Liver Cancer, Adult
Conditions
Keywords
Radiotherapy, Mebrofenin, Liver, Cancer, SPECT
Brief summary
This is a Phase 1 pilot study to assess feasibility and utility of 99mTc-mebrofenin hepatobiliary scintigraphy for measurement of functional liver change due to radiotherapy.
Detailed description
Patients with cancers of the liver who are not suitable for surgery or chemo/radio embolisation are often treated with stereotactic ablative body radiotherapy (SABR). SABR results in high local control rates but, similar to other treatment modalities, carries risk of damage to healthy surrounding liver. This study aims to use a novel nuclear medicine imaging tracer, 99mTcMebrofenin, to evaluate liver function before and after radiotherapy. Patients will have a 99mTcMebrofenin scan performed \< 2 weeks before radiotherapy and 1 and 6 months after radiotherapy. At the same time points, indocyanine green (ICG) and liver elasticity tests will be performed. These are global measures of liver function, whereas 99mTcMebrofenin is both global and local. From the imaging data, the Investigators will be able to correlate change in local liver function in each sub volume of the liver with the radiotherapy dose it received. The Investigators will be able to thus measure the effect of radiotherapy on global and local liver function.
Interventions
OTHER99mTc-mebrofenin hepatobiliary scintigraphy (HBS)
99mTc-mebrofenin HBS is a SPECT imaging procedure that allows evaluation of global and local liver function. Mebrofenin, bound to albumin, is taken up by hepatocytes in a similar manner to organic anions such as bilirubin. After hepatic uptake, the mebrofenin is excreted into the bile canaliculi. Dynamic imaging tools allow measurement of clearance rates for global function, and 3D SPECT imaging with corresponding CT allows visualisation of the local liver function with respect to anatomy. HBS allows direct visualisation of hepatocyte function.
OTHERIndocyanine Green
ICG is a fluorescent dye injected into the patient. The dye is exclusively excreted by the liver. The ICG clearance rate is measured in the finger of the subject.
OTHERLiver Elasticity
This is an Ultrasound measurement of the elasticity of the liver.
Sponsors
Royal North Shore Hospital
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to 100 Years
Healthy volunteers
No
Inclusion criteria
* Aged 18 or older * Has provided written Informed Consent for participation in this trial and is willing to comply with the study * Patients undergoing external beam radiotherapy at Northern Sydney Cancer Centre * Histologically proven hepatocellular carcinoma or oligometastatic liver metastases (3 or less). Histological diagnosis will be obtained if clinically indicated. * ECOG performance status 0-2
Exclusion criteria
* Previous high-dose radiotherapy to the liver * Previous SIRT * Women who are pregnant or lactating * Unwilling or unable to give informed consent * No venous access * Inability to lie supine and still for 30 minutes * History of allergic reactions attributed to compounds of similar chemical or biologic composition to indocyanine green, including those patients with a history of iodide or seafood allergy (excluded from ICG testing only) * Pacemaker (excluded from Fibroscan elasticity test only)
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change in global and local liver function | 3 years | 99mTC-mebrofenin hepatobiliary scintigraphy images after stereotactic ablative body radiotherapy to cancers of the liver. This will be reported as a change in function as a function of delivered radiotherapy dose. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Correlation between 99mTC mebrofenin HBS and various measures of global function | 3 years | This correlation will be measured using liver elasticity, Indocyanine Green (ICG) and Child-Pugh and Model for End stage Liver Disease (MELD) scores |
| Relationship between radiological features on CT images and SPECT images | 2 years | Relationship between radiological features or changes visable on computed tomography (CT) image data and changes in local liver function as observed on 99mTC mebrofenin HBS. |
| Radiotherapy dose sparing of functional liver | 2 years | The amount of sparing of dose to functional liver that can be achieved using 99mTC Mebrofenin HBS to guide treatment plan optimisation will be evaluated. |
Countries
Australia
Outcome results
None listed