Imaging Evaluation after Stereotactic Body Radiotherapy for Hepatocellular Carcinoma: Prognostic Value of Radiological Changes
KY Man, YS Luk, ALY Law, WKW Leung
Hong Kong J Radiol 2019;22:160-71
https://doi.org/10.12809/hkjr1916983
Objective: To evaluate the computed tomography and magnetic resonance imaging features of tumour response
and predictive factors of time to progression and survival after stereotactic body radiotherapy for hepatocellular
carcinoma.
Methods: Consecutive patients with hepatocellular carcinoma who were treated by stereotactic body radiotherapy
between June 2006 and September 2016 were included in this retrospective study. Clinical and radiological data
obtained using computed tomography or magnetic resonance imaging were examined. The response rate, in-field
local control, time to progression, overall survival and prognostic factors were evaluated. Treatment response
was classified according to modified Response Evaluation Criteria in Solid Tumors.
Results: In total, 73 patients were included. The complete response, partial response, stable disease, and disease
progression rates were 41.1%, 20.5%, 27.4% and 11% respectively. The in-field local control rates at 1 year and
2 years were 95.9% and 92.1%, respectively. The median follow-up time was 19 months and the median overall
survival was 20 months. T1-weighted or T2-weighted signal intensities, pattern of lipiodol stain, complete thin
rim enhancement and focal liver reaction in post-treatment images were shown to be independent predictors for
progression or overall survival.
Conclusion: Imaging evaluation of tumour response is important. Recognising and interpreting the radiological
features of tumour response (both tumour and juxtaposed non-tumourous hepatic parenchyma) is essential
in making an accurate assessment of treatment response. Accurate imaging evaluation may also help predict
survival.
Author affiliation(s):
KY Man, YS Luk, WKW Leung: Department of Radiology, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong
ALY Law: Department of Clinical Oncology, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong
中文摘要
肝細胞癌體部立體定向放療：影像預後分析
文家潤、陸嬈、羅麗柔、梁錦榮
目的：分析接受體部立體定向放療（SBRT）的肝細胞癌（HCC）患者的電腦斷層掃描和磁力共振掃描影像。評估腫瘤反應和其對總生存率的預後關係。
方法：回顧2006年6月至2016年9月期間接受SBRT治療的HCC患者的電腦斷層掃描和磁力共振掃描影像。評估腫瘤反應、野內局部控制率、疾病惡化時間、總生存率和預後因素。根據修改版實體腫瘤療效評估標準（RECIST）對治療反應進行分類。
結果：共納入73名患者。完全緩解、部分緩解、疾病穩定和疾病進展率分別為41.1%、20.5%、27.4%和11%。1年和2年野內局部控制率分別為95.9%和92.1%。中位隨訪19個月後，中位生存期為20個月。治療後影像的T1W/T2W信號轉變、lipiodol腫瘤染色現象、週邊邊緣密度增強以及局部肝反應均能獨立預測疾病惡化時間或總生存率。
結論：透過影像分析腫瘤反應是相當重要。識別和詮釋腫瘤反應的放射學特徵（腫瘤和並列的非腫瘤性肝實質）對於準確評估治療反應至關重要。精確分析影像能幫助預測總生存率。