Abstract
PurposeTo analyze the distribution of functional liver volume (FLV) in the margin volume (MV) surrounding hepatocellular carcinoma (HCC) with portal vein tumor thrombus (PVTT) before radiation therapy (RT) and to verify the safety of single photon emission computed tomography-based three-dimensional conformal radiotherapy (SPECT-B3DCRT) by exploring the relation of FLV in MV to radiation-induced liver disease (RILD).Methods and MaterialsClinical target volume (CTV) included main tumor and PVTT, and planning target volume (PTV) included CTV with a 10 mm margin. MV was defined as PTV–CTV. FLV ratio in MV was calculated as FLV in MV/MV × 100 (%). The two high-dose beams were planned to irradiate FLV as little as possible. Fifty-seven cases of HCC (26/57, 46%; Child–Pugh grade B) with PVTT underwent SPECT-B3DCRT which targeted the CTV to a total dose of 45 Gy/18 fractions. The destructive ratio was defined as radiation induced dysfunctional volume/FLV × 100 (%).ResultsWe observed a significant negative correlation between FLV ratio in MV and CTV (p < 0.001). Three cases with CTVs of 287, 587 and 1184 cm3 experienced transient RILD. The FLV ratio in MV was highest in patients with RILD: nine patients with CTV of 200–300 cm3, three with CTV of 500–600 cm3, and two with CTV of 1100–1200 cm3. The destructive ratio yielded a mean value of 24.2 ± 1.5%.ConclusionsRadiation planning that takes into account the distribution of FLV appears to result in the least possible RILD.
Highlights
More than a quarter of a century has passed since Yamada et al applied transcatheter arterial chemoembolization (TACE) for unresectable hepatocellular carcinoma (HCC) with portal tumor thrombus (PVTT), a technique that caused severe liver damage and had a poor prognosis [1]
We would expect interruption of portal venous flow by portal vein tumor thrombus (PVTT) to affect liver function; there is no documentation of analysis of liver function in the presence of PVTT, except our previous reports using single photon emission computed tomography (SPECT) with 99mTc galactosyl human serum albumin (99mTc-GSA) [3,4]
Our analyses were conducted based on the findings of two previous studies: that of Shuke et al [5], who found that 99mTc-GSA was superior to other radioisotopes for analyzing local liver function; and that of Nanashima et al [6], who found that SPECT with 99mTc-GSA was superior to enhanced computed tomography (CT) using contrast medium for evaluating liver function
Summary
More than a quarter of a century has passed since Yamada et al applied transcatheter arterial chemoembolization (TACE) for unresectable hepatocellular carcinoma (HCC) with portal tumor thrombus (PVTT), a technique that caused severe liver damage and had a poor prognosis [1]. We would expect interruption of portal venous flow by PVTT to affect liver function; there is no documentation of analysis of liver function in the presence of PVTT, except our previous reports using single photon emission computed tomography (SPECT) with 99mTc galactosyl human serum albumin (99mTc-GSA) [3,4]. Our analyses were conducted based on the findings of two previous studies: that of Shuke et al [5], who found that 99mTc-GSA was superior to other radioisotopes for analyzing local liver function; and that of Nanashima et al [6], who found that SPECT with 99mTc-GSA was superior to enhanced computed tomography (CT) using contrast medium for evaluating liver function. We classified HCC patients with PVTT into localized type (mainly corresponding to main tumor and PVTT surrounded by functional liver) and wedge type (corresponding to main tumor, PVTT, and dysfunctional liver) according to SPECT-delineated areas of non-accumulation [3].
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