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Natural history of hepatocellular carcinoma after stereotactic body radiation therapy

  • Special Section: Chronic liver disease
  • Published:
Abdominal Radiology Aims and scope Submit manuscript

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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Funding

This study was not funded by a grant; however, a few authors (Mishal Mendiratta-Lala, Dawn Owen, Kyle Cuneo, Theodore S. Lawrence, Matthew J. Schipper) are Co-PI’s on grant: P01 CA59827 (NIH funded).

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Authors and Affiliations

  1. Department of Radiology, University of Michigan School of Medicine, 1500 E. Medical Center Dr. UH B2A209R, Ann Arbor, MI, 48109-5030, USA

    Mishal Mendiratta-Lala, William Masch & Matthew S. Davenport

  2. Department of Radiation Oncology, Mayo Clinic Rochester, Rochester, MI, USA

    Dawn Owen

  3. Clinical Fellow Department of Radiology, University of Michigan School of Medicine, Ann Arbor, MI, USA

    Anum Aslam

  4. Department of Radiation Oncology, University of Michigan School of Medicine, Ann Arbor, MI, USA

    Chris Maurino, Matthew J. Schipper, Kyle Cuneo & Theodore S. Lawrence

  5. Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, MI, USA

    Theresa Devasia

  6. Division of Gastroenterology and Hepatology, University of Michigan School of Medicine, Ann Arbor, MI, USA

    Neehar D. Parikh

Authors
  1. Mishal Mendiratta-Lala
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  2. William Masch
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  3. Dawn Owen
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  4. Anum Aslam
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  5. Chris Maurino
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  6. Theresa Devasia
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  7. Matthew J. Schipper
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  8. Neehar D. Parikh
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  9. Kyle Cuneo
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  10. Theodore S. Lawrence
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  11. Matthew S. Davenport
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Contributions

All authors made substantial contributions to the conception or design of the work, or acquisition, analysis, or interpretation of data; drafted work or revised it critically; approved the version to be published; and agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy and integrity are appropriately resolved.

Corresponding author

Correspondence to Mishal Mendiratta-Lala.

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The authors declare that they have no conflict of interest.

Ethics approval

Institutional review board approval was obtained and informed consent waived for this Health Insurance Portability and Accountability Act (HIPAA)-compliant retrospective cohort study. This research was conducted retrospectively from data obtained for clinical purposes.

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Mendiratta-Lala, M., Masch, W., Owen, D. et al. Natural history of hepatocellular carcinoma after stereotactic body radiation therapy. Abdom Radiol 45, 3698–3708 (2020). https://doi.org/10.1007/s00261-020-02532-4

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  • DOI: https://doi.org/10.1007/s00261-020-02532-4

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