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Three irradiation techniques\u2014volumetric-modulated arc therapy (VMAT), intensity-modulated radiotherapy (IMRT), and three-dimensional conformal radiotherapy (3D-CRT)\u2014were systematically compared. Six patients with rHCC who underwent stereotactic body radiotherapy (SBRT) were included. Eligible patients had previously received SBRT to a different hepatic segment and had undergone\n                    <jats:sup>99m<\/jats:sup>\n                    Tc-GSA SPECT before the current course of radiotherapy. For treatment planning, planning computed tomography (CT) images were rigidly registered with\n                    <jats:sup>99m<\/jats:sup>\n                    Tc-GSA SPECT images, and functional liver regions were manually contoured by radiation oncologists. Using identical functional liver contours, three treatment plans\u2014VMAT, IMRT, and 3D-CRT\u2014were independently generated by medical physicists. The prescribed dose was 40\u00a0Gy, delivered in four fractions. These treatment plans were retrospectively created for research purposes and were separate from actual clinical treatments. Under identical planning target volume dose-coverage conditions, the dose\u2013volume histogram indices (V2\u2013V40) of the functional liver were compared among the three techniques. VMAT consistently demonstrated the best preservation of functional liver regions, particularly in the low-dose range, followed by IMRT and 3D-CRT. These findings demonstrate the feasibility of\n                    <jats:sup>99m<\/jats:sup>\n                    Tc-GSA SPECT-guided function-avoidance radiotherapy planning for the re-irradiation of rHCC and suggest that VMAT provides an optimal balance between target coverage and functional liver preservation.\n                  <\/jats:p>","DOI":"10.1007\/s12194-026-01114-1","type":"journal-article","created":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T09:38:23Z","timestamp":1786095503000},"page":"1338-1349","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["99mTechnetium SPECT\u2013guided functional liver\u2013sparing radiotherapy planning for recurrent hepatocellular carcinoma: a dosimetric comparison"],"prefix":"10.1007","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4589-0233","authenticated-orcid":false,"given":"Takuya","family":"Taniguchi","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kazutaka","family":"Miki","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kosei","family":"Adachi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shuto","family":"Nakaya","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kaede","family":"Kawagchi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Osamu","family":"Tanaka","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masayuki","family":"Matsuo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,8,7]]},"reference":[{"issue":"8","key":"1114_CR1","doi-asserted-by":"publisher","first-page":"448","DOI":"10.1038\/nrgastro.2010.100","volume":"7","author":"JD Yang","year":"2010","unstructured":"Yang JD, Roberts LR. Hepatocellular carcinoma: a global view. Nat Rev Gastroenterol Hepatol. 2010;7(8):448\u201358. https:\/\/doi.org\/10.1038\/nrgastro.2010.100.","journal-title":"Nat Rev Gastroenterol Hepatol"},{"issue":"4","key":"1114_CR2","doi-asserted-by":"publisher","first-page":"321","DOI":"10.1016\/j.livres.2023.11.004","volume":"7","author":"W Abdelhamed","year":"2023","unstructured":"Abdelhamed W, El-Kassas M. Hepatocellular carcinoma recurrence: predictors and management. Liver Res. 2023;7(4):321\u201332. https:\/\/doi.org\/10.1016\/j.livres.2023.11.004.","journal-title":"Liver Res"},{"key":"1114_CR3","doi-asserted-by":"publisher","first-page":"55","DOI":"10.1186\/1477-7819-8-55","volume":"8","author":"Y Zhou","year":"2010","unstructured":"Zhou Y, Zhao Y, Li B, et al. Repeat hepatectomy for recurrent hepatocellular carcinoma: a local experience and a systematic review. 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The study was approved by the Institutional Review Board (Approval No. 2024\u201306-11). Because this study involved no additional interventions and used only existing medical data, the requirement for written informed consent was waived, and an opt-out procedure was implemented. Study information was disclosed on the hospital website and patients were offered the opportunity to refuse participation. All data were anonymized prior to analysis in accordance with institutional and international ethical standards.","order":2,"name":"Ethics","label":"Ethical approval","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The requirement for informed consent was waived due to the retrospective nature of the study.","order":3,"name":"Ethics","label":"Informed consent","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Part of this work was presented in preliminary form at ESTRO Meets Asia 2019. The manuscript has been substantially expanded and revised for publication in your journal.","order":4,"name":"Ethics","label":"Prior presentation","group":{"name":"EthicsHeading","label":"Declarations"}}]}}