JNCI cancer spectrum · 2024
Phase I trial of single-photon emission computed tomography-guided liver-directed radiotherapy for patients with low functional liver volume.
СтатьяКлиническое исследование I фазыНазвание и аннотация: Перевод пока не подготовлен
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Chang Enoch, Wong Franklin C L, Chasen Beth A, Erwin William D, Das Prajnan, Holliday Emma B, Koong Albert C, Ludmir Ethan B, Minsky Bruce D, Noticewala Sonal S, Smith Grace L, Taniguchi Cullen M, Rodriguez Maria J, Beddar Sam, Martin-Paulpeter Rachael M, Niedzielski Joshua S, Sawakuchi Gabriel O, Schueler Emil, Perles Luis A, Xiao Lianchun, Szklaruk Janio, Park Peter C, Dasari Arvind N, Kaseb Ahmed O, Kee Bryan K, Lee Sunyoung S, Overman Michael J, Willis Jason A, Wolff Robert A, Tzeng Ching-Wei D, Vauthey Jean-Nicolas, Koay Eugene J
Аннотация
BACKGROUND: Traditional constraints specify that 700 cc of liver should be spared a hepatotoxic dose when delivering liver-directed radiotherapy to reduce the risk of inducing liver failure. We investigated the role of single-photon emission computed tomography (SPECT) to identify and preferentially avoid functional liver during liver-directed radiation treatment planning in patients with preserved liver function but limited functional liver volume after receiving prior hepatotoxic chemotherapy or surgical resection.
METHODS: This phase I trial with a 3 + 3 design evaluated the safety of liver-directed radiotherapy using escalating functional liver radiation dose constraints in patients with liver metastases. Dose-limiting toxicities were assessed 6-8 weeks and 6 months after completing radiotherapy.
RESULTS: All 12 patients had colorectal liver metastases and received prior hepatotoxic chemotherapy; 8 patients underwent prior liver resection. Median computed tomography anatomical nontumor liver volume was 1584 cc (range = 764-2699 cc). Median SPECT functional liver volume was 1117 cc (range = 570-1928 cc). Median nontarget computed tomography and SPECT liver volumes below the volumetric dose constraint were 997 cc (range = 544-1576 cc) and 684 cc (range = 429-1244 cc), respectively. The prescription dose was 67.5-75 Gy in 15 fractions or 75-100 Gy in 25 fractions. No dose-limiting toxicities were observed during follow-up. One-year in-field control was 57%. One-year overall survival was 73%.
CONCLUSION: Liver-directed radiotherapy can be safely delivered to high doses when incorporating functional SPECT into the radiation treatment planning process, which may enable sparing of lower volumes of liver than traditionally accepted in patients with preserved liver function.
TRIAL REGISTRATION: NCT02626312.
METHODS: This phase I trial with a 3 + 3 design evaluated the safety of liver-directed radiotherapy using escalating functional liver radiation dose constraints in patients with liver metastases. Dose-limiting toxicities were assessed 6-8 weeks and 6 months after completing radiotherapy.
RESULTS: All 12 patients had colorectal liver metastases and received prior hepatotoxic chemotherapy; 8 patients underwent prior liver resection. Median computed tomography anatomical nontumor liver volume was 1584 cc (range = 764-2699 cc). Median SPECT functional liver volume was 1117 cc (range = 570-1928 cc). Median nontarget computed tomography and SPECT liver volumes below the volumetric dose constraint were 997 cc (range = 544-1576 cc) and 684 cc (range = 429-1244 cc), respectively. The prescription dose was 67.5-75 Gy in 15 fractions or 75-100 Gy in 25 fractions. No dose-limiting toxicities were observed during follow-up. One-year in-field control was 57%. One-year overall survival was 73%.
CONCLUSION: Liver-directed radiotherapy can be safely delivered to high doses when incorporating functional SPECT into the radiation treatment planning process, which may enable sparing of lower volumes of liver than traditionally accepted in patients with preserved liver function.
TRIAL REGISTRATION: NCT02626312.