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Cancer is the second leading cause of death in the United States. A cancer cell is genetically unstable and hence can mutate faster. They can also modify their microenvironment and escape immune surveillance. The difficulties in treating cancer are further compounded by the emergence of rapid resistance to anticancer drugs. The most common ways to attain resistance in cancer cells include alteration in drug transport and metabolism, modification of drug target, elevated DNA damage response, or...

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Updated: Mar 29, 2026

Treatment of Liver Metastases Using an Internal Target Volume Method for Stereotactic Body Radiotherapy

Treatment of Liver Metastases Using an Internal Target Volume Method for Stereotactic Body Radiotherapy

Published on: May 8, 2018

Whole-liver Palliative Radiotherapy Using SIB for Diffuse Liver Metastases: 3D-CRT versus ^99mTc-GSA SPECT

Yoshinobu Shimohigashi¹, Ryo Toya^2,3, Yudai Kai¹

¹Department of Radiological Technology, Kumamoto University Hospital, Kumamoto, Japan.

Anticancer Research

|March 27, 2026

Summary

^99mTc-GSA SPECT-guided VMAT with simultaneous integrated boost (SIB) improves target dose delivery for liver metastases compared to 3D-CRT. This technique allows for a selective dose increase to the boost planning target volume (PTV_boost) in palliative radiotherapy.

Keywords:

99mTc-labeled diethylenetriamine pentaacetate-galactosyl human serum albumin Diffuse liver metastases inverse planning simultaneous integrated boost single-photon emission computed tomography volumetric modulated arc therapy whole-liver radiotherapy

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Area of Science:

Radiation Oncology
Medical Imaging
Nuclear Medicine

Background:

Palliative radiotherapy for diffuse liver metastases presents challenges in dose escalation to the target volume while sparing organs at risk.
Conventional three-dimensional conformal radiotherapy (3D-CRT) may not achieve optimal dose distribution for complex targets.
Volumetric modulated arc therapy (VMAT) offers potential for improved dose conformity and target coverage.

Purpose of the Study:

To compare dosimetric parameters of simultaneous integrated boost (SIB) VMAT guided by ^99mTc-GSA SPECT with conventional 3D-CRT for liver metastases.
To evaluate the feasibility of using functional liver structure (FLS) derived from SPECT for treatment planning.

Main Methods:

Five patients with diffuse liver metastases underwent ^99mTc-GSA SPECT and CT for RT planning.
Functional liver structure (FLS) was delineated using a SPECT threshold.
3D-CRT and VMAT plans (SIB) were created, aiming for specific PTV and organ at risk (OAR) dose constraints.

Main Results:

VMAT plans demonstrated significantly higher dosimetric parameters (D_mean, D_max, V_110%, V_120%) for both the planning target volume (PTV) and PTV_boost compared to 3D-CRT.
No significant differences were observed in FLS and most OAR parameters between the two techniques, except for the spinal cord.
^99mTc-GSA SPECT-guided VMAT with SIB enabled selective dose escalation to the PTV_boost.

Conclusions:

^99mTc-GSA SPECT-guided VMAT with SIB is a promising technique for selective target dose escalation in palliative radiotherapy for diffuse liver metastases.
This approach allows for improved dose delivery to the boost volume while maintaining comparable sparing of FLS and OARs to 3D-CRT.