic+oligometastases.">Long-term safety and efficacy of stereotactic body radiation therapy for hepatic oligometastases.</a> Pract Radiat Oncol. 6 (2), 86-95 (2016).</li><li>Scorsetti, M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Is+stereotactic+body+radiation+therapy+an+attractive+option+for+unresectable+liver+metastases?+A+preliminary+report+from+a+phase+2+trial.">Is stereotactic body radiation therapy an attractive option for unresectable liver metastases? A preliminary report from a phase 2 trial.</a> Int J Radiat Oncol Biol Phys. 86 (2), 336-342 (2013).</li><li>Andratschke, N. H., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Stereotactic+radiation+therapy+for+liver+metastases:+factors+affecting+local+control+and+survival.">Stereotactic radiation therapy for liver metastases: factors affecting local control and survival.</a> Radiat Oncol. 10, 69 (2015).</li><li>Huang, R., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Clinical+parameters+for+predicting+radiation-induced+liver+disease+after+intrahepatic+reirradiation+for+hepatocellular+carcinoma.">Clinical parameters for predicting radiation-induced liver disease after intrahepatic reirradiation for hepatocellular carcinoma.</a> Radiat Oncol. 11 (89), (2016).</li><li>Huang, F., Wu, G., Yang, K. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Oligometastasis+and+oligo-recurrence:+more+than+a+mirage.">Oligometastasis and oligo-recurrence: more than a mirage.</a> Radiat Oncol. 31 (9), 230 (2014).</li></ol>

呼吸引起的肝畸形和器官运动导致了与辐射传递有关的困难, 以及轮廓 (目标划定) 问题。对器官运动管理技术的改进提高了治疗的准确性和精确度, 这对 SBRT 是至关重要的。目前有几种图像引导技术和呼吸运动管理系统。基准标记植入是目标定位的常用技术。基准标记通常是圆柱形的金籽, 长度为2.5 到5毫米, 直径为0.8 毫米. 在病变附近植入一个基准标记, 使基于 X 射线的图像引导系统能够定位目标...

传统上, 转移被认为是癌症的末期阶段, 与预后和生存率差有关。但是, 山et al。在1984年报告说, 根据他们20年的经验, 完整的手术切除肺转移导致一个相对较高的存活率, 如果主要肿瘤部位是在系统控制的时候, 手术1。赫尔曼和 Weichselbaum 在1995年首次提出 oligometastases, 一个中间阶段之间的局部病变和系统性疾病与 polymetastases, 这可以治愈使用额外的局部治疗2,3。在过去的几十年中, 早期发现转移, 新的手术方法治疗 oligometastases (后) 和有效的化疗改善了预后的转移。肝脏是实体肿瘤最常见的转移器官之一, 肝 oligometastases 的手术切除可以改善生存。局部消融方法, 包括射频消融, radioembolization 和放疗, 为治疗肝转移已建议一些无法手术的病人, 以实现必要的局部肿瘤控制3,4,5,6,7. 在过去几年中, 一些前瞻性和回顾性的研究报告通过立体定向体放疗 (SBRT), 也称为立体定向消融放疗, 对肝转移瘤进行有效的局部肿瘤控制, 可耐受毒性4,5,8,9。
在病人定位和固定化方法方面已经有了改进;图像采集、整合和转移到放疗系统;呼吸运动管理;高剂量输出和快速辐射输送;以及从靶病变到周围正常组织的陡峭剂量梯度。由于这些进展, SBRT 实现高度精确和精确的放射治疗与极小的严重毒性10,11。呼吸运动管理是 SBRT 的基础, 特别是对肝脏和肺部病变。一种无创、临床方便的呼吸管理技术将极大地提高 SBRT 作为治疗方案的普及程度。本文详细介绍了肝转移的 SBRT 协议, 使用四维计算机断层扫描 (4 d-CT) 与腹部压缩机 (AC) 的图像引导帮助和肝脏运动管理。

<table border="0" cellpadding="0" cellspacing="0" width="875">
	<tbody>
		<tr height="51">
			<td height="51" style="height:51px;width:195px;">CT scan</td>
			<td style="width:188px;">Philips</td>
			<td style="width:265px;">Brilliance&#160;Big Bore&#160;16 Slice&#160;CT, 7387</td>
			<td style="width:228px;">Acquire CT images for contouring and planning</td>
		</tr>
		<tr height="51">
			<td height="51" style="height:51px;width:195px;">CT contrast</td>
			<td style="width:188px;">GE Healthcare</td>
			<td style="width:265px;">Omnipaque 350 mg L/mL</td>
			<td style="width:228px;">Enhence lesion in CT images</td>
		</tr>
		<tr height="40">
			<td height="40" style="height:40px;">Linear accelerator</td>
			<td>Elekta</td>
			<td>Synergy</td>
			<td>Deliver radiotherapy</td>
		</tr>
		<tr height="40">
			<td height="40" style="height:40px;">Palnning system</td>
			<td>Pinnacle</td>
			<td>Pinnacle 9.8</td>
			<td>Implement radiotherapy planning</td>
		</tr>
		<tr height="65">
			<td height="65" style="height:65px;width:195px;">Immobilization: BlueBag BodyFix</td>
			<td>Elekta</td>
			<td>900 mm x 2325 mm, P10104840</td>
			<td>Immobilize the patient</td>
		</tr>
		<tr height="66">
			<td height="66" style="height:66px;width:195px;">Immobilization: BodyFix Cover sheet</td>
			<td>Elekta</td>
			<td>2700 mm x 1400 mm, P10102-304</td>
			<td>Immobilize the patient</td>
		</tr>
		<tr height="73">
			<td height="73" style="height:73px;width:195px;">Immobilization: BodyFix abdominal compressor</td>
			<td>Elekta</td>
			<td>diaphragm control, P10102-149</td>
			<td style="width:228px;">Restrict breath motion and organ/lesion motion</td>
		</tr>
		<tr height="57">
			<td height="57" style="height:57px;width:195px;">Immobilization: vacuum pump</td>
			<td>Elekta</td>
			<td>vacuum pump, p2 120V, P10102-110</td>
			<td style="width:228px;">Shape body bag and cover sheet according to the patient</td>
		</tr>
	</tbody>
</table>

treatment of liver metastases using an internal target volume method for stereotactic body radiotherapy

由于有效的化疗和 oligometastatic 手术, 在过去数十年中, 转移性癌症患者的预后有所改善。对于无法手术的病人, 局部消融治疗, 如立体定向体放射治疗 (SBRT), 可以提供有效的局部肿瘤控制和最小的毒性。由于它的高精度和准确性, SBRT 提供了更高的辐射剂量每分数, 是更有效的, 并针对较小的辐射量比常规放疗。此外, 利用 SBRT 实现了靶向病灶向周围正常组织的陡峭剂量梯度;因此, SBRT 提供更有效的肿瘤控制, 并表现出较少的副作用比常规放疗。使用 SBRT 是普遍的治疗颅内病变 (称为立体定向放射外科);然而, 它现在也被用于治疗脊柱和肾上腺转移。由于在图像引导辅助和呼吸运动管理方面的进步, 一些研究已经研究了使用 SBRT 治疗肺或肝肿瘤, 这是作为一个病人呼吸移动。这些研究的结果表明, SBRT 有利控制肿瘤的运动性病变。
四维计算机断层扫描 (4 维 ct) 与腹部压缩机 (AC) 是临床上方便有效的呼吸运动管理。因为这种方法是无创的, 并允许自由呼吸, 它的使用减少并发症。此外, 病人认为这种方法很方便。此外, 它被认为比其他方法的呼吸运动管理的医生和治疗师。应用4维 CT 和 AC 治疗肺部病变也得到了广泛的研究, 该技术正在获得接受治疗肝损害。然而, 使用4维 CT 的交流治疗肝脏病变的协议与治疗肺部病变的方法不同。在本文中, 我们描述了一个新的协议 SBRT 4 维 CT 和交流治疗肝转移。

SBRT 可以通过强调制放疗 (IMRT) (与6辐射束) 或容积式电弧放疗 (VMAT) (连续剂量传递和龙门旋转) 来覆盖所有目标的单一治疗, 因为单一的手术可能<img alt="image" src="/files/ftp_upload/57050/57050imgv2.jpg">不能达到切除所有肿瘤的效果。有代表性的 SBRT 治疗计划表明, 手术不可行时两种肝转移瘤的放疗计划成功。两个转移肿瘤的长度为 3cm (从段4到段 8) 和4.3 厘米 (段 8), 其体积分别为13厘...

Watch this Scientific Journal Video about Treatment of Liver Metastases Using an Internal Target Volume Method for Stereotactic Body Radiotherapy at JoVE.com

Treatment of Liver Metastases Using an Internal Target Volume Method for Stereotactic Body Radiotherapy

立体定向体放疗 (SBRT) 需要严格的准确性和精确度, 以提供高辐射剂量每分数到小的治疗量, 以改善肿瘤控制和同时减少毒性。在此, 我们提出了一个无创和临床方便的呼吸运动管理协议 SBRT 肝转移。

内靶容积法治疗肝转移瘤的立体定向体放疗

The prognosis of patients with metastatic cancers has improved in the past decades due to effective chemotherapy and oligometastatic surgery. For ...

Research

JoVE Journal

Medicine

Combination Radiotherapy in an Orthotopic Mouse Brain Tumor Model

在原位小鼠脑肿瘤模型结合放疗

Glioblastoma multiforme (GBM) are the most common and aggressive adult primary brain tumors1. In recent years there has been substantial progress in the ...

科研

医学

Stereotactic Radiosurgery for Gynecologic Cancer

妇科肿瘤的立体定向放射外科

Stereotactic body radiotherapy (SBRT) distinguishes itself by necessitating more rigid patient immobilization, accounting for respiratory motion, ...

Ex Vivo Treatment Response of Primary Tumors and/or Associated Metastases for Preclinical and Clinical Development of Therapeutics

Ex Vivo Treatment Response of Primary Tumors and/or Associated Metastases for Preclinical and Clinical Development of Therapeutics

原发性肿瘤和/或转移相关的临床前和治疗的临床开发的离体处理响应

The molecular analysis of established cancer cell lines has been the mainstay of cancer research for the past several decades. Cell culture provides both ...

Isolated Hepatic Perfusion as a Treatment for Liver Metastases of Uveal Melanoma

隔离肝脏灌注作为治疗葡萄膜黑色素瘤肝转移

Isolated hepatic perfusion (IHP) is a procedure where the liver is surgically isolated and perfused with a high concentration of the chemotherapeutic ...

Dynamic Lung Tumor Tracking for Stereotactic Ablative Body Radiation Therapy

动态肺肿瘤跟踪烧蚀立体定向放射身体治疗

Physicians considering stereotactic ablative body radiation therapy (SBRT) for the treatment of extracranial cancer targets must be aware of the sizeable ...

An Improved Method for Rapid Intubation of the Trachea in Mice

在小鼠气管插管快速的改进方法

Despite some anatomical and physiological differences, mouse models continue to be an essential tool for studying human lung disease. Bleomycin toxicity ...

Percutaneous Hepatic Perfusion (PHP) with Melphalan as a Treatment for Unresectable Metastases Confined to the Liver

Percutaneous Hepatic Perfusion PHP with Melphalan as a Treatment for Unresectable Metastases Confined to the Liver

经皮肝脏灌注（PHP）与美法仑作为囿于肝脏不能手术切除转移的治疗

Unresectable liver metastases of colorectal cancer can be treated with systemic chemotherapy, aiming to limit the disease, extend survival or turn ...

Method of Direct Segmental Intra-hepatic Delivery Using a Rat Liver Hilar Clamp Model

直接节段性肝内交付使用大鼠肝门部夹具模型方法

Major hepatic surgery with inflow occlusion, and liver transplantation, necessitate a period of warm ischemia, and a period of reperfusion leading to ...

Radiation Planning Assistant - A Streamlined, Fully Automated Radiotherapy Treatment Planning System

放射规划助理-一个流线型的全自动放疗治疗计划系统

The Radiation Planning Assistant (RPA) is a system developed for the fully automated creation of radiotherapy treatment plans, including volume-modulated ...

Measurement of the Hepatic Venous Pressure Gradient and Transjugular Liver Biopsy

肝静脉压梯度和转性肝活检测量

Here we provide a detailed protocol describing the clinical procedure of hepatic venous pressure gradient (HVPG) measurement in patients with advanced ...