Department of Radiological Technology, Kumamoto University Hospital, Kumamoto, Japan.
Department of Radiation Oncology, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
In Vivo. 2020 Nov-Dec;34(6):3583-3588. doi: 10.21873/invivo.12202.
BACKGROUND/AIM: A recent planning study suggested that Tc-labelled diethylene triamine pentaacetate-galactosyl human serum albumin (Tc-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 Tc-GSA SPECT IGIP for stereotactic body radiotherapy (SBRT) in a patient with hepatocellular carcinoma (HCC).
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 Tc-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.
Recurrent HCC was successfully and safely salvaged via re-irradiation with SBRT using Tc-GSA SPECT-IGIP.
背景/目的：最近的一项规划研究表明，Tc 标记的二乙三胺五乙酸半乳糖基人血清白蛋白（Tc-GSA）单光子发射计算机断层扫描（SPECT）图像引导的反向规划（IGIP）在保护肝功能方面显示出比传统规划更优越的剂量学优势。在这里，我们报告了首例 Tc-GSA SPECT IGIP 在肝细胞癌（HCC）立体定向体放射治疗（SBRT）中的临床转化。
一名 60 岁男性在肝切除术后第 1 段因复发性 HCC 出现阻塞性黄疸。他在 8 年前接受了 45 Gy/15 次分割的重复放疗（RT），在 2 年前接受了 30 Gy/5 次分割的 RT。我们使用 Tc-GSA SPECT-IGIP 进行了 40 Gy/8 次分割的 SBRT。我们证实了功能 IGIP 比传统规划具有优越的剂量学优势。他在使用靶体积评估时达到了完全缓解。患者在 18 个月内无复发且存活。他没有发生放射性肝损伤。
通过使用 Tc-GSA SPECT-IGIP 的 SBRT 对复发性 HCC 进行再照射，成功且安全地进行了挽救性治疗。
