Radio daignosis

The  study is  conduct to determine the natural history of imaging findings by magnetic resonance imaging (MRI) of HCC treat with SBRT and test the hypothesis that APHE following SBRT does not suggest persistent entreat tumor. Arterial phase hyper enhancement  is a key feature of untreated or recurrent hepatocellular carcinoma (HCC); standard response assessment such as modify Response Evaluation Criteria in Solid Tumors (mRECIST)are use with caution.

Standard response assessment

particularly in the early phases after stereotactic body radiation therapy (SBRT) therapy; so as not to misinterpret treatment response, according to a study to be present at the ARRS 2019 Annual Meeting; set for May 5-10 in Honolulu, HI. A total of 146 patients undergoing SBRT for HCC were retrospectively screen for inclusion criteria which include HCC treat with SBRT; multiphasic MRI 3 months prior to SBRT, minimum 1 year of follow-up MRI after SBRT; and underlying cirrhosis.

Exclusion criterion was any patient who underwent locoregional therapy within 3 months to the liver segment containing the SBRT-treated HCC. Sixty-two patients with 67 HCCs are include in the study. Within the first 12 months after SBRT; size decrease in 66% of treated tumors and remain unchang in 34%.

Underwent locoregional therapy

After SBRT, 75% of treated HCCs continued to demonstrate solid arterial phase enhancement; and only 25% were nonenhancing at the time of first follow-up. Of the treated tumors demonstrating arterial enhancement; 58% were APHE. Based on these posttreatment enhancement patterns, when graded by mRECIST criteria at 3-6 months, 25% met criteria for complete response (CR), and 75% met criteria for stable disease (SD). However, at 1 year none of the 67 tumors are clinically judged to have local progression.

Study results suggest SBRT is an effective locoregional treatment option for HCC and is associate with a low local progression rate. Persistent arterial phase enhancement is an expect post-SBRT finding, and does not indicate viable neoplasm; thus, using standard response assessment classification systems such as mRECIST may lead to a misinterpretation of treatment response, particularly in the early phases after SBRT therapy.

Effective locoregional treatment

Mishal Mendiratta-Lala, MD, author of the study says “The results of this research are extremely exciting, as it will significantly impact clinical care. Historically, APHE seen in HCC treated with SBRT has been interpreted as viable disease and patients have undergone repeat treatments. However, our results, as well as a few additional studies from our institution, suggest that these lesions are non-viable, and thus these patients do not need to undergo additional treatments, and can even be eligible for transplant.”