Matthew H Stenmark1, Yue Cao2, Hesheng Wang3, Andrew Jackson4, Edgar Ben-Josef5, Randall K Ten Haken3, Theodore S Lawrence3, Mary Feng3. 1. Department of Radiation Oncology, University of Michigan Health System, Ann Arbor, United States; Veterans Affairs Medical Center, Ann Arbor, United States. Electronic address: stenmark@umich.edu. 2. Department of Radiation Oncology, University of Michigan Health System, Ann Arbor, United States; Department of Radiology, University of Michigan Health System, Ann Arbor, United States; Department of Biomedical Engineering, University of Michigan Health System, Ann Arbor, United States. 3. Department of Radiation Oncology, University of Michigan Health System, Ann Arbor, United States. 4. Memorial Sloan Kettering Cancer Center, New York, United States. 5. University of Pennsylvania, Philadelphia, United States.
Abstract
PURPOSE: To estimate the limit of functional liver reserve for safe application of hepatic irradiation using changes in indocyanine green, an established assay of liver function. MATERIALS AND METHODS: From 2005 to 2011, 60 patients undergoing hepatic irradiation were enrolled in a prospective study assessing the plasma retention fraction of indocyanine green at 15-min (ICG-R15) prior to, during (at 60% of planned dose), and after radiotherapy (RT). The limit of functional liver reserve was estimated from the damage fraction of functional liver (DFL) post-RT [1-(ICG-R15pre-RT/ICG-R15post-RT)] where no toxicity was observed using a beta distribution function. RESULTS: Of 48 evaluable patients, 3 (6%) developed RILD, all within 2.5 months of completing RT. The mean ICG-R15 for non-RILD patients pre-RT, during-RT and 1-month post-RT was 20.3%(SE 2.6), 22.0%(3.0), and 27.5%(2.8), and for RILD patients was 6.3%(4.3), 10.8%(2.7), and 47.6%(8.8). RILD was observed at post-RT damage fractions of ≥78%. Both DFL assessed by during-RT ICG and MLD predicted for DFL post-RT (p<0.0001). Limiting the post-RT DFL to 50%, predicted a 99% probability of a true complication rate <15%. CONCLUSION: The DFL as assessed by changes in ICG during treatment serves as an early indicator of a patient's tolerance to hepatic irradiation. Published by Elsevier Ireland Ltd.
PURPOSE: To estimate the limit of functional liver reserve for safe application of hepatic irradiation using changes in indocyanine green, an established assay of liver function. MATERIALS AND METHODS: From 2005 to 2011, 60 patients undergoing hepatic irradiation were enrolled in a prospective study assessing the plasma retention fraction of indocyanine green at 15-min (ICG-R15) prior to, during (at 60% of planned dose), and after radiotherapy (RT). The limit of functional liver reserve was estimated from the damage fraction of functional liver (DFL) post-RT [1-(ICG-R15pre-RT/ICG-R15post-RT)] where no toxicity was observed using a beta distribution function. RESULTS: Of 48 evaluable patients, 3 (6%) developed RILD, all within 2.5 months of completing RT. The mean ICG-R15 for non-RILD patients pre-RT, during-RT and 1-month post-RT was 20.3%(SE 2.6), 22.0%(3.0), and 27.5%(2.8), and for RILD patients was 6.3%(4.3), 10.8%(2.7), and 47.6%(8.8). RILD was observed at post-RT damage fractions of ≥78%. Both DFL assessed by during-RT ICG and MLD predicted for DFL post-RT (p<0.0001). Limiting the post-RT DFL to 50%, predicted a 99% probability of a true complication rate <15%. CONCLUSION: The DFL as assessed by changes in ICG during treatment serves as an early indicator of a patient's tolerance to hepatic irradiation. Published by Elsevier Ireland Ltd.
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