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Radiological tumor response and histopathological correlation of hepatocellular carcinoma treated with stereotactic body radiation therapy as a bridge to liver transplantation

  • Hepatobiliary
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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.

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Abbreviations

HCC:

Hepatocellular carcinoma

HCV:

Hepatitis C virus

NASH:

Non-alcoholic steatohepatitis

TACE:

Transarterial chemoembolization

RFA:

Radiofrequency ablation

LT:

Liver transplantation

SBRT:

Stereotactic body radiation therapy

GTV:

Gross tumor volume

PTV:

Planning target volume

SD:

Stable disease

PR:

Partial response

PD:

Progressive disease

CR:

Complete response

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Authors and Affiliations

  1. Joint Department of Medical Imaging, University Health Network/Mount Sinai Hospital/Women’s College Hospital, 585 University Avenue, Toronto, ON, M5G 2N2, Canada

    Katerina Mastrocostas, Hyun-Jung Jang & Tae Kyoung Kim

  2. Laboratory Medicine Program, Department of Pathology, Toronto General Hospital, 585 University Avenue, Toronto, ON, M5G 2N2, Canada

    Sandra Fischer

  3. Radiation Medicine Program, Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, 610 University Avenue, Toronto, ON, M5G 2C1, Canada

    Pablo Munoz-Schuffenegger & Laura A. Dawson

  4. Department of Biostatistics, Princess Margaret Cancer Centre, 610 University Avenue, Toronto, ON, M5G 2M9, Canada

    Zhihui A. Liu

  5. Multi Organ Transplant Program, Department of Surgery, Toronto General Hospital, 585 University Avenue, Toronto, ON, M5G 2N2, Canada

    Gonzalo Sapisochin

Authors
  1. Katerina Mastrocostas
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  2. Sandra Fischer
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  3. Pablo Munoz-Schuffenegger
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  4. Hyun-Jung Jang
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Correspondence to Tae Kyoung Kim.

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Institutional review board of University Health Network, Toronto, ON, Canada approved this retrospective study.

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Mastrocostas, K., Fischer, S., Munoz-Schuffenegger, P. et al. Radiological tumor response and histopathological correlation of hepatocellular carcinoma treated with stereotactic body radiation therapy as a bridge to liver transplantation. Abdom Radiol 46, 1572–1585 (2021). https://doi.org/10.1007/s00261-020-02821-y

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