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Case Reports
. 2020 Nov-Dec;34(6):3583-3588.
doi: 10.21873/invivo.12202.

Stereotactic Body Radiotherapy Based on 99mTc-GSA SPECT Image-guided Inverse Planning for Hepatocellular Carcinoma

Yudai Kai #  1 , Ryo Toya #  2 , Tetsuo Saito  3 , Tomohiko Matsuyama  3 , Yoshiyuki Fukugawa  3 , Shinya Shiraishi  4 , Yoshinobu Shimohigashi  1 , Natsuo Oya  3
Affiliations
Case Reports

Stereotactic Body Radiotherapy Based on 99mTc-GSA SPECT Image-guided Inverse Planning for Hepatocellular Carcinoma

Yudai Kai et al. In Vivo. 2020 Nov-Dec.

Abstract

Background/aim: A recent planning study suggested that 99mTc-labelled diethylene triamine pentaacetate-galactosyl human serum albumin (99mTc-GSA) single-photon emission computed tomography (SPECT) image-guided inverse planning (IGIP) shows dosimetric superiority to conventional planning in sparing liver function. Here, we report the first clinical translation of 99mTc-GSA SPECT IGIP for stereotactic body radiotherapy (SBRT) in a patient with hepatocellular carcinoma (HCC).

Case report: A 60-year-old male developed obstructive jaundice caused by recurrent HCC in segment 1 after hepatic resection. He underwent repeated radiotherapy (RT) consisting of 45 Gy in 15 fractions 8 years ago and 30 Gy in 5 fractions 2 years ago. We performed SBRT consisting of 40 Gy in 8 fractions using 99mTc-GSA SPECT-IGIP. We confirmed the dosimetric superiority of functional IGIP to conventional planning. He achieved complete response as assessed using the target volume. The patient has remained alive without recurrence for 18 months. He did not experience radiation-induced liver disease.

Conclusion: Recurrent HCC was successfully and safely salvaged via re-irradiation with SBRT using 99mTc-GSA SPECT-IGIP.

Keywords: Hepatocellular carcinoma; dose-function histogram; radiation-induced liver disease; re-irradiation; single-photon emission computed tomography; stereotactic body radiation therapy; volumetric modulated arc radiotherapy.

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Conflict of interest statement

The Authors declare no conflicts of interest.

Figures

Figure 1
Figure 1. Dose distributions of previous radiotherapy consisting of (A) 45 Gy in 15 fractions and (B) 30 Gy in 5 fractions. Coloured areas illustrate the relative doses to the prescribed doses
Figure 2
Figure 2. Contrast-enhanced computed tomography. (A) Pre-treatment contrast-enhanced computed tomography (CT) and (B) post-treatment contrast-enhanced CT images obtained 14 months after the completion of stereotactic body radiotherapy (SBRT) consisting of 40 Gy in 8 fractions. The target volume (arrow) completely disappeared after SBRT
Figure 3
Figure 3. Images for radiotherapy planning. (A) Planning computed tomography (CT), (B) single-photon emission computed tomography (SPECT) and (C) fused planning CT and SPECT image (planning SPECT/CT). The functional liver structure (FLS) is rendered in orange.
Figure 4
Figure 4. Dose distributions of plans F (A) and plan C (B). The functional liver structure, gross tumour volume, clinical target volume and planning target volume are rendered in orange, red, blue and pink, respectively. FLS: Functional liver structure; GTV: gross tumour volume; CTV: clinical target volume; PTV: planning target volume.
Figure 5
Figure 5. (A) Dose-volume histogram of the non-cancerous liver parenchyma (liver – GTV) and (B) dose-function histogram of the liver. GTV: Gross tumour volume; PTV: Planning target volume
See this image and copyright information in PMC

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