PMID- 38405302
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20240227
IS  - 2452-1094 (Print)
IS  - 2452-1094 (Electronic)
IS  - 2452-1094 (Linking)
VI  - 9
IP  - 2
DP  - 2024 Feb
TI  - Stereotactic Body Radiation Therapy (SBRT) for Hepatocellular Carcinoma (HCC) 
      With Single Photon Emission Computed Tomography (SPECT) Functional Treatment 
      Planning in Patients With Advanced Hepatic Cirrhosis.
PG  - 101367
LID - 10.1016/j.adro.2023.101367 [doi]
LID - 101367
AB  - PURPOSE: We report on the feasibility and outcomes of liver stereotactic body 
      radiation therapy (SBRT) for hepatocellular carcinoma (HCC) with single-photon 
      emission computed tomography (SPECT) functional treatment planning in patients 
      with Child-Pugh (CP) B/C cirrhosis. METHODS AND MATERIALS: Liver SPECT with 
      (99m)Tc-sulfur colloid was coregistered to treatment planning computed tomography 
      (CT) for the guided avoidance of functional hepatic parenchyma during SBRT. 
      Functional liver volumes (FLVs) obtained from SPECT were compared with anatomic 
      liver volumes defined on the planning CT. Radiation dose constraints were adapted 
      exclusively to FLV. Local control, toxicity, and survival were reported with at 
      least 6 months of radiographic follow-up. Pre- and posttransplant outcomes were 
      analyzed in a subset of patients who completed SBRT as a bridge to liver 
      transplant. Model of End-Stage Liver Disease was used to score hepatic function 
      before and after SBRT completion. RESULTS: With a median follow-up of 32 months, 
      45 patients (58 lesions) with HCC and CP-B/C cirrhosis received SBRT to a median 
      dose of 45 Gy (3-5 fractions). FLV loss (34%, P < .001) was observed in all 
      patients, and the functional and anatomic liver volumes matched well in a control 
      group of noncirrhotic/non-HCC patients. Despite marked functional parenchyma 
      retraction, the amount of FLV on SPECT exposed to the threshold irradiation was 
      significantly less than the CT liver volumes (P < .001) because of the optimized 
      beam placement during dosimetry planning. Twenty-three patients (51%) 
      successfully completed orthotopic liver transplant, with a median time to 
      transplant of 9.2 months. With 91% in-field local control, the overall 2-year 
      survival was 65% (90% after the orthotopic liver transplant), with no incidence 
      of radiation-induced liver disease observed within 3 to 4 months or accelerated 
      CP class migration from B to C within the first 6 months post-SBRT. Mean Model of 
      End-Stage Liver Disease-Na score was not significantly elevated at 3-month 
      intervals after SBRT completion. CONCLUSIONS: Functional treatment planning with 
      (99m)Tc sulfur colloid SPECT/CT allows identification and avoidance of functional 
      hepatic parenchyma in patients with CP-B/C cirrhosis, leading to low toxicity and 
      satisfactory transplant outcomes.
CI  - (c) 2023 The Authors.
FAU - Kirichenko, Alexander
AU  - Kirichenko A
AD  - Division of Radiation Oncology, Allegheny Health Network Cancer Institute, 
      Pittsburgh, Pennsylvania.
FAU - Uemura, Tadahiro
AU  - Uemura T
AD  - Division of Abdominal Transplantation and Hepato-Biliary Surgery, Allegheny 
      General Hospital, Pittsburgh, Pennsylvania.
FAU - Liang, Yun
AU  - Liang Y
AD  - Division of Radiation Oncology, Allegheny Health Network Cancer Institute, 
      Pittsburgh, Pennsylvania.
FAU - Hasan, Shaakir
AU  - Hasan S
AD  - New York Proton Center, New York, New York.
FAU - Abel, Steven
AU  - Abel S
AD  - Division of Radiation Oncology, Allegheny Health Network Cancer Institute, 
      Pittsburgh, Pennsylvania.
FAU - Renz, Paul
AU  - Renz P
AD  - Division of Radiation Oncology, Allegheny Health Network Cancer Institute, 
      Pittsburgh, Pennsylvania.
FAU - Shamsesfandabadi, Parisa
AU  - Shamsesfandabadi P
AD  - Division of Radiation Oncology, Allegheny Health Network Cancer Institute, 
      Pittsburgh, Pennsylvania.
FAU - Carpenter, Jennifer
AU  - Carpenter J
AD  - Division of Abdominal Transplantation and Hepato-Biliary Surgery, Allegheny 
      General Hospital, Pittsburgh, Pennsylvania.
FAU - Yin, Yue
AU  - Yin Y
AD  - Allegheny-Singer Research Institute, Biostatistics, Allegheny Health Network, 
      Pittsburgh, Pennsylvania.
FAU - Thai, Ngoc
AU  - Thai N
AD  - Division of Abdominal Transplantation and Hepato-Biliary Surgery, Allegheny 
      General Hospital, Pittsburgh, Pennsylvania.
LA  - eng
PT  - Journal Article
DEP - 20230901
PL  - United States
TA  - Adv Radiat Oncol
JT  - Advances in radiation oncology
JID - 101677247
PMC - PMC10885583
EDAT- 2024/02/26 06:44
MHDA- 2024/02/26 06:45
PMCR- 2023/09/01
CRDT- 2024/02/26 04:42
PHST- 2023/03/28 00:00 [received]
PHST- 2023/08/19 00:00 [accepted]
PHST- 2024/02/26 06:45 [medline]
PHST- 2024/02/26 06:44 [pubmed]
PHST- 2024/02/26 04:42 [entrez]
PHST- 2023/09/01 00:00 [pmc-release]
AID - S2452-1094(23)00195-1 [pii]
AID - 101367 [pii]
AID - 10.1016/j.adro.2023.101367 [doi]
PST - epublish
SO  - Adv Radiat Oncol. 2023 Sep 1;9(2):101367. doi: 10.1016/j.adro.2023.101367. 
      eCollection 2024 Feb.