Shirai Shintaro, Sato Morio, Noda Yasutaka, Kumayama Yoshitaka, Shimizu Noritaka
Shintaro Shirai, Morio Sato, Yasutaka Noda, Yoshitaka Kumayama, Noritaka Shimizu, Department of Radiology, Wakayama Medical University, Wakayama Shi, Wakayama 641-8510, Japan.
World J Radiol. 2014 Aug 28;6(8):598-606. doi: 10.4329/wjr.v6.i8.598.
In single photon emission computed tomography-based three-dimensional radiotherapy (SPECT-B-3DCRT), images of Tc-99m galactosyl human serum albumin (GSA), which bind to receptors on functional liver cells, are merged with the computed tomography simulation images. Functional liver is defined as the area of normal liver where GSA accumulation exceeds that of hepatocellular carcinoma (HCC). In cirrhotic patients with a gigantic, proton-beam-untreatable HCC of ≥ 14 cm in diameter, the use of SPECT-B-3DCRT in combination with transcatheter arterial chemoembolization achieved a 2-year local tumor control rate of 78.6% and a 2-year survival rate of 33.3%. SPECT-B-3DCRT was applied to HCC to preserve as much functional liver as possible. Sixty-four patients with HCC, including 30 with Child B liver cirrhosis, received SPECT-B-3DCRT and none experienced fatal radiation-induced liver disease (RILD). The Child-Pugh score deteriorated by 1 or 2 in > 20% of functional liver volume that was irradiated with ≥ 20 Gy. The deterioration in the Child-Pugh score decreased when the radiation plan was designed to irradiate ≤ 20% of the functional liver volume in patients given doses of ≥ 20 Gy (FLV20Gy). Therefore, FLV20Gy ≤ 20% may represent a safety index to prevent RILD during 3DCRT for HCC. To supplement FLV20Gy as a qualitative index, we propose a quantitative indicator, F 20Gy, which was calculated as F 20Gy = 100% × (the GSA count in the area irradiated with ≥ 20 Gy)/(the GSA count in the whole liver).
在基于单光子发射计算机断层扫描的三维放射治疗（SPECT-B-3DCRT）中，将与功能性肝细胞上的受体结合的锝-99m半乳糖基人血清白蛋白（GSA）图像与计算机断层扫描模拟图像合并。功能性肝被定义为GSA蓄积超过肝细胞癌（HCC）的正常肝区域。在直径≥14 cm、巨大且无法用质子束治疗的HCC肝硬化患者中，SPECT-B-3DCRT联合经动脉化疗栓塞的2年局部肿瘤控制率为78.6%，2年生存率为33.3%。SPECT-B-3DCRT应用于HCC以尽可能保留更多的功能性肝。64例HCC患者，包括30例Child B级肝硬化患者，接受了SPECT-B-3DCRT，无一例发生致命的放射性肝病（RILD）。当≥20 Gy照射功能性肝体积的>20%时，Child-Pugh评分恶化1或2分。当放射治疗计划设计为在给予≥20 Gy剂量的患者中照射≤20%的功能性肝体积（FLV20Gy）时，Child-Pugh评分的恶化程度降低。因此，FLV20Gy≤20%可能是预防HCC三维适形放疗期间RILD的安全指标。为了补充FLV20Gy作为定性指标，我们提出了一个定量指标F 20Gy，其计算方法为F 20Gy = 100%×（≥20 Gy照射区域的GSA计数）/（全肝的GSA计数）。
