Functional Liver Image-Guided Hepatic Therapy (FLIGHT) with Hepatobiliary Iminodiacetic Acid (HIDA) Scans

Publication date: Available online 1 May 2018
Source:Practical Radiation Oncology
Author(s): David E. Long, Mark Tann, Ke (Colin) Huang, Gregory Bartlett, James Galle, Yukie Furukawa, Mary Maluccio, John A. Cox, Feng-Ming (Spring) Kong, Susannah G. Ellsworth
PurposeHepatobiliary iminodiacetic acid (HIDA) scans provide global and regional assessments of liver function that can serve as a road map for functional avoidance in stereotactic body radiation therapy (SBRT) planning. Functional liver image-guided hepatic therapy (FLIGHT), an innovative planning technique, is described and compared to standard planning using functional dose-volume histograms (fDVHs). Thresholds predicting for decompensation during follow-up are evaluated.Materials and MethodsWe studied 17 patients who underwent HIDA scans before SBRT. All SBRT cases were replanned using FLIGHT, and dosimetric endpoints were compared for FLIGHT vs. standard SBRT planning: FRC15HIDA (amount of function <15Gy), mean liver dose (MLD), equivalent uniform dose (EUD), and functional EUD (FEUD). Receiver operating characteristics curves were used to evaluate whether baseline HIDA values, standard cirrhosis scoring, and/or dosimetric data predicted clinical decompensation.ResultsCompared to standard planning, FLIGHT significantly improved FRC15HIDA (mean improvement 5.3%), as well as MLD, EUD, and FEUD (p<0.05). Considerable interindividual variations in the extent of benefit were noted. Decompensation during follow-up was associated with baseline global HIDA <2.915%/min/m², FRC15HIDA<2.11%/min/m², and MELD ≥11 (p<0.05).ConclusionsFLIGHT with HIDA-based parameters may complement blood chemistry-based assessments of liver function and facilitate individualized, adaptive liver SBRT planning.



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