Dynamic computed tomography appearance of tumor response after stereotactic body radiation therapy for hepatocellular carcinoma: How should we evaluate treatment effects?

Kimura, Tomoki; Takahashi, Shojiro; Kenjo, Masahiro; Nishibuchi, Ikuno; Takahashi, Ippei; Takeuchi, Yuki; Doi, Yoshiko; Kaneyasu, Yuko; Murakami, Yuji; Honda, Yoji; Aikata, Hiroshi; Chayama, Kazuaki; Nagata, Yasushi

doi:10.1111/hepr.12007

Cited by 30 publications

(17 citation statements)

References 14 publications

(26 reference statements)

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“…This finding is not entirely surprising on the basis of prior experiences with neoplasms undergoing SBRT in other sites in the body [24, 41]. However, this finding indicates that an adjustment in the interpretation of posttreatment imaging studies is required because persistent enhancement after surgical resection or ablative therapy (e.g., radiotherapy, cryotherapy) would be normally considered as a sign of treatment failure.…”

Section: Discussionmentioning

confidence: 80%

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Effect of Stereotactic Body Radiotherapy on the Growth Kinetics and Enhancement Pattern of Primary Renal Tumors

Sun

Brook

Powell

et al. 2016

American Journal of Roentgenology

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OBJECTIVE. The objective of our study was to assess the growth rate and enhancement of renal masses before and after treatment with stereotactic body radiotherapy (SBRT). MATERIALS AND METHODS. This retrospective study included all patients with renal masses who underwent SBRT during a 5-year period. Orthogonal measurements of renal masses were obtained on pre- and posttreatment CT or MRI. Pre- and posttreatment growth rates were compared for renal mass diameter and volume using the t test. Pre- and posttreatment tumor enhancement values were compared for tumors that underwent multiphasic contrast-enhanced MRI. RESULTS. Forty patients underwent SBRT for the treatment of 41 renal tumors: clear cell renal cell carcinomas (RCCs) (n = 16), papillary RCCs (n = 6), oncocytic neoplasms (n = 8), unclassified RCCs (n = 2), urothelial carcinoma (n = 1), and no pathologic diagnosis (n = 8). The mean maximum tumor diameter before treatment was 3.9 cm (range, 1.6–8.3 cm). Three hundred thirty-eight pre- and posttreatment imaging studies were analyzed: 214 MRI studies and 124 CT studies. The mean pre- and posttreatment lengths of observation were 416 days (range, 2–1800 days) and 561 days (83–1366 days), respectively. The mean pretreatment tumor growth rate of 0.68 cm/y decreased to –0.37 cm/y post treatment (p < 0.0001), and the mean tumor volume growth rate of 21.2 cm3/y before treatment decreased to –5.35 cm3/y after treatment (p = 0.002). Local control—defined as less than 5 mm of growth—was achieved in 38 of 41 (92.7%) tumors. The Response Evaluation Criteria in Solid Tumors (RECIST) 1.1 showed progression in one tumor (2.4%), stability in 31 tumors (75.6%), partial response in eight tumors (19.5%), and complete response in one tumor (2.4%). No statistically significant change in tumor enhancement was shown (mean follow-up, 142 days; range, 7–581 days). CONCLUSION. Renal tumors treated with SBRT show statistically significant reductions in growth rate and tumor size after treatment but do not show statistically significant differences in enhancement in the initial (mean, 142 days) posttreatment period.

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Section: Discussionmentioning

confidence: 80%

“…However, these criteria may not be applicable to assess response to SBRT. For example, persistent enhancement is observed in vestibular schwannomas successfully treated with SBRT [23], and early enhancement may be observed in hepatocellular carcinomas after treatment with SBRT [24]. …”

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confidence: 99%

Effect of Stereotactic Body Radiotherapy on the Growth Kinetics and Enhancement Pattern of Primary Renal Tumors

Sun

Brook

Powell

et al. 2016

American Journal of Roentgenology

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“…The dynamic CT appearance of tumor response after SBRT is also various [9], and it is sometime difficult to distinguish from the CT appearance of normal liver injury. This study suggested that it will be useful to understand these various imaging patterns of normal liver injury for evaluation of tumor response after SBRT.…”

Section: Discussionmentioning

confidence: 99%

“…Few studies have investigated the relationship between the change in CT appearance over time following SBRT and related factors or adverse effects. We have also observed that the CT appearance of tumor response following SBRT differs from that following conventional radiotherapy [9]; however, we focused on normal or cirrhotic liver injury in the present study.…”

Section: Introductionmentioning

confidence: 99%

The Time Course of Dynamic Computed Tomographic Appearance of Radiation Injury to the Cirrhotic Liver Following Stereotactic Body Radiation Therapy for Hepatocellular Carcinoma

Kimura

Takahashi

et al. 2015

PLoS ONE

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This study aimed to evaluate the dynamic computed tomographic (CT) appearance of focal radiation injury to cirrhotic liver tissue around the tumor following stereotactic body radiation therapy (SBRT) for hepatocellular carcinoma (HCC). Seventy-seven patients with 92 HCCs were observed for >6 months. Sixty-four and 13 patients belonged to Child–Pugh class A and B, respectively. The median SBRT dose was 48 Gy/4fr. Dynamic CT scans were performed in non–enhanced, arterial, portal, and venous phases. The median follow-up period was 18 months. Dynamic CT appearances were classified into 3 types: type 1, hyperdensity in all enhanced phases; type 2, hypodensity in arterial and portal phases; type 3, isodensity in all enhanced phases. Half of the type 2 or 3 appearances significantly changed to type 1, particularly in patients belonging to Child–Pugh class A. After 3–6 months, Child–Pugh class B was a significant factor in type 3 patients. Thus, dynamic CT appearances were classified into 3 patterns and significantly changed over time into the enhancement group (type 1) in most patients belonging to Child–Pugh class A. Child–Pugh class B was a significant factor in the non–enhancement group (type 3).

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“…The Model for End‐Stage Liver Disease (MELD)‐Na score was calculated as described by Kim et al . Details of the inclusion criteria for SBRT and treatment procedure have been described previously . The summary of treatment procedure was as follows.…”

Section: Case Reportsmentioning

confidence: 99%

Case reports of portal vein thrombosis and bile duct stenosis after stereotactic body radiation therapy for hepatocellular carcinoma

Takahashi

Kimura

Kenjo

et al. 2014

Hepatology Research

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The aim of this study was to evaluate portal vein and bile duct toxicity after stereotactic body radiation therapy (SBRT) for hepatocellular carcinoma (HCC). We retrospectively reviewed 63 patients who were administrated SBRT once for HCC. The prescribed doses were from 48 Gy in four fractions to 60 Gy in eight fractions. Portal vein thrombosis and bile duct stenosis were evaluated. The dose received by 2% of the volume (D2 ) of the portal vein and bile duct was calculated. Portal vein thrombosis was observed in three patients (4.8%). Common points of these patients were Child-Pugh class B and D2 of the portal vein 40 Gy or more (BED3 ≥200 Gy). Bile duct stenosis was observed in one patient (1.6%). The patient had a history of cholangiocarcinoma and left hepatic lobectomy. Portal vein thrombosis may be necessary to be considered when SBRT for HCC is administrated to patients in higher Child-Pugh class with higher D2 of the portal vein.

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Dynamic computed tomography appearance of tumor response after stereotactic body radiation therapy for hepatocellular carcinoma: How should we evaluate treatment effects?

Abstract: The dynamic CT appearance after SBRT for HCC was classified into four types. Residual early arterial enhancement disappeared within 6 months in most type 3 cases; therefore, early assessment within 3 months may result in a misleading response evaluation.

Cited by 30 publications

References 14 publications

Effect of Stereotactic Body Radiotherapy on the Growth Kinetics and Enhancement Pattern of Primary Renal Tumors

Effect of Stereotactic Body Radiotherapy on the Growth Kinetics and Enhancement Pattern of Primary Renal Tumors

The Time Course of Dynamic Computed Tomographic Appearance of Radiation Injury to the Cirrhotic Liver Following Stereotactic Body Radiation Therapy for Hepatocellular Carcinoma

Case reports of portal vein thrombosis and bile duct stenosis after stereotactic body radiation therapy for hepatocellular carcinoma

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