Radiological tumor response and histopathological correlation of hepatocellular carcinoma treated with stereotactic body
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HEPATOBILIARY
Radiological tumor response and histopathological correlation of hepatocellular carcinoma treated with stereotactic body radiation therapy as a bridge to liver transplantation Katerina Mastrocostas1 · Sandra Fischer2 · Pablo Munoz‑Schuffenegger3 · Hyun‑Jung Jang1 · Laura A. Dawson3 · Zhihui A. Liu4 · Gonzalo Sapisochin5 · Tae Kyoung Kim1 Received: 28 August 2020 / Revised: 4 October 2020 / Accepted: 10 October 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose To assess the imaging findings of hepatocellular carcinoma (HCC) treated with stereotactic body radiation therapy (SBRT) as a bridging therapy prior to liver transplantation (LT), with histopathological correlation at liver explant. Methods Our institutional review board approved this retrospective study. The study subjects included 25 HCC lesions in 23 patients (20 males; median age, 60 years; range 41–68 years) who underwent LT after SBRT for HCC as a bridge to LT in a single tertiary referral institution over a 12-year period. Target HCC lesions were assessed for imaging biomarkers on contrast-enhanced CT or MRI including change in HCC diameter and assessment of percentage necrosis. The radiologic response at pre-LT imaging was compared to explant pathology. Results There was a positive correlation between the tumor size (Spearman’s ρ = 0.86; p < 0.001) and percentage necrosis (p < 0.001) on Pre-LT imaging and those on pathology. Partial response (PR), stable disease (SD), and progressive disease (PD) according to RECIST 1.1 were seen in 8 (32%), 15 (60%), and 2 (8%) lesions on pre-LT imaging, respectively. Of the 15 lesions with radiologic SD, 5/15 (33%) showed necrosis of more than 50% on post-SBRT imaging, while 9/15 (60%) showed necrosis of more than 50% at explant pathologic analysis, showing a tendency to underestimate the degree of tumor necrosis compared to pathology. Conclusion RECIST 1.1 radiologic response criteria may underestimate the response to treatment with SBRT, and radiologic estimation of percent tumor necrosis was more closely correlated with pathologic percent tumor necrosis. Keywords Liver · Stereotactic radiotherapy · Hepatocellular carcinoma · Transplantation · Cirrhosis · CT · MRI
* Tae Kyoung Kim [email protected] Katerina Mastrocostas [email protected] Sandra Fischer [email protected] Pablo Munoz‑Schuffenegger [email protected] Hyun‑Jung Jang hyun‑[email protected]
1
Joint Department of Medical Imaging, University Health Network/Mount Sinai Hospital/Women’s College Hospital, 585 University Avenue, Toronto, ON M5G 2N2, Canada
2
Laboratory Medicine Program, Department of Pathology, Toronto General Hospital, 585 University Avenue, Toronto, ON M5G 2N2, Canada
3
Radiation Medicine Program, Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, 610 University Avenue, Toronto, ON M5G 2C1, Canada
4
Department of Biostatistics, Princess Margaret Cancer Centre, 610 University Avenue, Toronto,
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