| Title: |
Single-Photon Emission Computed Tomography Functional Liver Imaging to Facilitate Reirradiation for Liver Malignancies: A Phase I Trial |
| Authors: |
Chang, Enoch; Holliday, Emma B; Szklaruk, Janio; Erwin, William D; Ludmir, Ethan B; Noticewala, Sonal S; Das, Prajnan; Koong, Albert C; Minsky, Bruce D; Smith, Grace L; Sawakuchi, Gabriel O; Martin-Paulpeter, Rachael M; Niedzielski, Joshua S; Perles, Luis A; Beddar, Sam; Valino, Veronica S; Nguyen, Joshua L; Raghav, Kanwal P S; Javle, Milind; Kaseb, Ahmed O; Dasari, Arvind N; Overman, Michael J; Parseghian, Christine M; Odisio, Bruno C; Mahvash, Armeen; Kuban, Joshua D; Shen, Shu-En; Wang, Xin S; Gupta, Aashish C; Al Taie, Mais M; Brock, Kristy K; Tzeng, Ching-Wei D; Vauthey, Jean-Nicolas; Wong, Franklin C L; Koay, Eugene J |
| Source: |
Faculty, Staff and Student Publications |
| Publisher Information: |
DigitalCommons@TMC |
| Publication Year: |
2026 |
| Collection: |
Houston Academy of Medicine-Texas Medical Center (HAM-TMC): DigitalCommons@The Texas Medical Center |
| Subject Terms: |
Liver cancers; Phase I trial; Quantitative imaging biomarkers; Reirradiation; SPECT; Bioinformatics; Biomedical Informatics; Genetic Phenomena; Medical Genetics; Medical Sciences; Medical Specialties; Medicine and Health Sciences; Oncology |
| Description: |
Background & aims: This phase I trial evaluated the safety of hypofractionated liver reirradiation (reRT) with preferential sparing of functional liver identified by technetium-99m sulfur colloid single-photon emission computed tomography (Tc-99m SC SPECT; hereafter SPECT) for patients previously treated with external beam radiotherapy or transarterial radioembolization. Methods: A 3+3 design evaluated the safety of two escalating SPECT-based functional liver volumetric dose constraints. Dose-limiting toxicities (DLTs), liver segment volumes, and MRI functional liver imaging score, relative liver enhancement, and elastography were assessed. Results: Thirteen patients were enrolled from 2018 to 2021. Median reRT gross tumor volume was 61 cm3 (range 1-677 cm3). Median non-tumor CT and SPECT liver volumes spared from ≥24 Gy were 1,076 cm3 (range 712-1,649 cm3) and 740 cm3 (range 533-1,001 cm3), respectively. The first three patients in dose level 0 (sparing ≥400 cm3 functional liver from ≥24 Gy) and the next three patients in dose level +1 (sparing ≥300 cm3 functional liver from ≥24 Gy) experienced no DLTs. Of the next seven patients treated using dose level +1 constraints, one developed acute (≤8 weeks) grade 3 ascites, and one developed late grade 3 ascites, both possibly attributable to reRT. None developed radiation-induced liver disease. At 6-8 weeks follow-up, hypertrophy was observed in untreated liver segments from six patients. Atrophy was observed in treated liver segments from five patients. Quantitative MRI changes were associated with DLTs. One-year cumulative incidence of in-field progression was 23% (95% CI, 6-47). One-year overall survival was 62% (95% CI, 40-95). Conclusions: SPECT may facilitate safe reRT for liver tumors. Impact and implications: Although ablative liver-directed radiotherapy confers excellent local control rates for patients with hepatocellular carcinoma, intrahepatic cholangiocarcinoma, and liver metastases, recurrence in the previously uninvolved liver occurs in 50-70% of ... |
| Document Type: |
text |
| File Description: |
application/pdf |
| Language: |
English |
| Relation: |
https://digitalcommons.library.tmc.edu/uthgsbs_docs/5646; https://digitalcommons.library.tmc.edu/context/uthgsbs_docs/article/6510/viewcontent/PIIS2589555926000133_compressed.pdf |
| DOI: |
10.1016/j.jhepr.2026.101743 |
| Availability: |
https://digitalcommons.library.tmc.edu/uthgsbs_docs/5646; https://doi.org/10.1016/j.jhepr.2026.101743; https://digitalcommons.library.tmc.edu/context/uthgsbs_docs/article/6510/viewcontent/PIIS2589555926000133_compressed.pdf |
| Accession Number: |
edsbas.B5E8347F |
| Database: |
BASE |