Hepatobiliary scintigraphy allows the evaluation of short-term functional toxicity of liver stereotactic body radiotherapy: Results of a pilot study.

Berardino De Bari,Raphaël Moeckli,Thomas Breuneval,Letizia Deantonio,Mahmut Ozsahin,John Prior,Christine Geldhof,Nicklaus Schaefer,Sarah Godin,Michele Zeverino,Jean Bourhis

doi:10.1371/journal.pone.0204013

Abstract

PurposeTo study the potential of (99m)Tc-Mebrofenin hepatobiliary scintigraphy (HBS) in identifying the short-term variations of liver function after stereotactic body radiotherapy (SBRT) for liver cancers.Material and methodsWe treated with SBRT 3 patients (pts) affected by a cholangiocarcinoma and 3 patient presenting liver metastases (3x15 Gy, 4 pts; 5x8 Gy, 1 pt; 6x5 Gy, 1 pt). All patients received HBS before and 3 months after SBRT, which were co-registered with the simulation CT-scan. Structures corresponding to isodoses from 10–90 Gy were created, with intervals of 10 Gy. Finally, the variations of the mean activity (MBq) in each isodose structure have been calculated. Then, a linear regression analysis was performed.ResultsWe showed a linear reduction of the activity, significantly related to the delivered dose (p<0.01), and a reduction of the perfusion of 0.78% for each delivered Gy. The linear equation has predictive value of the loss of the function of 96% (R2 = 0.9605).ConclusionsHBS could improve treatment plans for liver SBRT, by allowing the identification of the liver function variations after SBRT and, potentially, the prediction of remnant liver function after SBRT. These preliminary results should be confirmed on long-term prospective data and larger population.

Highlights

Stereotactic body radiotherapy (SBRT) is one of the therapeutic options in the treatment of primary or secondary liver cancers not suitable for surgery [1,2], with encouraging rates of local control (LC) and overall survival (OS) [3,4].Radiation-induced liver disease (RILD) is a rare, but severe potential side effect of liver irradiation: several dosimetric constraints have been established and are available in the literature to reduce the risk of RILD [5,6]
These constraints are based on the doses delivered on the whole liver, delineated as it appears on the simulation CT scan, but they do not take into account the regional variations of the liver function, potentially related to concomitant liver diseases
To the best of our knowledge, we report the first clinical experience exploring the role of hepatobiliary scintigraphy (HBS) in the evaluation of the short-term radiation induced variations of hepatic function (HF) after SBRT

Summary

Introduction

Radiation-induced liver disease (RILD) is a rare, but severe potential side effect of liver irradiation: several dosimetric constraints have been established and are available in the literature to reduce the risk of RILD [5,6]. These constraints are based on the doses delivered on the whole liver, delineated as it appears on the simulation CT scan, but they do not take into account the regional variations of the liver function, potentially related to concomitant liver diseases (i.e., cirrhosis in patients treated for a hepatocellular cancer [HCC], hepatic toxicity of previous systemic treatments, the effects of previous local ablative therapies, etc). One case report has been published exploring the potential of HBS in monitoring the short-term variations of hepatic function (HF) after liver SBRT [10]

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