Abstract
BACKGROUND/AIM: This is a report of the first clinical implementation of (99m)Tc-labeled diethylene triamine pentaacetate-galactosyl human serum albumin ((99m)Tc-GSA) single-photon emission computed tomography (SPECT) image-guided inverse planning into palliative radiotherapy (RT) for diffuse liver metastases. CASE REPORT: A 48-year-old man developed chemo-refractory diffuse liver metastases from thymic carcinoma characterized by abdominal pain and distension. Palliative RT was performed with a total dose of 20 Gy in five fractions using double arc volumetric modulated arc therapy to reduce the dose to functional liver defined by (99m)Tc-GSA SPECT images. His symptoms were immediately relieved after RT and did not experience radiation-induced liver disease. Both Functional Assessment of Cancer Therapy (FACT)-G and FACT-Hep total scores improved after 2 weeks of RT initiation and did not become worse than baseline scores. CONCLUSION: The (99m)Tc-GSA SPECT image-guided palliative RT is an effective and safe treatment for patients with diffuse liver metastases.