Natural history of hepatocellular carcinoma after stereotactic body radiation therapy
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SPECIAL SECTION: CHRONIC LIVER DISEASE
Natural history of hepatocellular carcinoma after stereotactic body radiation therapy Mishal Mendiratta‑Lala1 · William Masch1 · Dawn Owen2 · Anum Aslam3 · Chris Maurino4 · Theresa Devasia5 · Matthew J. Schipper4 · Neehar D. Parikh6 · Kyle Cuneo4 · Theodore S. Lawrence4 · Matthew S. Davenport1
© Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose To determine the long-term natural history of size change in SBRT-treated HCC to identify an imaging biomarker to help assess treatment response. Methods This was a retrospective cohort study of consecutive HCCs treated with SBRT from January 2008 to December 2016 with either 2 years post-treatment MRI follow-up or post-treatment resection histology. Size, major features for HCC, and mRECIST and LI-RADS v.2018 treatment response criteria were assessed at each post-treatment MRI. Local progression, distant progression, and survival were modeled with Kaplan Meier analyses. Results 56 HCCs met inclusion criteria. Mean baseline HCC diameter was 30 mm (range: 9–105 mm). At 3 months, 76% (N = 43) of treated HCCs decreased in size (mean reduction: 8 mm, range: 5–99 mm) and 0% (N = 0) increased in size. By 24 months, 11% (N = 5) had increased in size and were considered local progression. APHE remained in 77% (43/56) at 3 months, 38% (19/50) at 12 months, and 23% (11/47) at 24 months. mRECIST-defined viable disease was observed in 77% (43/56) at 3 months and 20% (9/47) at 24 months. LI-RADS v.2018 criteria identified viable or equivocal disease in 0% at 3 months and 10% (5/47) at 24 months. Conclusion Gradual loss of APHE and slow decrease in size are normal findings in HCCs treated with SBRT, and persistent APHE does not indicate viable disease. mRECIST is not accurate in the assessment of HCC after SBRT due to an overreliance on APHE to define viable disease. Increasing mass size or new nodular APHE at the treatment site may indicate local progression. Keywords Hepatocellular carcinoma (HCC) · Stereotactic body radiation therapy (SBRT) · Arterial phase hyperenhancement (APHE) · Treatment response
Introduction Hepatocellular carcinoma (HCC) is the most common primary malignancy of the liver [1]. Despite recent advances in therapy, 5-year survival rates remain low ( 3 months prior to initiating SBRT. Forty-five patients with 56 HCCs met inclusion and exclusion criteria (Fig. 1). All pre-treatment HCCs were classified as definite HCC by Organ Procurement and Transplantation Network imaging criteria (i.e., OPTN 5) [26], LI-RADS v2018 criteria (i.e., LI-RADS 5) [6] or by biopsy.
Imaging All patients underwent multiphasic contrast-enhanced MRI within 3 months prior to SBRT. MRI was performed on a 1.5- or 3.0-T magnet using a 16- or 32-channel phased array coil and included the following sequences: axial and coronal T2-weighted single-shot fast spin echo (FSE), axial T1-weighted dual echo gradient recalled echo (GRE), axial T2-weighted respiratory-triggered FSE with fat saturation, axial T1-weighted spoi
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