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SBRT for HCC: Overview of technique and treatment response assessment

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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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Authors and Affiliations

  1. Department of Radiology, University of Michigan, Ann Arbor, MI, USA

    Kimberly L. Shampain, Caitlin E. Hackett, Anum Aslam, William R. Masch & Mishal Mendiratta-Lala

  2. Department of Radiology, University of British Columbia, Vancouver, BC, Canada

    Sohrab Towfighi, Alison C. Harris & Silvia D. Chang

  3. Department of Hepatology, Henry Ford Hospital, Detroit, MI, USA

    Kanika Khanna & Vivek Mendiratta

  4. Department of Radiology and Medical Imaging, University of Virginia, Charlottesville, VA, USA

    Ahmed M. Gabr

  5. Department of Radiation Oncology, Mayo Clinic Rochester, Rochester, MN, USA

    Dawn Owen

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  1. Kimberly L. Shampain
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Shampain, K.L., Hackett, C.E., Towfighi, S. et al. SBRT for HCC: Overview of technique and treatment response assessment. Abdom Radiol 46, 3615–3624 (2021). https://doi.org/10.1007/s00261-021-03107-7

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