Author: Madhava Aryal, James M. Balter, Yue Cao, Daniel T Chang, Kyle Cuneo, Joseph R. Evans, Theodore Lawrence, John Rice, Randall K. Ten Haken, Lise Wei 👨🔬
Affiliation: University of Michigan, Department of Radiation Oncology University of Michigan 🌍
Purpose: This study aims to identify predictors of global liver function change measured by albumin-bilirubin (ALBI) score following stereotactic body radiation therapy (SBRT) in hepatocellular carcinoma (HCC) patients. By integrating gadoxetic acid-enhanced magnetic resonance imaging (MRI) uptake and dosimetric data, the goal is to develop functional-based treatment planning strategies that preserve hepatic function.
Methods: Twenty-four patients with HCC enrolled on an IRB-approved adaptive SBRT trial had liver dynamic gadoxetic acid−enhanced magnetic resonance imaging and blood sample collections before and 1 month after SBRT. Gadoxetic acid uptake rate (k1) maps were quantified for regional hepatic function and coregistered to both 2-Gy equivalent dose and physical dose distributions. Mean or integral-based metrics, dose-volume or function-volume histogram metrics, and function-dose-volume histogram metrics were calculated. These metrics were correlated with percentage ALBI score changes by Spearman rank correlation with Bonferroni correction.
Results: We found that the greater the fractional volume of liver with high hepatic function (k1 intensity) that receives low dose, the less the decline of ALBI score post-RT. The threshold for preserving global hepatic function is 10 % of the maximum k1 intensity and 5 Gy EQD2. The integration of regional function (k1) and dosimetric data improved the ability to predict ALBI score changes compared to dosimetric or functional data alone.
Conclusion: Combining regional liver function metrics from gadoxetic acid-enhanced MRI with radiation dose provides a robust model for predicting ALBI score changes following SBRT. These findings suggest the potential for functional-based treatment planning to better preserve liver function in HCC patients undergoing SBRT.