Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, USA.
Department of Pathology, Molecular and Cell-Based Medicine, Icahn School of Medicine at Mount Sinai, Annenberg Building, 15th Floor, 1468 Madison Avenue, New York, NY 10029, USA.
Eur J Radiol. 2023 Oct;167:111077. doi: 10.1016/j.ejrad.2023.111077. Epub 2023 Sep 1.
To describe the longitudinal response in patients with hepatocellular carcinoma (HCC) treated with stereotactic body radiation therapy (SBRT) and who underwent liver transplant (LT) using gadoxetate-enhanced MRI.
Five men (median age 61y, range 57-64y) with 6 HCCs treated with SBRT (median dose 50 Gy) who subsequently underwent LT were included in this retrospective study. Patients underwent gadoxetate-enhanced MRI before and after SBRT over a period of 3-18 months. Response was assessed using RECIST1.1, mRECIST, LI-RADS and image subtraction, by 2 observers in consensus. Percentage of pathologic tumor necrosis was evaluated.
LT was performed 278 days (IQR, 148-418d) after completion of SBRT and 48d after the last MRI. Histopathology demonstrated tumor necrosis of 48 ± 42% (range, 10-100%). Mean tumor size at baseline and last post-treatment MRIs pre-LT were 2.6 ± 0.8 cm and 2.4 ± 0.9 cm. Enhancing tumor component size at baseline MRI and last post-treatment MRI pre-LT were 1.6 ± 0.8 cm and 0.9 ± 1.0 cm. Responses assessed at the last LRI pre-LT were: partial response (PR, n = 3), stable disease (SD, n = 3) using RECIST1.1; complete response (CR, n = 2), partial response (PR, n = 2), stable disease (SD, n = 2) using mRECIST; and LR-TR viable (n = 4), LR-TR non-viable (n = 2) using LI-RADS. At the last MRI pre-LT, per-lesion features of arterial phase hyperenhancement (APHE, 4/6), portal venous washout (3/6) and capsule (3/6) were observed. 5/6 lesions displayed a hypointense perilesional halo on hepatobiliary phase with a mean delay of 3.1 months post-SBRT.
This case-series showed decreased size, persistent APHE, and incomplete pathologic necrosis in most HCCs treated with SBRT undergoing transplant.
描述接受立体定向体部放射治疗（SBRT）并随后接受肝移植（LT）的肝细胞癌（HCC）患者的纵向反应，这些患者使用钆塞酸增强 MRI 进行检查。
本回顾性研究纳入了 5 名男性（中位年龄 61 岁，范围 57-64 岁），共 6 个 HCC 接受 SBRT 治疗（中位剂量 50Gy），随后接受 LT。患者在 SBRT 后 3-18 个月期间接受了钆塞酸增强 MRI 检查。通过 2 位观察者的共识评估 RECIST1.1、mRECIST、LI-RADS 和图像减影的反应。评估病理性肿瘤坏死的百分比。
SBRT 完成后 278 天（IQR，148-418d）进行 LT，最后一次 MRI 检查后 48 天进行 LT。组织病理学显示肿瘤坏死率为 48±42%（范围，10-100%）。LT 前基线和最后一次治疗后 MRI 的平均肿瘤大小为 2.6±0.8cm 和 2.4±0.9cm。LT 前基线 MRI 和最后一次治疗后 MRI 的增强肿瘤成分大小分别为 1.6±0.8cm 和 0.9±1.0cm。LT 前最后一次 LRI 的反应评估结果为：RECIST1.1 下部分缓解（PR，n=3），稳定疾病（SD，n=3）；mRECIST 下完全缓解（CR，n=2），部分缓解（PR，n=2），稳定疾病（SD，n=2）；LI-RADS 下 LR-TR 存活（n=4），LR-TR 非存活（n=2）。LT 前最后一次 MRI 显示，6 个病灶中有 4 个病灶在动脉期呈高增强（APHE），3 个病灶在门静脉期出现洗脱（PVE），3 个病灶有包膜。6 个病灶中有 5 个在肝胆期显示出低信号的瘤周晕环，平均延迟 3.1 个月。
这项病例系列研究显示，接受 SBRT 治疗的 HCC 患者在接受移植时，大多数肿瘤的大小减小，持续性 APHE 和不完全的病理性坏死。
