PMID- 31439270 OWN - NLM STAT- MEDLINE DCOM- 20210212 LR - 20210212 IS - 1873-4022 (Electronic) IS - 1873-4022 (Linking) VI - 45 IP - 2 DP - 2020 Summer TI - Functional liver-image guided hepatic therapy (FLIGHT): A technique to maximize hepatic functional reserve. PG - 117-120 LID - S0958-3947(19)30096-2 [pii] LID - 10.1016/j.meddos.2019.07.007 [doi] AB - INTRODUCTION: Radiation planning approaches for liver radiation often do not consider the regional variation that can exist in liver function. This study dosimetrically compares functional liver image-guided hepatic therapy (FLIGHT) to standard stereotactic body radiation therapy (SBRT) plans. In the FLIGHT plans, functional data from hepatobiliary iminodiacetic acid (HIDA) single photon emission computed tomography (SPECT) scans serve as a road map to guide beam arrangement. While meeting the same target volume coverage, plans are optimized to reduce dose to high-functioning liver. MATERIALS AND METHODS: The study included 10 patients with hepatocellular carcinoma (HCC) with baseline HIDA SPECT imaging. Standard SBRT plans which did not systematically incorporate these scans had previously been completed on all 10 plans. Retrospectively, FLIGHT plans were created based on the use of contours of relative liver function from the HIDA SPECT as avoidance structures. Resulting dose to each relative functional liver structure was examined and compared qualitatively and using Wilcoxin rank-sum tests. Target coverage, doses to organs at risk (OARs), conformity index (CI), and gradient index (GI) were also evaluated. RESULTS: While maintaining the same target coverage, FLIGHT plans reduced the mean dose to the high functioning liver by a median of 3.0 Gy (range 0.7 to 4.6 Gy), which represented a 31.4% mean reduction compared to standard planning. FLIGHT plans reduced the volume of high functioning liver receiving 15 Gy by a mean of 59.3 cc (range 7 to 170 cc), for a mean reduction of 41.9%. The mean dose to areas of liver function defined by 25% to 100% and 50% to 100% maximum was reduced with FLIGHT from 10.5 Gy to 8.5 Gy and from 10.5 Gy to 7.5 Gy, respectively (p < 0.005 for both comparisons). The FLIGHT plans' mean CI and GI did not differ significantly from the standard plans' (p = 0.721 and 0.169, respectively). CONCLUSION: FLIGHT SBRT allows for field design and plan optimization individualized to a patient's baseline regional liver function to maximize hepatic functional reserve. This personalized approach is achieved without compromising target coverage or OAR sparing. CI - Copyright (c) 2019 American Association of Medical Dosimetrists. Published by Elsevier Inc. All rights reserved. FAU - Furukawa, Yukie AU - Furukawa Y AD - Department of Radiation Oncology, Indiana University School of Medicine, Indianapolis, IN 46202, USA. FAU - Long, David E AU - Long DE AD - Department of Radiation Oncology, Indiana University School of Medicine, Indianapolis, IN 46202, USA. FAU - Ellsworth, Susannah G AU - Ellsworth SG AD - Department of Radiation Oncology, Indiana University School of Medicine, Indianapolis, IN 46202, USA. Electronic address: sgellswo@iu.edu. LA - eng PT - Comparative Study PT - Journal Article DEP - 20190819 PL - United States TA - Med Dosim JT - Medical dosimetry : official journal of the American Association of Medical Dosimetrists JID - 8908862 SB - IM MH - Aged MH - Carcinoma, Hepatocellular/*radiotherapy MH - Female MH - Humans MH - Liver Function Tests MH - Liver Neoplasms/*radiotherapy MH - Male MH - Middle Aged MH - *Radiosurgery MH - *Radiotherapy Planning, Computer-Assisted MH - *Single Photon Emission Computed Tomography Computed Tomography OTO - NOTNLM OT - Hepatocellular carcinoma OT - Liver function OT - Stereotactic body radiation therapy COIS- Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. EDAT- 2019/08/24 06:00 MHDA- 2021/02/13 06:00 CRDT- 2019/08/24 06:00 PHST- 2017/05/02 00:00 [received] PHST- 2019/07/31 00:00 [revised] PHST- 2019/07/31 00:00 [accepted] PHST- 2019/08/24 06:00 [pubmed] PHST- 2021/02/13 06:00 [medline] PHST- 2019/08/24 06:00 [entrez] AID - S0958-3947(19)30096-2 [pii] AID - 10.1016/j.meddos.2019.07.007 [doi] PST - ppublish SO - Med Dosim. 2020 Summer;45(2):117-120. doi: 10.1016/j.meddos.2019.07.007. Epub 2019 Aug 19.