Incorporating GSA-SPECT into CT-based dose-volume histograms for advanced hepatocellular carcinoma radiotherapy

Shirai, Shintaro; Sato, Morio; Noda, Yasutaka; Kumayama, Yoshitaka; Shimizu, Norifumi

doi:10.4329/wjr.v6.i8.598

Cited by 9 publications

(11 citation statements)

References 23 publications

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“…Prior radiation avoidance feasibility studies have sought to avoid irradiation of discrete functional tissue volumes defined by perfused lung [32,33,39] or functional liver [40,41] estimated on SPECT imaging. Shirai and colleagues employed manual segmentation to define functional liver volumes on GSA SPECT and incorporated a functional dose–volume constraint (functional volume receiving 20 Gy or higher) in conformal radiotherapy plans, which resulted in less liver function deterioration as measured by Child– Turcotte–Pugh scores post therapy [40].…”

Section: Discussionmentioning

confidence: 99%

“…Shirai and colleagues employed manual segmentation to define functional liver volumes on GSA SPECT and incorporated a functional dose–volume constraint (functional volume receiving 20 Gy or higher) in conformal radiotherapy plans, which resulted in less liver function deterioration as measured by Child– Turcotte–Pugh scores post therapy [40]. Their demonstration of technical feasibility and observed lower risk of RILD lends credibility to functional liver avoidance strategies.…”

Section: Discussionmentioning

confidence: 99%

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Differential hepatic avoidance radiation therapy: Proof of concept in hepatocellular carcinoma patients

Bowen¹,

Saini²,

Chapman³

et al. 2015

Radiotherapy and Oncology

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Purpose To evaluate the feasibility of a novel planning concept that differentially redistributes RT dose away from functional liver regions as defined by 99mTc-sulphur colloid (SC) uptake on patient SPECT/ CT images. Materials and methods Ten HCC patients with different Child–Turcotte–Pugh scores (A5-B9) underwent SC SPECT/CT scans in treatment position prior to RT that were registered to planning CT scans. Proton pencil beam scanning (PBS) therapy plans were optimized to deliver 37.5–60.0 Gy (RBE) over 5–15 fractions using single field uniform dose technique robust to range and setup uncertainty. Photon volumetrically modulated arc therapy (VMAT) plans were optimized to the same prescribed dose and minimum target coverage. For both treatment modalities, differential hepatic avoidance RT (DHART) plans were generated to decrease dose to functional liver volumes (FLV) defined by a range of thresholds relative to maximum SC uptake (43–90%) in the tumor-subtracted liver. Radiation dose was redistributed away from regions of increased SC uptake in each FLV by linearly scaling mean dose objectives during PBS or VMAT optimization. DHART planning feasibility was assessed by a significantly negative Spearman’s rank correlation (RS) between dose difference and SC uptake. Patient, tumor, and treatment planning characteristics were tested for association to DHART planning feasibility using non-parametric Kruskal–Wallis ANOVA. Results Compared to conventional plans, DHART plans achieved a 3% FLV dose reduction for every 10% SC uptake increase. DHART planning was feasible in the majority of patients with 60% of patients having RS < −0.5 (p < 0.01, range −1.0 to 0.2) and was particularly effective in 30% of patients (RS < −0.9). Mean dose to FLV was reduced by up to 20% in these patients. Only fractionation regimen was associated with DHART planning feasibility: 15 fraction courses were more feasible than 5–6 fraction courses (RS < −0.93 vs. RS > −0.60, p < 0.02). Conclusion Differential avoidance of functional liver regions defined on sulphur colloid SPECT/CT is achievable with either photon VMAT or proton PBS therapy. Further investigation with phantom studies and in a larger cohort of patients may validate the utility of DHART planning for HCC radiotherapy.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Differential hepatic avoidance radiation therapy: Proof of concept in hepatocellular carcinoma patients

Bowen¹,

Saini²,

Chapman³

et al. 2015

Radiotherapy and Oncology

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“…We used it to create a functional DVH for RT of HCC using Tc-99m GSA. FL does not always correspond to the normal liver in patients with liver cirrhosis and/or HCC with PVTT [23] . GSA-SPECT usually shows no accumulation of radioactivity in the normal liver in the lobe with the tumor thrombus, so the normal liver is registered as dysfunctional liver [9,10] .…”

Section: Discussionmentioning

confidence: 99%

Cutoff Values for Dose-liver Function Parameters to Prevent Radiation-induced Liver Disease in Advanced Hepatoma

Shirai

Kumayama

Sato

et al. 2015

Journal of Gastroenterology and Hepatology Research

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AIM:To retrospectively explore the cutoff values that predict radiation-induced liver disease (RILD) in hepatocellular carcinoma (HCC) patients with portal vein tumor thrombus (PVTT) in the main trunk and/or the first branch who had previously received singlephoton-emission computed tomography (SPECT)-based threedimensional conformal radiotherapy (3DCRT; SPECT-B-3DCRT) using Tc-99m-galactosyl human serum albumin (Tc-99m GSA). METHODS: Seventy-five HCC patients with PVTT underwent SPECT-B-3DCRT (total dose of 45 Gy/18 fractions) in the stopbreathing position with an error of ≤5 mm. SPECT allowed the minimum possible irradiation of the functional liver (FL). ChildPugh score deterioration (CPSD) by 2 (=RILD) or CPSD by 1 was scored within four months of completing SPECT-B-3DCRT. Receiver-operating characteristic (ROC) analysis of the outcomes RILD vs CPSD by 1 was conducted to determine the accuracy and cutoff values for FLV20Gy (percentage of FL volume receiving ≥20 Gy), F20Gy (GSA counts within the irradiated liver area receiving ≥20 Gy ×100/GSA counts in the whole liver), F20Gy/LHL15 (liver radioactivity counts at 15 min/heart plus liver radioactivity counts at 15 min), and F20Gy/total count ratio (liver radioactivity counts/liver plus total background radioactivity counts). RESULTS:The cutoff values and accuracy of FLV20Gy, F20Gy, F20Gy/ LHL15, and F20Gy/total count ratio were 26.4 and 0.826 (p=0.024), 30.2 and 0.913 (p=0.004), 37.7 and 0.913 (p=0.001), and 43.0 and 0.957 (p<0.001), respectively. CONCLUSION: An F20Gy/total count ratio of 43.0 is the most reliable cutoff value for preventing RILD.

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“…Tsegmed et al 14 reported on the efficacy of the dose delivery that avoids the functional liver volume, which was defined using Gd‐EOB‐DTPA‐enhanced MRI. Furthermore, single‐photon emission computed tomography (SPECT) with 99mTc‐galactosyl human serum albumin (GSA) is a widely accepted preoperative and preradiotherapy procedure for evaluating hepatic functional reserve 15,16 . Sugahara et al 15 reported the usefulness of GSA‐SPECT in evaluating regional hepatic function and the progression of viral hepatitis before undergoing a surgical hepatectomy.…”

Section: Introductionmentioning

confidence: 99%

“…Sugahara et al 15 reported the usefulness of GSA‐SPECT in evaluating regional hepatic function and the progression of viral hepatitis before undergoing a surgical hepatectomy. Shirai et al 16 defined the functional liver as the region of a normal liver in which GSA accumulation exceeded that of the HCC. They reported that the planning designed to irradiate under 20% of the functional liver volume is a useful safety index to prevent RILD after radiotherapy for HCC.…”

Section: Introductionmentioning

confidence: 99%

Estimation of liver elasticity using the finite element method and four‐dimensional computed tomography images as a biomarker of liver fibrosis

et al. 2021

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Purpose Current radiotherapy planning procedures are generally designed based on anatomical information only and use computed tomography (CT) images that do not incorporate organ‐functional information. In this study, we developed a method for estimating liver elasticity using the finite element method (FEM) and four‐dimensional CT (4DCT) images acquired during radiotherapy planning, and we subsequently evaluated its feasibility as a biomarker for liver fibrosis. Materials and methods Twenty patients who underwent 4DCT and ultrasound‐based transient elastography (UTE) were enrolled. All patients had chronic liver disease or cirrhosis. Liver elasticity measurements of the UTE were performed on the right lobe of the patient’s liver in 20 patients. The serum biomarkers of the aspartate aminotransferase (AST)‐to‐platelet ratio index (APRI) and fibrosis‐4 index (FIB‐4) were available in 18 of the 20 total patients, which were measured within 1 week after undergoing 4DCT. The displacement between the 4DCT images obtained at the endpoints of exhalation and inspiration was determined using the actual (via deformable image registration) and simulated (via FEM) respiration‐induced displacement. The elasticity of each element of the liver model was optimized by minimizing the error between the actual and simulated respiration‐induced displacement. Then, each patient's estimated liver elasticity was defined as the mean Young’s modulus of the liver’s right lobe and that of the whole liver using the estimated elasticity map. The estimated liver elasticity was evaluated for correlations with the elasticity obtained via UTE and with two serum biomarkers (APRI and FIB‐4). Results The mean ± standard deviation (SD) of the errors between the actual and simulated respiration‐induced displacement in the liver model was 0.54 ± 0.33 mm. The estimated liver’s right lobe elasticity was statistically significantly correlated with the UTE (r = 0.87, P < 0.001). Furthermore, the estimated whole liver elasticity was statistically significantly correlated with the UTE (r = 0.84, P < 0.001), APRI score (r = 0.62, P = 0.005), and FIB‐4 score (r = 0.54, P = 0.021). Conclusion In this study, liver elasticity was estimated through FEM‐based simulation and actual respiratory‐induced liver displacement obtained from 4DCT images. Furthermore, we assessed that the estimated elasticity of the liver’s right lobe was strongly correlated with the UTE. Therefore, the estimated elasticity has the potential to be a feasible imaging biomarker for assessing liver fibrosis using only 4DCT images without additional inspection or equipment costs. Because our results were derived from a limited sample of 20 patients, it is necessary to evaluate the accuracy of elasticity estimation for each liver segment on larger groups of biopsied patients to utilize liver elasticity information for radiotherapy planning.

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Incorporating GSA-SPECT into CT-based dose-volume histograms for advanced hepatocellular carcinoma radiotherapy

Cited by 9 publications

References 23 publications

Differential hepatic avoidance radiation therapy: Proof of concept in hepatocellular carcinoma patients

Differential hepatic avoidance radiation therapy: Proof of concept in hepatocellular carcinoma patients

Cutoff Values for Dose-liver Function Parameters to Prevent Radiation-induced Liver Disease in Advanced Hepatoma

Estimation of liver elasticity using the finite element method and four‐dimensional computed tomography images as a biomarker of liver fibrosis

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