Department of Radiology, University of Michigan, Ann Arbor, MI, USA.
Department of Radiology, University of British Columbia, Vancouver, BC, Canada.
Abdom Radiol (NY). 2021 Aug;46(8):3615-3624. doi: 10.1007/s00261-021-03107-7. Epub 2021 May 7.
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.
立体定向体部放射治疗（SBRT）是一种新兴的局部区域治疗（LRT）方式，用于治疗肝细胞癌（HCC）患者。在多学科环境中评估使用 LRT 治疗 HCC 的决策，选择特定的 LRT 取决于治疗意图，如桥接移植、降期移植、根治性/治愈性治疗和/或姑息治疗，以及患者的临床因素。准确评估治疗反应对于指导这些患者的临床管理是必要的。接受 LRT 的患者需要连续进行影像学评估，以评估治疗反应和复发情况。因此，准确了解 SBRT 后预期的影像学表现对于避免将正常治疗后变化误诊为局部进展或存活肿瘤至关重要。SBRT 治疗的 HCC 表现出独特的影像学表现，与接受其他形式 LRT 治疗的 HCC 不同。特别是，SBRT 治疗的 HCC 在短期随访成像上可显示持续的 APHE 和洗脱。本综述简要总结了 SBRT 治疗 HCC 的现有证据，包括患者人群、SBRT 技术和程序、增强横断面成像上的肿瘤反应评估和预期表现以及治疗反应评估中的陷阱。
