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Chlorogiannis DD, Moussa AM, Zhao K, Alexander ES, Sofocleous CT, Sotirchos VS. Imaging Considerations before and after Liver-Directed Locoregional Treatments for Metastatic Colorectal Cancer. Diagnostics (Basel) 2024; 14:772. [PMID: 38611685 PMCID: PMC11011364 DOI: 10.3390/diagnostics14070772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Revised: 03/28/2024] [Accepted: 04/02/2024] [Indexed: 04/14/2024] Open
Abstract
Colorectal cancer is a leading cause of cancer-related death. Liver metastases will develop in over one-third of patients with colorectal cancer and are a major cause of morbidity and mortality. Even though surgical resection has been considered the mainstay of treatment, only approximately 20% of the patients are surgical candidates. Liver-directed locoregional therapies such as thermal ablation, Yttrium-90 transarterial radioembolization, and stereotactic body radiation therapy are pivotal in managing colorectal liver metastatic disease. Comprehensive pre- and post-intervention imaging, encompassing both anatomic and metabolic assessments, is invaluable for precise treatment planning, staging, treatment response assessment, and the prompt identification of local or distant tumor progression. This review outlines the value of imaging for colorectal liver metastatic disease and offers insights into imaging follow-up after locoregional liver-directed therapy.
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Affiliation(s)
| | - Amgad M. Moussa
- Interventional Radiology Service, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Ken Zhao
- Interventional Radiology Service, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Erica S. Alexander
- Interventional Radiology Service, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | | | - Vlasios S. Sotirchos
- Interventional Radiology Service, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
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Bordeau K, Michalet M, Dorion V, Keskes A, Valdenaire S, Debuire P, Cantaloube M, Cabaillé M, Draghici R, Ychou M, Assenat E, Jarlier M, Gourgou S, Guiu B, Ursic-Bedoya J, Aillères N, Fenoglietto P, Azria D, Riou O. A prospective registry study of stereotactic magnetic resonance guided radiotherapy (MRgRT) for primary liver tumors. Radiother Oncol 2023; 189:109912. [PMID: 37739315 DOI: 10.1016/j.radonc.2023.109912] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 09/04/2023] [Accepted: 09/09/2023] [Indexed: 09/24/2023]
Abstract
BACKGROUND AND PURPOSE Stereotactic body radiation therapy (SBRT) has demonstrated safe and effective results for primary liver tumors. Magnetic Resonance guided Radiotherapy (MRgRT) is an innovative radiotherapy modality for abdominal tumors. The aim of this study is to report on acute and late toxicities and initial oncological results for primary liver tumors treated with MRgRT. MATERIALS AND METHODS We prospectively included in our cohort all patients treated by MRgRT for a primary liver tumor at the Montpellier Cancer Institute. The primary endpoint was acute and late toxicities assessed according to CTCAE v 5.0. The mean prescribed dose was 50 Gy in 5 fractions. RESULTS Between October 2019 and April 2022, MRgRT treated 56 patients for 72 primary liver lesions. No acute or late toxicities of CTCAE grade greater than 2 attributable to radiotherapy were noted during follow-up. No cases of radiation-induced liver disease (RILD), either classical or non-classical, occurred. After a median follow-up of 13.2 months (95% CI [8.8; 15.7]), overall survival was 85.1% (95% CI: [70.8; 92.7]) at 1 year and 74.2% at 18 months (95% CI [52.6; 87.0]). Local control was 98.1% (95% CI: [87.4; 99.7]) and 94.7% (95% CI: [79.5; 98.7]) at 12 and 18 months, respectively. Among the HCC subgroup, no local recurrences were observed. CONCLUSION MRgRT for primary liver tumors is safe without severe adverse events and reach excellent local control. Numerous studies are underway to better assess the value of MRI guidance and adaptive process in these indications.
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Affiliation(s)
- Karl Bordeau
- University Federation of Radiation Oncology of Mediterranean Occitanie, Montpellier Cancer Institute (ICM), Univ Montpellier, INSERM U1194 IRCM, Montpellier, France
| | - Morgan Michalet
- University Federation of Radiation Oncology of Mediterranean Occitanie, Montpellier Cancer Institute (ICM), Univ Montpellier, INSERM U1194 IRCM, Montpellier, France
| | - Valérie Dorion
- University Federation of Radiation Oncology of Mediterranean Occitanie, Montpellier Cancer Institute (ICM), Univ Montpellier, INSERM U1194 IRCM, Montpellier, France
| | - Aïcha Keskes
- University Federation of Radiation Oncology of Mediterranean Occitanie, Montpellier Cancer Institute (ICM), Univ Montpellier, INSERM U1194 IRCM, Montpellier, France
| | - Simon Valdenaire
- University Federation of Radiation Oncology of Mediterranean Occitanie, Montpellier Cancer Institute (ICM), Univ Montpellier, INSERM U1194 IRCM, Montpellier, France
| | - Pierre Debuire
- University Federation of Radiation Oncology of Mediterranean Occitanie, Montpellier Cancer Institute (ICM), Univ Montpellier, INSERM U1194 IRCM, Montpellier, France
| | - Marie Cantaloube
- University Federation of Radiation Oncology of Mediterranean Occitanie, Montpellier Cancer Institute (ICM), Univ Montpellier, INSERM U1194 IRCM, Montpellier, France
| | - Morgane Cabaillé
- University Federation of Radiation Oncology of Mediterranean Occitanie, Montpellier Cancer Institute (ICM), Univ Montpellier, INSERM U1194 IRCM, Montpellier, France
| | - Roxana Draghici
- University Federation of Radiation Oncology of Mediterranean Occitanie, Montpellier Cancer Institute (ICM), Univ Montpellier, INSERM U1194 IRCM, Montpellier, France
| | - Marc Ychou
- Medical oncology department, ICM, Montpellier Cancer Institute, Univ Montpellier, Montpellier, France
| | - Eric Assenat
- Medical oncology department, CHU St Eloi 34000, Montpellier, France
| | - Marta Jarlier
- Biometrics Unit ICM, Montpellier Cancer Institute, Univ Montpellier, Montpellier, France
| | - Sophie Gourgou
- Biometrics Unit ICM, Montpellier Cancer Institute, Univ Montpellier, Montpellier, France
| | - Boris Guiu
- Radiology department, CHU St Eloi 34000, Montpellier, France
| | - José Ursic-Bedoya
- Liver Transplantation Unit, Department of Hepatology, Montpellier University Hospital, University of Montpellier, 34295, Montpellier, France
| | - Norbert Aillères
- University Federation of Radiation Oncology of Mediterranean Occitanie, Montpellier Cancer Institute (ICM), Univ Montpellier, INSERM U1194 IRCM, Montpellier, France
| | - Pascal Fenoglietto
- University Federation of Radiation Oncology of Mediterranean Occitanie, Montpellier Cancer Institute (ICM), Univ Montpellier, INSERM U1194 IRCM, Montpellier, France
| | - David Azria
- University Federation of Radiation Oncology of Mediterranean Occitanie, Montpellier Cancer Institute (ICM), Univ Montpellier, INSERM U1194 IRCM, Montpellier, France
| | - Olivier Riou
- University Federation of Radiation Oncology of Mediterranean Occitanie, Montpellier Cancer Institute (ICM), Univ Montpellier, INSERM U1194 IRCM, Montpellier, France.
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Omiya Y, Morisaka H, Matsuda M, Saito M, Hashimoto T, Motosugi U, Onishi H. Liver parenchymal changes detected by MR elastography and diffusion-weighted imaging after stereotactic body radiotherapy for hepatocellular carcinoma. Abdom Radiol (NY) 2023; 48:3353-3361. [PMID: 37542553 DOI: 10.1007/s00261-023-03995-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 06/18/2023] [Accepted: 06/19/2023] [Indexed: 08/07/2023]
Abstract
BACKGROUND Stereotactic body radiotherapy (SBRT) is a local treatment option for hepatocellular carcinoma (HCC). SBRT-induced focal reactions on the liver parenchyma have not been thoroughly evaluated using quantitative magnetic resonance imaging (MRI). PURPOSE To quantitatively evaluate liver parenchymal changes caused by SBRT for HCC using magnetic resonance elastography (MRE) and diffusion-weighted imaging (DWI). METHOD We retrospectively evaluated 22 adult patients who received SBRT for HCC and 27 who received locoregional therapy other than SBRT (controls). Liver stiffness by MRE and apparent diffusion coefficient (ADC) values by DWI of the liver parenchyma were measured before and after SBRT. Regions of interest (ROIs) were drawn on the two areas of radiation dose distribution levels, > 30 Gy and ≤ 30 Gy; a ROI was drawn in the control group. The two indices were compared before and after SBRT using a Wilcoxon matched-pairs signed-rank test. RESULTS Liver stiffness and ADC values were significantly increased after SBRT in the dose areas of > 30 Gy compared with those before SBRT (4.05 vs 4.85 kPa; p < 0.05 in liver stiffness, and 1.10 vs 1.40 ×10-3 s/mm2; p < 0.05 in ADC values). In the dose area of ≦ 30 Gy, liver stiffness showed a significant increase in one reader (p = 0.033) but not in another reader (p = 0.085); ADC value showed no significant difference before and after SBRT as per both readers (p > 0.05). The control group demonstrated no significant differences before and after treatment (p > 0.05). CONCLUSION MRE and DWI can be used to detect SBRT-induced liver parenchymal changes.
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Affiliation(s)
- Yoshie Omiya
- Department of Radiology, University of Yamanashi, 1110 Shimokato, Chuo, Yamanashi, 409-3898, Japan.
| | - Hiroyuki Morisaka
- Department of Radiology, University of Yamanashi, 1110 Shimokato, Chuo, Yamanashi, 409-3898, Japan
| | - Masaki Matsuda
- Department of Radiology, University of Yamanashi, 1110 Shimokato, Chuo, Yamanashi, 409-3898, Japan
| | - Masahide Saito
- Department of Radiology, University of Yamanashi, 1110 Shimokato, Chuo, Yamanashi, 409-3898, Japan
| | - Takaaki Hashimoto
- Department of Radiology, Kofu Municipal Hospital, Masutsubocho, Kofu, 400-0832, Japan
| | - Utaroh Motosugi
- Department of Radiology, Kofu-Kyoritsu Hospital, Takara, Kofu, Yamanashi, 400-0034, Japan
| | - Hiroshi Onishi
- Department of Radiology, University of Yamanashi, 1110 Shimokato, Chuo, Yamanashi, 409-3898, Japan
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Sharma HK, Kyriakakos C, Jabbour TE, Ward S, Buckstein M, Taouli B, Lewis S. Longitudinal assessment of hepatocellular carcinoma response to stereotactic body radiation using gadoxetate-enhanced MRI: A case series. Eur J Radiol 2023; 167:111077. [PMID: 37688918 DOI: 10.1016/j.ejrad.2023.111077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 08/09/2023] [Accepted: 08/30/2023] [Indexed: 09/11/2023]
Abstract
PURPOSE To describe the longitudinal response in patients with hepatocellular carcinoma (HCC) treated with stereotactic body radiation therapy (SBRT) and who underwent liver transplant (LT) using gadoxetate-enhanced MRI. METHODS Five men (median age 61y, range 57-64y) with 6 HCCs treated with SBRT (median dose 50 Gy) who subsequently underwent LT were included in this retrospective study. Patients underwent gadoxetate-enhanced MRI before and after SBRT over a period of 3-18 months. Response was assessed using RECIST1.1, mRECIST, LI-RADS and image subtraction, by 2 observers in consensus. Percentage of pathologic tumor necrosis was evaluated. RESULTS LT was performed 278 days (IQR, 148-418d) after completion of SBRT and 48d after the last MRI. Histopathology demonstrated tumor necrosis of 48 ± 42% (range, 10-100%). Mean tumor size at baseline and last post-treatment MRIs pre-LT were 2.6 ± 0.8 cm and 2.4 ± 0.9 cm. Enhancing tumor component size at baseline MRI and last post-treatment MRI pre-LT were 1.6 ± 0.8 cm and 0.9 ± 1.0 cm. Responses assessed at the last LRI pre-LT were: partial response (PR, n = 3), stable disease (SD, n = 3) using RECIST1.1; complete response (CR, n = 2), partial response (PR, n = 2), stable disease (SD, n = 2) using mRECIST; and LR-TR viable (n = 4), LR-TR non-viable (n = 2) using LI-RADS. At the last MRI pre-LT, per-lesion features of arterial phase hyperenhancement (APHE, 4/6), portal venous washout (3/6) and capsule (3/6) were observed. 5/6 lesions displayed a hypointense perilesional halo on hepatobiliary phase with a mean delay of 3.1 months post-SBRT. CONCLUSIONS This case-series showed decreased size, persistent APHE, and incomplete pathologic necrosis in most HCCs treated with SBRT undergoing transplant.
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Affiliation(s)
- Himanshu Kumar Sharma
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, USA
| | - Christopher Kyriakakos
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, USA
| | - Tony El Jabbour
- Department of Pathology, Molecular and Cell-Based Medicine, Icahn School of Medicine at Mount Sinai, Annenberg Building, 15th Floor, 1468 Madison Avenue, New York, NY 10029, USA
| | - Stephen Ward
- Department of Pathology, Molecular and Cell-Based Medicine, Icahn School of Medicine at Mount Sinai, Annenberg Building, 15th Floor, 1468 Madison Avenue, New York, NY 10029, USA
| | - Michael Buckstein
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, 1184 5th Avenue, First Floor, New York, NY 10029, USA
| | - Bachir Taouli
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, USA; BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, USA
| | - Sara Lewis
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, USA; BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, USA.
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Cox DRA, Chung W, Grace J, Wong D, Kutaiba N, Ranatunga D, Khor R, Perini MV, Fink M, Jones R, Goodwin M, Dobrovic A, Testro A, Muralidharan V. Evaluating treatment response following locoregional therapy for hepatocellular carcinoma: A review of the available serological and radiological tools for assessment. JGH OPEN 2023; 7:249-260. [PMID: 37125252 PMCID: PMC10134770 DOI: 10.1002/jgh3.12879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 02/01/2023] [Accepted: 02/09/2023] [Indexed: 04/05/2023]
Abstract
Hepatocellular carcinoma (HCC) is an aggressive primary malignancy of the liver and is the third most common cause of cancer-related global mortality. There has been a steady increase in treatment options for HCC in recent years, including innovations in both curative and non-curative therapies. These advances have brought new challenges and necessary improvements in strategies of disease monitoring, to allow early detection of HCC recurrence. Current serological and radiological strategies for post-treatment monitoring and prognostication and their limitations will be discussed and evaluated in this review.
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Affiliation(s)
- Daniel R A Cox
- Department of Surgery (Austin Precinct) The University of Melbourne Melbourne Victoria Australia
- Hepatopancreatobiliary and Liver Transplant Surgery Unit Austin Health Melbourne Victoria Australia
| | - William Chung
- Department of Medicine (Austin Precinct) The University of Melbourne Melbourne Victoria Australia
- Liver Transplant Unit, Department of Gastroenterology and Hepatology Austin Health Melbourne Victoria Australia
| | - Josephine Grace
- Department of Medicine (Austin Precinct) The University of Melbourne Melbourne Victoria Australia
- Liver Transplant Unit, Department of Gastroenterology and Hepatology Austin Health Melbourne Victoria Australia
| | - Darren Wong
- Department of Medicine (Austin Precinct) The University of Melbourne Melbourne Victoria Australia
- Liver Transplant Unit, Department of Gastroenterology and Hepatology Austin Health Melbourne Victoria Australia
| | - Numan Kutaiba
- Department of Radiology Austin Health Melbourne Victoria Australia
| | - Dinesh Ranatunga
- Department of Radiology Austin Health Melbourne Victoria Australia
| | - Richard Khor
- Department of Radiation Oncology Austin Health Melbourne Victoria Australia
- School of Molecular Sciences, La Trobe University Melbourne Victoria Australia
- Department of Medical Imaging and Radiation Sciences Monash University Melbourne Victoria Australia
| | - Marcos V Perini
- Department of Surgery (Austin Precinct) The University of Melbourne Melbourne Victoria Australia
- Hepatopancreatobiliary and Liver Transplant Surgery Unit Austin Health Melbourne Victoria Australia
| | - Michael Fink
- Department of Surgery (Austin Precinct) The University of Melbourne Melbourne Victoria Australia
- Hepatopancreatobiliary and Liver Transplant Surgery Unit Austin Health Melbourne Victoria Australia
| | - Robert Jones
- Department of Surgery (Austin Precinct) The University of Melbourne Melbourne Victoria Australia
- Hepatopancreatobiliary and Liver Transplant Surgery Unit Austin Health Melbourne Victoria Australia
- Liver Transplant Unit, Department of Gastroenterology and Hepatology Austin Health Melbourne Victoria Australia
| | - Mark Goodwin
- Department of Radiology Austin Health Melbourne Victoria Australia
| | - Alex Dobrovic
- Department of Surgery (Austin Precinct) The University of Melbourne Melbourne Victoria Australia
| | - Adam Testro
- Department of Medicine (Austin Precinct) The University of Melbourne Melbourne Victoria Australia
- Liver Transplant Unit, Department of Gastroenterology and Hepatology Austin Health Melbourne Victoria Australia
| | - Vijayaragavan Muralidharan
- Department of Surgery (Austin Precinct) The University of Melbourne Melbourne Victoria Australia
- Hepatopancreatobiliary and Liver Transplant Surgery Unit Austin Health Melbourne Victoria Australia
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Hui C, Baclay R, Lau B, von Eyben R, Vitzthum L, Pollom E, Chang DT. Outcomes and Imaging Analysis in Hepatocellular Carcinoma Treated With Stereotactic Body Radiation Therapy. Pract Radiat Oncol 2023; 13:e139-e148. [PMID: 36868725 DOI: 10.1016/j.prro.2022.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 08/15/2022] [Accepted: 08/29/2022] [Indexed: 11/05/2022]
Abstract
PURPOSE Although arterial phase enhancement is commonly used to evaluate treatment response for hepatocellular carcinoma, it may not accurately describe response for lesions treated with stereotactic body radiation therapy (SBRT). We aimed to describe the post-SBRT imaging findings to better inform the optimal timing of salvage therapy after SBRT. METHODS AND MATERIALS We retrospectively reviewed patients with hepatocellular carcinoma treated with SBRT from 2006 to 2021 at a single institution with available imaging showing lesions with characteristic arterial enhancement and portal venous washout. Patients were then stratified into 3 groups based on treatment: (1) concurrent SBRT and transarterial chemoembolization, (2) SBRT only, and (3) SBRT followed by early salvage therapy due to persistent enhancement. Overall survival was analyzed with the Kaplan-Meier method, and cumulative incidences were calculated with competing risk analysis. RESULTS We included 82 lesions in 73 patients. The median follow-up time was 22.3 months (range, 2.2-88.1 months). The median time to overall survival was 43.7 months (95% confidence interval, 28.1-57.6 months) and median progression-free survival was 10.5 months (95% confidence interval, 7.2-14.0 months). There were 10 (12.2%) lesions that experienced local progression and there was no difference in rates of local progression between the 3 groups (P = .32). In the SBRT-only group, the median time to resolution of arterial enhancement and washout was 5.3 months (range, 1.6-23.7 months). At 3, 6, 9, and 12 months, 82%, 41%, 13%, and 8% of lesions, respectively, continued to show arterial hyperenhancement. CONCLUSIONS Tumors treated with SBRT may continue to exhibit persistence of arterial hyperenhancement. Without an increase in size of enhancement, continued surveillance may be appropriate for these patients.
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Affiliation(s)
- Caressa Hui
- Department of Radiation Oncology, Stanford University, Stanford, California
| | - Richel Baclay
- Department of Radiation Oncology, Stanford University, Stanford, California
| | - Brianna Lau
- Department of Radiation Oncology, Stanford University, Stanford, California
| | - Rie von Eyben
- Department of Radiation Oncology, Stanford University, Stanford, California
| | - Lucas Vitzthum
- Department of Radiation Oncology, Stanford University, Stanford, California
| | - Erqi Pollom
- Department of Radiation Oncology, Stanford University, Stanford, California
| | - Daniel T Chang
- Department of Radiation Oncology, Stanford University, Stanford, California.
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Xu Y, Yang Y, Li L, Ye F, Zhao X. The α-RECIST (RECIST 1.1 Combined With Alpha Fetoprotein): A Novel Tool for Identifying Tumor Response of Conversion-Radiotherapy for Unresectable Hepatocellular Carcinoma Before Hepatectomy. Front Oncol 2022; 12:905260. [PMID: 35686094 PMCID: PMC9170883 DOI: 10.3389/fonc.2022.905260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Accepted: 04/19/2022] [Indexed: 12/24/2022] Open
Abstract
Purpose To develop a novel criterion based on the response evaluation criteria in solid tumors (RECIST) 1.1 and alpha fetoprotein (AFP) and evaluate its performance in tumor response for patients with unresectable hepatocellular carcinoma (uHCC) receiving conversion-radiotherapy before hepatectomy. Method From June 2012 to December 2020, a total of 39 patients with uHCC, who received intensity-modulated radiotherapy (IMRT) before hepatectomy, were retrospectively included in this study. Pre- and post-treatment contrast-enhanced magnetic resonance imaging (CE-MRI) scans were performed in all patients. Eight modified criteria were developed with the combination of RECIST 1.1, modified RECIST (mRECIST), and the percentage change of AFP, baseline AFP. The endpoint events were recurrence-free survival (RFS). Results The median RFS and OS was 26.5 (IQR, 15.7-43.1), 38.8 (IQR, 18.4-53.6) months. An optimal revised evaluation criterion named α-RECIST (alpha fetoprotein-RECIST 1.1) was developed by combining the RECIST 1.1 with the AFPΔ (cut-off value, 76%). Patients defined as responders by α-RECIST showed significantly better RFS and OS than those defined as non-responders (p = 0.035, 0.048). The other criteria (RECIST 1.1, mRECIST, αΔ-mRECIST, α&Δ-RECIST, α&Δ-mRECIST, αBL-RECIST, αBL-mRECIST, α&BL-RECIST, α&BL-mRECIST) all failed to identify responders from non-responders (p = 0.405, 0.201, 0.773, 0.424, 0.266, 0.060, 0.721, 0.644, 0.910, respectively) when correlated with RFS. Responders according to α-RECIST showed significant better RFS compared to non-responders [HR, 0.31 (95% CI: 0.10, 0.98); p=0.046], but no statistical significance was observed in terms of OS [HR, 0.33 (95% CI: 0.11, 1.05); p = 0.06]. Conclusions Patients identified as responders by α-RECIST provided significant better RFS. The α-RECIST criteria might be a promising tool for identifying tumor response of conversion-radiotherapy for unresectable hepatocellular carcinoma before hepatectomy.
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Affiliation(s)
- Ying Xu
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yi Yang
- Department of Hepatobiliary Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Key Laboratory of Gene Editing Screening and Research and Development (R&D) of Digestive System Tumor Drugs, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lu Li
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Feng Ye
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xinming Zhao
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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8
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Shampain KL, Hackett CE, Towfighi S, Aslam A, Masch WR, Harris AC, Chang SD, Khanna K, Mendiratta V, Gabr AM, Owen D, Mendiratta-Lala M. SBRT for HCC: Overview of technique and treatment response assessment. Abdom Radiol (NY) 2021; 46:3615-3624. [PMID: 33963419 DOI: 10.1007/s00261-021-03107-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 04/20/2021] [Accepted: 04/24/2021] [Indexed: 02/06/2023]
Abstract
Stereotactic body radiation therapy (SBRT) is an emerging locoregional treatment (LRT) modality used in the management of patients with hepatocellular carcinoma (HCC). The decision to treat HCC with LRT is evaluated in a multidisciplinary setting, and the specific LRT chosen depends on the treatment intent, such as bridge-to-transplant, down-staging to transplant, definitive/curative treatment, and/or palliation, as well as underlying patient clinical factors. Accurate assessment of treatment response is necessary in order to guide clinical management in these patients. Patients who undergo LRT need continuous imaging evaluation to assess treatment response and to evaluate for recurrence. Thus, an accurate understanding of expected post-SBRT imaging findings is critical to avoid misinterpreting normal post-treatment changes as local progression or viable tumor. SBRT-treated HCC demonstrates unique imaging findings that differ from HCC treated with other forms of LRT. In particular, SBRT-treated HCC can demonstrate persistent APHE and washout on short-term follow-up imaging. This brief review summarizes current evidence for the use of SBRT for HCC, including patient population, SBRT technique and procedure, tumor response assessment on contrast-enhanced cross-sectional imaging with expected findings, and pitfalls in treatment response evaluation.
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Affiliation(s)
| | | | - Sohrab Towfighi
- Department of Radiology, University of British Columbia, Vancouver, BC, Canada
| | - Anum Aslam
- Department of Radiology, University of Michigan, Ann Arbor, MI, USA
| | - William R Masch
- Department of Radiology, University of Michigan, Ann Arbor, MI, USA
| | - Alison C Harris
- Department of Radiology, University of British Columbia, Vancouver, BC, Canada
| | - Silvia D Chang
- Department of Radiology, University of British Columbia, Vancouver, BC, Canada
| | - Kanika Khanna
- Department of Hepatology, Henry Ford Hospital, Detroit, MI, USA
| | | | - Ahmed M Gabr
- Department of Radiology and Medical Imaging, University of Virginia, Charlottesville, VA, USA
| | - Dawn Owen
- Department of Radiation Oncology, Mayo Clinic Rochester, Rochester, MN, USA
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Mendiratta-Lala M, Masch W, Owen D, Aslam A, Maurino C, Devasia T, Schipper MJ, Parikh ND, Cuneo K, Lawrence TS, Davenport MS. Natural history of hepatocellular carcinoma after stereotactic body radiation therapy. Abdom Radiol (NY) 2020; 45:3698-3708. [PMID: 32303772 DOI: 10.1007/s00261-020-02532-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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.
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10
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Pettersson O, Fröss-Baron K, Crona J, Sundin A. Tumor Contrast-Enhancement for Monitoring of PRRT 177Lu-DOTATATE in Pancreatic Neuroendocrine Tumor Patients. Front Oncol 2020; 10:193. [PMID: 32154181 PMCID: PMC7047407 DOI: 10.3389/fonc.2020.00193] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 02/05/2020] [Indexed: 01/14/2023] Open
Abstract
Background: Therapy monitoring of cancer treatment by contrast-enhanced CT (CECT), applying response evaluation criteria in solid tumors criteria version 1. 1 (RECIST 1.1) is less suitable for neuroendocrine tumors (NETs) which, when responding, tend to show stabilization rather than shrinkage. New methods are needed to further classify patients in order to identify non-responders at an early stage and avoid unnecessary adverse effects and costs. Changes in arterial tumor attenuation and contrast-enhancement could be used to identify the effect of therapy, perhaps even in early stages of treatment. Methods: Patients with metastatic pancreatic NETs (PNETs) receiving peptide receptor radionuclide therapy (PRRT) with 177Lu-DOTATATE underwent CECT at baseline, mid-treatment (PRRT cycles 3–5) and at follow-up, 3 months after the last PRRT cycle. At baseline CECT, the liver metastasis with the highest arterial attenuation was identified in each patient. The fold changes in arterial tumor attenuation (Hounsfield Units, HU), contrast-enhancement (HU), and transversal tumor area (cm2) between CECT at baseline, mid-treatment and follow-up were calculated. Correlation of the tumor metrics to outcome parameters such as progression-free survival (PFS) and time to best response was performed. Results: Fifty-two patients were included (27 men, 25 women), median age 60 years (range 29–80), median Ki-67 8% (range 1–30). Six patients had grade 1 PNETs, forty had grade 2 and four had grade 3 tumors. As an internal control, it was first tested and established that the tumor contrast-enhancement was not merely related to that of the abdominal aorta. The mean ± SD arterial attenuation of the liver metastases was similar at baseline, 217 ± 62 HU and at mid-treatment, 238 ± 80 HU and then decreased to 198 ± 62 HU at follow-up, compared to baseline (p = 0.024, n = 52) and mid-treatment (p = 0.0004, n = 43). The transversal tumor area decreased 25% between baseline and follow-up (p = 0.013, n = 52). Tumor contrast-enhancement increased slightly from baseline to mid-treatment and these fold changes correlated with PFS (R2 = 0.33, p = 0.0002, n = 37) and with time to best response (R2 = 0.34, p < 0.0001, n = 37). Conclusions: Early changes in contrast-enhancement and arterial attenuation in PNET liver metastases may for CECT monitoring of PRRT yield complementary information to evaluation by RECIST 1.1.
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Affiliation(s)
- Olof Pettersson
- Section of Radiology, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | | | - Joakim Crona
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Anders Sundin
- Section of Radiology, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
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11
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Voizard N, Cerny M, Assad A, Billiard JS, Olivié D, Perreault P, Kielar A, Do RKG, Yokoo T, Sirlin CB, Tang A. Assessment of hepatocellular carcinoma treatment response with LI-RADS: a pictorial review. Insights Imaging 2019; 10:121. [PMID: 31853668 PMCID: PMC6920285 DOI: 10.1186/s13244-019-0801-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 09/26/2019] [Indexed: 02/07/2023] Open
Abstract
Computed tomography (CT) and magnetic resonance imaging (MRI) play critical roles for assessing treatment response of hepatocellular carcinoma (HCC) after locoregional therapy. Interpretation is challenging because posttreatment imaging findings depend on the type of treatment, magnitude of treatment response, time interval after treatment, and other factors. To help radiologists interpret and report treatment response in a clear, simple, and standardized manner, the Liver Imaging Reporting and Data System (LI-RADS) has developed a Treatment Response (LR-TR) algorithm. Introduced in 2017, the system provides criteria to categorize response of HCC to locoregional treatment (e.g., chemical ablation, energy-based ablation, transcatheter therapy, and radiation therapy). LR-TR categories include Nonevaluable, Nonviable, Equivocal, and Viable. LR-TR does not apply to patients on systemic therapies. This article reviews the LR-TR algorithm; discusses locoregional therapies for HCC, treatment concepts, and expected posttreatment findings; and illustrates LI-RADS treatment response assessment with CT and MRI.
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Affiliation(s)
- Nicolas Voizard
- Department of Radiology, Centre hospitalier de l'Université de Montréal (CHUM), Montreal, Québec, Canada
| | - Milena Cerny
- Centre de recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), Montréal, Québec, Canada
| | - Anis Assad
- Department of Radiology, Centre hospitalier de l'Université de Montréal (CHUM), Montreal, Québec, Canada
| | - Jean-Sébastien Billiard
- Department of Radiology, Centre hospitalier de l'Université de Montréal (CHUM), Montreal, Québec, Canada
| | - Damien Olivié
- Department of Radiology, Centre hospitalier de l'Université de Montréal (CHUM), Montreal, Québec, Canada
| | - Pierre Perreault
- Department of Radiology, Centre hospitalier de l'Université de Montréal (CHUM), Montreal, Québec, Canada
| | - Ania Kielar
- Joint Department of Medical Imaging, University of Toronto, Toronto, Canada
| | - Richard K G Do
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Takeshi Yokoo
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Claude B Sirlin
- Liver Imaging Group, Department of Radiology, University of California San Diego, San Diego, CA, USA
| | - An Tang
- Department of Radiology, Centre hospitalier de l'Université de Montréal (CHUM), Montreal, Québec, Canada.
- Centre de recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), Montréal, Québec, Canada.
- Department of Radiology, Radio-oncology and Nuclear Medicine, University of Montreal, Montreal, Canada.
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Local Tumor Control and Patient Outcome Using Stereotactic Body Radiation Therapy for Hepatocellular Carcinoma: iRECIST as a Potential Substitute for Traditional Criteria. AJR Am J Roentgenol 2019; 213:1232-1239. [PMID: 31613663 DOI: 10.2214/ajr.18.20842] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVE. The purpose of this study was to investigate whether, compared with traditional criteria, the modified Response Evaluation Criteria in Solid Tumors version 1.1 for immune-based therapeutics (iRECIST) improves prediction of local tumor control and survival in patients with hepatocellular carcinoma (HCC) treated with stereotactic body radiotherapy (SBRT). MATERIALS AND METHODS. Fifty-one HCC lesions (mean size, 3.1 cm) treated with SBRT in 41 patients (mean age, 67 years) were retrospectively included. Each patient underwent CT or MRI before SBRT and at least once after SBRT. Best overall response was categorized using Response Evaluation Criteria in Solid Tumors version 1.1 (RECIST 1.1), iRECIST, World Health Organization (WHO) criteria, modified Response Evaluation Criteria in Solid Tumors (mRECIST), and European Association for the Study of the Liver (EASL) criteria. Lesions were then classified as local tumor control (i.e., stable disease, partial response, or complete response) or local treatment failure (i.e., progressive disease) by each tumor response criteria. Proportions of local tumor control were compared using the McNemar exact test. The 1-year overall survival was estimated using the Kaplan-Meier method. RESULTS. The median follow-up after SBRT was 21.0 months. The local tumor control rate was 94.1% (48/51) by iRECIST, 88.2% (45/51) by RECIST 1.1, 72.5% (37/51) by WHO criteria, 80.4% (41/51) by mRECIST, and 72.5% (37/51) by EASL criteria. The local tumor control rate was significantly higher according to iRECIST compared with WHO (p = 0.0010) and EASL (p = 0.0225) criteria. The 1-year survival rate for patients with local tumor control according to iRECIST (86.4%) was higher (although not statistically significant) compared with the 1-year survival rate for patients with local tumor control according to the other response criteria. CONCLUSION. iRECIST may provide more robust interpretation of HCC response after SBRT, yielding improved prediction of local tumor control and 1-year survival rates compared with traditional criteria.
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13
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Song SH, Jeong WK, Choi D, Kim YK, Park HC, Yu JI. Evaluation of early treatment response to radiotherapy for HCC using pre- and post-treatment MRI. Acta Radiol 2019; 60:826-835. [PMID: 30282483 DOI: 10.1177/0284185118805253] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Affiliation(s)
- So Hee Song
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Woo Kyoung Jeong
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Dongil Choi
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Young Kon Kim
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hee Chul Park
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jeong Il Yu
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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14
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Mastrocostas K, Jang HJ, Fischer S, Dawson LA, Munoz-Schuffenegger P, Sapisochin G, Kim TK. Imaging post-stereotactic body radiation therapy responses for hepatocellular carcinoma: typical imaging patterns and pitfalls. Abdom Radiol (NY) 2019; 44:1795-1807. [PMID: 30710166 DOI: 10.1007/s00261-019-01901-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Stereotactic body radiation therapy (SBRT) has increased utility in the management of hepatocellular carcinoma (HCC) ranging from local therapy in early-stage HCC not suitable for other focal therapies to end-stage HCC. As the indications for the use of SBRT in HCC expand, diagnostic imaging is being increasingly used to assess response to treatment. The imaging features of tumor response do not parallel those of other focal therapies such as radiofrequency ablation or trans-arterial chemoembolization that immediately devascularize the tumor. The tumor response to SBRT on imaging takes much longer and often shows gradual changes including the reduction of enhancement and size over several months. It is essential to recognize the typical imaging patterns of response, as well as the appearance of focal liver reaction in the non-target liver that can confound image interpretation. The timing of treatment response assessment imaging is fundamental to minimize the potential for false negative response. The purpose of this article is to review the variable post-SBRT imaging features of HCC and adjacent liver parenchyma and discuss the potential pitfalls of imaging evaluation after SBRT for HCC.
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15
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Schaub SK, Hartvigson PE, Lock MI, Høyer M, Brunner TB, Cardenes HR, Dawson LA, Kim EY, Mayr NA, Lo SS, Apisarnthanarax S. Stereotactic Body Radiation Therapy for Hepatocellular Carcinoma: Current Trends and Controversies. Technol Cancer Res Treat 2018; 17:1533033818790217. [PMID: 30068240 PMCID: PMC6071169 DOI: 10.1177/1533033818790217] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Hepatocellular carcinoma is the fourth leading cause of cancer-related death worldwide.
Depending on the extent of disease and competing comorbidities for mortality, multiple
liver-directed therapy options exist for the treatment of hepatocellular carcinoma.
Advancements in radiation oncology have led to the emergence of stereotactic body
radiation therapy as a promising liver-directed therapy, which delivers high doses of
radiation with a steep dose gradient to maximize local tumor control and minimize
radiation-induced treatment toxicity. In this study, we review the current clinical data
as well as the unresolved issues and controversies regarding stereotactic body radiation
therapy for hepatocellular carcinoma: (1) Is there a radiation dose–response relationship
with hepatocellular carcinoma? (2) What are the optimal dosimetric predictors of
radiation-induced liver disease, and do they differ for patients with varying liver
function? (3) How do we assess treatment response on imaging? (4) How does stereotactic
body radiation therapy compare to other liver-directed therapy modalities, including
proton beam therapy? Based on the current literature discussed, this review highlights
future possible research and clinical directions.
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Affiliation(s)
- Stephanie K Schaub
- 1 Department of Radiation Oncology, University of Washington, Seattle, WA, USA
| | - Pehr E Hartvigson
- 1 Department of Radiation Oncology, University of Washington, Seattle, WA, USA
| | - Michael I Lock
- 2 Department of Radiation Oncology, University of Western Ontario, London, Canada
| | - Morten Høyer
- 3 Aarhus University Hospital, Danish Center for Particle Therapy, Aarhus, Denmark
| | - Thomas B Brunner
- 4 Klinik für Strahlentherapie, Universitätsklinikum Magdeburg, Magdeburg, Germany
| | | | - Laura A Dawson
- 6 Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada
| | - Edward Y Kim
- 1 Department of Radiation Oncology, University of Washington, Seattle, WA, USA
| | - Nina A Mayr
- 1 Department of Radiation Oncology, University of Washington, Seattle, WA, USA
| | - Simon S Lo
- 1 Department of Radiation Oncology, University of Washington, Seattle, WA, USA
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Lo EC, N. Rucker A, Federle MP. Hepatocellular Carcinoma and Intrahepatic Cholangiocarcinoma: Imaging for Diagnosis, Tumor Response to Treatment and Liver Response to Radiation. Semin Radiat Oncol 2018; 28:267-276. [DOI: 10.1016/j.semradonc.2018.06.010] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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17
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Lee Y, Kim SY, Lee SS, Park SH, Kim KW, Byun JH, Lee M. Pitfalls in Gd-EOB-DTPA-Enhanced Liver Magnetic Resonance Imaging With an Emphasis on Nontumorous Lesions. Clin Liver Dis (Hoboken) 2018; 12:50-59. [PMID: 30988911 PMCID: PMC6385906 DOI: 10.1002/cld.723] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Revised: 03/01/2018] [Accepted: 04/08/2018] [Indexed: 02/04/2023] Open
Affiliation(s)
- Yedaun Lee
- Department of Radiology, Haeundae Paik HospitalInje University College of MedicineBusanRepublic of Korea
| | - So Yeon Kim
- Department of Radiology and Research Institute of RadiologyUniversity of Ulsan College of MedicineAsan Medical Center, 88, Olympic‐ro 43‐gil, Songpa‐guSeoul138‐736Korea
| | - Seung Soo Lee
- Department of Radiology and Research Institute of RadiologyUniversity of Ulsan College of MedicineAsan Medical Center, 88, Olympic‐ro 43‐gil, Songpa‐guSeoul138‐736Korea
| | - Seong Ho Park
- Department of Radiology and Research Institute of RadiologyUniversity of Ulsan College of MedicineAsan Medical Center, 88, Olympic‐ro 43‐gil, Songpa‐guSeoul138‐736Korea
| | - Kyoung Won Kim
- Department of Radiology and Research Institute of RadiologyUniversity of Ulsan College of MedicineAsan Medical Center, 88, Olympic‐ro 43‐gil, Songpa‐guSeoul138‐736Korea
| | - Jae Ho Byun
- Department of Radiology and Research Institute of RadiologyUniversity of Ulsan College of MedicineAsan Medical Center, 88, Olympic‐ro 43‐gil, Songpa‐guSeoul138‐736Korea
| | - Moon‐Gyu Lee
- Department of Radiology and Research Institute of RadiologyUniversity of Ulsan College of MedicineAsan Medical Center, 88, Olympic‐ro 43‐gil, Songpa‐guSeoul138‐736Korea
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18
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FDG-Avid Focal Liver Reaction From Proton Therapy in a Patient With Primary Esophageal Adenocarcinoma. Clin Nucl Med 2018; 43:e139-e141. [PMID: 29561521 DOI: 10.1097/rlu.0000000000002035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
A 25-year-old man with IgA deficiency was treated with 2 months of chemotherapy and proton therapy for gastroesophageal junction adenocarcinoma. Restaging PET/CT 18 days posttherapy demonstrated 2 new foci of increased FDG uptake in the left hepatic lobe, which were favored to represent radiation injury as opposed to new metastases. Follow-up MRI with contrast 2 weeks later demonstrated hypoenhancement and T1/T2 hypointensity in the liver, without restricted diffusion, which correlated with the dominant FDG-avid focus. The hepatic lesions resolved on subsequent FDG PET/CT and MRI studies, confirming the diagnosis of acute radiation injury.
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19
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Joo I, Kim HC, Kim GM, Paeng JC. Imaging Evaluation Following 90Y Radioembolization of Liver Tumors: What Radiologists Should Know. Korean J Radiol 2018. [PMID: 29520178 PMCID: PMC5840049 DOI: 10.3348/kjr.2018.19.2.209] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Radioembolization using beta-emitting yttrium-90 microspheres is being increasingly used for the treatment of primary and metastatic liver cancers. It is a form of intra-arterial brachytherapy which delivers intense radiation to liver tumors with little embolic effect; this mode of action results in unique post-treatment imaging findings. It is important to understand these imaging findings to avoid misinterpretation of tumor response and to determine further management of the disease. Herein, we discuss the current concepts for assessing tumor response, common post-treatment imaging features, and associated complications following radioembolization.
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Affiliation(s)
- Ijin Joo
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul 03080, Korea
| | - Hyo-Cheol Kim
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul 03080, Korea
| | - Gyoung Min Kim
- Department of Radiology, Severance Hospital, Seoul 03722, Korea
| | - Jin Chul Paeng
- Department of Nuclear Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul 03080, Korea
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20
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Kellock T, Liang T, Harris A, Schellenberg D, Ma R, Ho S, Yap WW. Stereotactic body radiation therapy (SBRT) for hepatocellular carcinoma: imaging evaluation post treatment. Br J Radiol 2018; 91:20170118. [PMID: 29334232 DOI: 10.1259/bjr.20170118] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Surgical resection, when feasible, is the standard of care for hepatocellular carcinoma. However, many tumours are not resectable at the time of diagnosis. Recently, stereotactic body radiation therapy (SBRT) has emerged as a non-invasive local therapy for both non-resectable primary hepatic malignancies as well as hepatic metastases. Knowledge of the expected hepatic parenchymal appearance post treatment, as well as potential pitfalls and complications, is essential for accurate evaluation of treatment response. This pictorial review provides a fundamental description of the SBRT technique, outlines the expected cross-sectional imaging appearances of tumour response, and highlights potential pitfalls in interpretation. The expected liver parenchymal changes post-SBRT are also reviewed, along with some common radiation-induced complications.
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Affiliation(s)
- Trenton Kellock
- 1 Department of Radiology, University of British Columbia, Faculty of Medicine , Vancouver, BC , Canada
| | - Teresa Liang
- 1 Department of Radiology, University of British Columbia, Faculty of Medicine , Vancouver, BC , Canada
| | - Alison Harris
- 2 Department of Radiology, Vancouver General Hospital , Vancouver, BC , Canada
| | - Devin Schellenberg
- 3 Department of Radiation Oncology, BC Cancer Agency , Vancouver, BC , Canada
| | - Roy Ma
- 3 Department of Radiation Oncology, BC Cancer Agency , Vancouver, BC , Canada
| | - Stephen Ho
- 2 Department of Radiology, Vancouver General Hospital , Vancouver, BC , Canada
| | - Wan Wan Yap
- 4 Department of Radiology, BC Cancer Agency , Vancouver, BC , Canada
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Kielar A, Fowler KJ, Lewis S, Yaghmai V, Miller FH, Yarmohammadi H, Kim C, Chernyak V, Yokoo T, Meyer J, Newton I, Do RK. Locoregional therapies for hepatocellular carcinoma and the new LI-RADS treatment response algorithm. Abdom Radiol (NY) 2018; 43:218-230. [PMID: 28780679 DOI: 10.1007/s00261-017-1281-6] [Citation(s) in RCA: 77] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Radiologists play a central role in the assessment of patient response to locoregional therapies for hepatocellular carcinoma (HCC). The identification of viable tumor following treatment guides further management and potentially affects transplantation eligibility. Liver Imaging Reporting and Data Systems (LI-RADS) first introduced the concept of LR-treated in 2014, and a new treatment response algorithm is included in the 2017 update to assist radiologists in image interpretation of HCC after locoregional therapy. In addition to offering imaging criteria for viable and nonviable HCC, new concepts of nonevaluable tumors as well as tumors with equivocal viability are introduced. Existing guidelines provided by response evaluation criteria in solid tumors (RECIST) and modified RECIST address patient-level assessments and are routinely used in clinical trials but do not address the variable appearances following different locoregional therapies. The new LI-RADS treatment response algorithm addresses this gap and offers a comprehensive approach to assess treatment response for individual lesions after a variety of locoregional therapies, using either contrast-enhanced CT or MRI.
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Affiliation(s)
- Ania Kielar
- Department of Radiology, University of Ottawa, Ottawa, Canada
| | - Kathryn J Fowler
- Department of Radiology, Washington University, St. Louis, MO, USA
| | - Sara Lewis
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Vahid Yaghmai
- Department of Radiology, Northwestern Memorial Hospital, Northwestern University-Feinberg School of Medicine, Chicago, IL, USA
| | - Frank H Miller
- Department of Radiology, Northwestern Memorial Hospital, Northwestern University-Feinberg School of Medicine, Chicago, IL, USA
| | - Hooman Yarmohammadi
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Charles Kim
- Department of Radiology, Duke University, Durham, NC, USA
| | - Victoria Chernyak
- Department of Radiology, Montefiore Medical Center, New York, NY, USA
| | - Takeshi Yokoo
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Jeffrey Meyer
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Isabel Newton
- Department of Radiology, UC San Diego, San Diego, CA, USA
| | - Richard K Do
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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22
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Zeng ZC, Seong J, Yoon SM, Cheng JCH, Lam KO, Lee AS, Law A, Zhang JY, Hu Y. Consensus on Stereotactic Body Radiation Therapy for Small-Sized Hepatocellular Carcinoma at the 7th Asia-Pacific Primary Liver Cancer Expert Meeting. Liver Cancer 2017; 6:264-274. [PMID: 29234630 PMCID: PMC5704685 DOI: 10.1159/000475768] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Stereotactic body radiation therapy (SBRT) is an advanced technique of external beam radiation therapy that delivers large ablative doses of radiation. In the past decade, many cancer centers have adopted SBRT as one mode of radically treating small-sized hepatocellular carcinoma (HCC), based on encouraging clinical outcomes. SBRT thus seems reasonable as first-line treatment of inoperable HCC confined to the liver. However, most of the clinical studies to date have been retrospective in nature, with key issues still under investigation. SUMMARY The above-mentioned publications were subjected to scrutiny, fueling discussions at the 7th Asia-Pacific Primary Liver Cancer Expert (APPLE 2016) Meeting on various clinical variables, such as indications for SBRT, therapeutic outcomes, treatment-related toxicities, doses prescribed, and specific techniques. The consensus reached should be of interest to all professionals active in the treatment of HCC, especially radiation oncologists. KEY MESSAGES SBRT is a safe and effective therapeutic option for patients with small-sized HCC, offering substantial local control, improved overall survival, and low toxicity.
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Affiliation(s)
- Zhao-Chong Zeng
- Department of Radiation Oncology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jinsil Seong
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea,*Jinsil Seong, MD, PhD, Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University Health System, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 120-752 (Korea), E-Mail , Zhao-Chong Zeng, MD, PhD, Department of Radiation Oncology, Zhongshan Hospital, Fudan University, 136 Yi Xue Yuan Road, Shanghai 200032 (China), E-Mail
| | - Sang Min Yoon
- Department of Radiation Oncology, Asan Liver Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | | | - Ka-On Lam
- Department of Clinical Oncology, Queen Mary Hospital, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, SAR, China
| | - Ann-Shing Lee
- Department of Clinical Oncology, Tuen Mun Hospital, Hong Kong, SAR, China
| | - Ada Law
- Department of Oncology, Pamela Youde Nethersole Eastern Hospital, Hong Kong, SAR, China
| | - Jian-Ying Zhang
- Department of Radiation Oncology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yong Hu
- Department of Radiation Oncology, Zhongshan Hospital, Fudan University, Shanghai, China
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Mendiratta-Lala M, Gu E, Owen D, Cuneo KC, Bazzi L, Lawrence TS, Hussain HK, Davenport MS. Imaging Findings Within the First 12 Months of Hepatocellular Carcinoma Treated With Stereotactic Body Radiation Therapy. Int J Radiat Oncol Biol Phys 2017; 102:1063-1069. [PMID: 29029891 DOI: 10.1016/j.ijrobp.2017.08.022] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Revised: 07/15/2017] [Accepted: 08/16/2017] [Indexed: 02/08/2023]
Abstract
PURPOSE To correlate the imaging findings of treated hepatocellular carcinoma (HCC) after stereotactic body radiation therapy (SBRT) with explant pathology and alpha-fetoprotein (AFP) response. METHODS AND MATERIALS From 2007 to 2015, of 146 patients treated with liver SBRT for Barcelona Clinic Liver Cancer stage A hepatocellular carcinoma, 10 were identified with inclusion criteria and had regular interval follow-up magnetic resonance imaging/triple phase computed tomography and explant pathology or declining AFP values for radiology-pathology response correlation. Reference standards for successful response were >90% necrosis on explant pathology or pretreatment AFP >75 ng/mL normalizing to <10 ng/mL within 1 year after SBRT without other treatment. Subjects were treated with 24 to 50 Gy in 3 to 5 fractions. Multiphasic magnetic resonance imaging or computed tomography performed at 3, 6, 9, and 12 months after SBRT was compared with pretreatment imaging by 2 expert radiologists. Descriptive statistics were calculated. RESULTS There were 10 subjects with 10 treated HCCs, classified as 3 Organ Procurement and Transplantation Network (OPTN) 5a, 4 OPTN 5b, and 3 OPTN 5x. All had successfully treated HCCs, according to explant pathology or declining AFP. Four of 10 HCCs had persistent central arterial hyperenhancement 3 to 12 months after SBRT; persistent wash-out was common up to 12 months (9 of 10). Of 10 treated HCCs, 9 exhibited decreased size at 12 months. Liver parenchyma adjacent to the lesion showed early (3-6 months) hyperemia followed by late (6-12 months) capsular retraction and delayed enhancement. No patient had a significant decline in liver function. CONCLUSIONS In the absence of increasing size, persistent central arterial hyperenhancement and wash-out can occur within the first 12 months after SBRT in successfully treated HCCs and may not represent residual viable tumor. Liver parenchyma adjacent to the treated lesion showed inflammation followed by fibrosis, without significant change in hepatic function. Until a radiologic signature of tumor control is determined, freedom from local progression seems to be the best measure of HCC control after SBRT.
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Affiliation(s)
| | - Everett Gu
- Department of Radiology, University of Michigan, Ann Arbor, Michigan
| | - Dawn Owen
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Kyle C Cuneo
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Latifa Bazzi
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Theodore S Lawrence
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Hero K Hussain
- Department of Radiology, University of Michigan, Ann Arbor, Michigan
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Tumor response assessment by MRI following stereotactic body radiation therapy for hepatocellular carcinoma. PLoS One 2017; 12:e0176118. [PMID: 28441447 PMCID: PMC5404860 DOI: 10.1371/journal.pone.0176118] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2016] [Accepted: 04/05/2017] [Indexed: 02/07/2023] Open
Abstract
Background To evaluate the MRI features of a tumor response, local control, and predictive factors of local control after stereotactic body radiation therapy (SBRT) for hepatocellular carcinoma (HCC). Methods Thirty-five consecutive patients with 48 HCCs who were treated by SBRT were included in this retrospective study. All patients provided written informed consent to be treated by SBRT, and prior to inclusion they authorized use of the treatment data for further studies. The assessment was made using MRI, with determination of local and hepatic responses according to Response Evaluation Criteria in Solid Tumors (RECIST) and modified RECIST (mRECIST) criteria during a two-year follow-up. Results The local response rate according to mRECIST was higher than with RECIST. A tumor diameter less than 20 mm at baseline was an independent predictive factor for RECIST and mRECIST responses, as was diffusion-weighted signal for RECIST. During follow-up, a tumor diameter of <20 mm (p = 0.034) and absence of a high intensity on T2-weighted (p = 0.006) and diffusion-weighted images (p = 0.039) were associated with a better response according to RECIST. Post-treatment changes include peritumoral ring-like enhanced changes with high intensity on T2-weighted images. Conclusions SBRT is a promising technique for the treatment of inoperable HCC. Post-treatment changes on MRI images can resemble tumor progression and as such must be adequately distinguished. The regression of tumorous enhancement is variable over time, although diffusion-weighted and T2-weighted intensities are predictive factors for tumor RECIST responses on subsequent MRIs. They hence provide a way to reliably predict treatment responses.
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Lock M, Malayeri AA, Mian OY, Mayr NA, Herman JM, Lo SS. Computed tomography imaging assessment of postexternal beam radiation changes of the liver. Future Oncol 2016; 12:2729-2739. [PMID: 27576360 DOI: 10.2217/fon-2016-0165] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Radiation is being used for patients with primary and secondary liver cancers, as a rapidly evolving treatment. However, postradiation imaging changes of the liver are not well understood and therefore challenging to interpret. Distinguishing normal radiation changes from residual or recurrent disease is difficult. Size and contrast enhancement have been used to guide interpretation and clinical recommendations, but normal radiation changes can make interpretation difficult and are not accounted for in available guidelines. Knowledge of dose- and time-dependent changes in addition to imaging findings, such as morphological and enhancement patterns, provides useful differentiating parameters. This paper reviews recent studies using computed tomography that can guide interpretation and help differentiate tumor from benign changes after external beam radiation.
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Affiliation(s)
- Michael Lock
- Department of Radiation Oncology, London Regional Cancer Program, University of Western Ontario, London, ON, Canada
| | - Ashkan A Malayeri
- Department of Radiology, National Institutes of Health, Bethesda, MD, USA
| | - Omar Y Mian
- Department of Radiation Oncology, Johns Hopkins University, Baltimore, MD, USA
| | - Nina A Mayr
- Department of Radiation Oncology, University of Washington School of Medicine, Seattle, WA, USA
| | - Joseph M Herman
- Department of Radiation Oncology, Johns Hopkins University, Baltimore, MD, USA
| | - Simon S Lo
- Department of Radiation Oncology, University of Washington School of Medicine, Seattle, WA, USA
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26
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Hoogenboom TC, Thursz M, Aboagye EO, Sharma R. Functional imaging of hepatocellular carcinoma. Hepat Oncol 2016; 3:137-153. [PMID: 30191034 DOI: 10.2217/hep-2015-0005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Accepted: 01/20/2016] [Indexed: 02/06/2023] Open
Abstract
Imaging plays a key role in the clinical management of hepatocellular carcinoma (HCC), but conventional imaging techniques have limited sensitivity in visualizing small tumors and assessing response to locoregional treatments and sorafenib. Functional imaging techniques allow visualization of organ and tumor physiology. Assessment of functional characteristics of tissue, such as metabolism, proliferation and stiffness, may overcome some of the limitations of structural imaging. In particular, novel molecular imaging agents offer a potential tool for early diagnosis of HCC, and radiomics may aid in response assessment and generate prognostic models. Further prospective research is warranted to evaluate emerging techniques and their cost-effectiveness in the context of HCC in order to improve detection and response assessment.
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Affiliation(s)
- Tim Ch Hoogenboom
- Department of Experimental Medicine, Imperial College London, Hammersmith Hospital, Du Cane Road, London, W12 0HS, UK.,Department of Experimental Medicine, Imperial College London, Hammersmith Hospital, Du Cane Road, London, W12 0HS, UK
| | - Mark Thursz
- Department of Hepatology, Imperial College NHS Trust, 10th Floor, Norfolk Place, St Mary's Hospital, London, UK.,Department of Hepatology, Imperial College NHS Trust, 10th Floor, Norfolk Place, St Mary's Hospital, London, UK
| | - Eric O Aboagye
- Comprehensive Cancer Imaging Centre at Imperial College, Faculty of Medicine, Imperial College London, GN1, Ground Floor, Commonwealth building, Hammersmith Campus, London, UK.,Comprehensive Cancer Imaging Centre at Imperial College, Faculty of Medicine, Imperial College London, GN1, Ground Floor, Commonwealth building, Hammersmith Campus, London, UK
| | - Rohini Sharma
- Department of Experimental Medicine, Imperial College London, Hammersmith Hospital, Du Cane Road, London, W12 0HS, UK.,Department of Experimental Medicine, Imperial College London, Hammersmith Hospital, Du Cane Road, London, W12 0HS, UK
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27
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Evaluation of response after SBRT for liver tumors. Rep Pract Oncol Radiother 2015; 22:170-175. [PMID: 28490989 DOI: 10.1016/j.rpor.2015.12.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Accepted: 12/01/2015] [Indexed: 12/13/2022] Open
Abstract
Stereotactic body radiotherapy (SBRT) has developed over the last few years for the treatment of primary and metastatic hepatic tumors. The tumoral and adjacent peritumoral modifications caused by this radiosurgery limit the evaluation of response by anatomic imaging and dimensional criteria alone, such as with RECIST. This suggests that it is of interest to also take into account the residual enhancement and hyper metabolism of these hepatic targets. We have reviewed the English language literature regarding the response of hepatic lesions treated by SBRT, and found that only seven articles were specifically concerned with this problem. The response of the hepatocellular carcinoma after SBRT has been studied specifically with multiphase enhanced CT-scan. Criteria set by the European Association of Study of the Liver better estimate response at each time point of follow up than RECIST does. Non-enhancement, reflecting tumor necrosis, is additionally an early indicator of response with extended response in time and a best non-enhancement percentage is observed at 12 months. The response after treatment by SBRT of cholangiocarcinoma has not yet generated a specific report. Use of RECIST criteria is also inadequate in the evaluation of response after SBRT for hepatic metastases. Response of liver metastases to SBRT is better assessed with a combination of size and enhancement pattern. The occurrence of a lobulated enhancement during follow up is efficient to predict local progression in a specific, reproducible, and sensitive way. Patients with FDG-avid hepatic metastases are also better evaluated with PET-CT and functional criteria than routine imaging and metric evaluation alone.
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Key Words
- CT, computerized tomography
- EASL, European Association of Study of the Liver
- FDG, fluorodeoxyglucose
- HCC, Hepatocellular carcinoma
- Liver
- MRI, magnetic resonance imaging
- PERCIST, PET Response Criteria in Solid Tumors
- PET, positron-emission tomography
- Positron-emission tomography
- RECIST, criteria of response in solid tumors
- SBRT, stereotactic body radiotherapy
- SUV, standard uptake value
- Stereotactic body radiotherapy
- Tomography
- Treatment effectiveness
- X-ray computed
- mRECIST, modified criteria of response in solid tumors
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Jung J, Yoon SM, Cho B, Choi YE, Kwak J, Kim SY, Lee SW, Ahn SD, Choi EK, Kim JH. Hepatic reaction dose for parenchymal changes on Gd-EOB-DTPA-enhanced magnetic resonance images after stereotactic body radiation therapy for hepatocellular carcinoma. J Med Imaging Radiat Oncol 2015; 60:96-101. [DOI: 10.1111/1754-9485.12393] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Accepted: 08/30/2015] [Indexed: 12/20/2022]
Affiliation(s)
- Jinhong Jung
- Department of Radiation Oncology; Asan Medical Center; University of Ulsan College of Medicine; Seoul Korea
- Department of Radiation Oncology; Kyung Hee University Medical Center; Kyung Hee University School of Medicine; Seoul Korea
| | - Sang Min Yoon
- Department of Radiation Oncology; Asan Medical Center; University of Ulsan College of Medicine; Seoul Korea
| | - Byungchul Cho
- Department of Radiation Oncology; Asan Medical Center; University of Ulsan College of Medicine; Seoul Korea
| | - Young Eun Choi
- Department of Radiation Oncology; Asan Medical Center; University of Ulsan College of Medicine; Seoul Korea
| | - Jungwon Kwak
- Department of Radiation Oncology; Asan Medical Center; University of Ulsan College of Medicine; Seoul Korea
| | - So Yeon Kim
- Department of Radiology; Asan Medical Center; University of Ulsan College of Medicine; Seoul Korea
| | - Sang-wook Lee
- Department of Radiation Oncology; Asan Medical Center; University of Ulsan College of Medicine; Seoul Korea
| | - Seung Do Ahn
- Department of Radiation Oncology; Asan Medical Center; University of Ulsan College of Medicine; Seoul Korea
| | - Eun Kyung Choi
- Department of Radiation Oncology; Asan Medical Center; University of Ulsan College of Medicine; Seoul Korea
| | - Jong Hoon Kim
- Department of Radiation Oncology; Asan Medical Center; University of Ulsan College of Medicine; Seoul Korea
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Jacob J, Nguyen F, Deutsch E, Mornex F. [Stereotactic body radiation therapy in the management of liver tumours]. Cancer Radiother 2014; 18:486-94. [PMID: 25195113 DOI: 10.1016/j.canrad.2014.07.145] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Revised: 07/09/2014] [Accepted: 07/14/2014] [Indexed: 12/22/2022]
Abstract
Stereotactic radiotherapy is a high-precision technique based on the administration of high doses to a limited target volume. This treatment constitutes a therapeutic progress in the management of many tumours, especially hepatic ones. If surgery remains the standard local therapy, stereotactic radiotherapy is first dedicated to inoperable patients or unresectable tumours. Patients with moderately altered general status, preserved liver function and tumour lesions limited in number as in size are eligible to this technique. Results in terms of local control are satisfying, regarding primary tumours (notably hepatocellular carcinomas) as metastases stemming from various origins. If treatment protocols and follow-up modalities are not standardized to this day, iconographic acquisition using four-dimensional computed tomography, target volumes delineation based on morphological and/or metabolic data, and image-guided radiotherapy contribute to an oncologic efficacy and an improved sparing of the functional liver. The purpose of this literature review is to report the results of the main works having assessed stereotactic radiotherapy in the management of primary and secondary liver tumours. Technical particularities of this radiation modality will also be described.
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Affiliation(s)
- J Jacob
- Service d'oncologie-radiothérapie, hôpital d'instruction des armées du Val-de-Grâce, 74, boulevard de Port-Royal, 75230 Paris cedex 05, France.
| | - F Nguyen
- Département de radiothérapie, institut de cancérologie Gustave-Roussy, 114, rue Édouard-Vaillant, 94805 Villejuif cedex, France
| | - E Deutsch
- Département de radiothérapie, institut de cancérologie Gustave-Roussy, 114, rue Édouard-Vaillant, 94805 Villejuif cedex, France
| | - F Mornex
- Service de radiothérapie-oncologie, centre hospitalier Lyon-Sud, 165, chemin du Grand-Revoyet, 69310 Pierre-Bénite, France; EMR 3738, université Claude-Bernard Lyon 1, 69373 Lyon cedex 08, France
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