ID: 168 Main category: Extracranial Main secondary category: Clinical Topics: Dose planning, Imaging, Liver, Metastasis,

Type of presentation: I am willing to do an oral session I am willing to do a poster session TITLE DOSE PLANNING IN STEREOTACTIC RADIOTHERAPY OF LIVER TUMORS USING 18-FLUORODEOXYGALACTOSE AND PET/CT-SCANNING DESCRIPTION Objectives: Dose planning constraints in stereotactic body radiation therapy (SBRT) of liver tumors is primarily based on liver volume after exclusion of the clinical target volume (CTV) estimated by CT-scanning. We have developed a method where the dose planning process takes metabolic liver function rather than volume into consideration.

Methods: The present method is based on the carbohydrate galactose which is metabolized primarily in the liver and PET/CT-scanning. 120 minutes prior to PET/CT, a bolus of 18fluorodeoxygalactose (18FDGal) is administrated as an intravenous bolus injection. Hepatic uptake and net metabolic clearance, K are quantified from time changes in 18FDGal-activity during dynamic scanning in 40 minutes. Conventional contrast enhanced CT-scanning is acquired simultaneously. Results from PET/CT are compared to galactose elimination capacity as a measure of global liver function.

Results: The 18FDGal PET/CT procedure was developed in a pig model and has now been tested in 12 patients with a variety of liver diseases inclusive liver tumors of whom 5 patients had cirrhosis of the liver. Preliminary results show positive correlation between function and FDGal uptake. 18FDGal PET/CT-scanning is now being tested as a dose planning procedure in patients undergoing SBRT for liver tumors.

Conclusion and perspectives: Preliminary results show that dose planning for SBRT based on 18FDGal PET/CT scanning in patients with liver tumors is feasible. Dose planning for radiotherapy in general and for SBRT in particular may in the future be based on combined physiological and anatomical imaging rather than anatomical imaging alone.

Key refs: 1. Srensen-M et al.: Hepatic uptake and metabolism of galactose can be quantified in vivo by 2-[18F]fluoro-2-deoxygalactose positron emission tomography. Am J Physiol Gastrointest Liver Physiol 295: G27G36, 2008.

2. Hyer-M et al.: Phase II study on stereotactic body radiotherapy of colorectal metastases. Acta Oncol 45: 823-830, 2007