Limits...
CT Imaging Findings after Stereotactic Radiotherapy for Liver Tumors.

Brook OR, Thornton E, Mendiratta-Lala M, Mahadevan A, Raptopoulos V, Brook A, Najarian R, Sheiman R, Siewert B - Gastroenterol Res Pract (2015)

Bottom Line: Partial response (>30% decrease in long diameter) was seen in 25/36 (69%) HCCs, 14/25 (58%) metastases, and 7/7 (100%) of CCCs.Conclusion.Prominent halo of delayed enhancement of the adjacent liver is frequent finding.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215, USA.

ABSTRACT
Purpose. To study radiological response to stereotactic radiotherapy for focal liver tumors. Materials and Methods. In this IRB-approved, HIPAA-compliant study CTs of 68 consecutive patients who underwent stereotactic radiotherapy for liver tumors between 01/2006 and 01/2010 were retrospectively reviewed. Two independent reviewers evaluated lesion volume and enhancement pattern of the lesion and of juxtaposed liver parenchyma. Results. 36 subjects with hepatocellular carcinoma (HCC), 25 with liver metastases, and seven with cholangiocarcinoma (CCC) were included in study. Mean follow-up time was 5.6 ± 7.1 months for HCC, 6.4 ± 5.1 months for metastases, and 10.1 ± 4.8 months for the CCC. Complete response was seen in 4/36 (11.1%) HCCs and 1/25 (4%) metastases. Partial response (>30% decrease in long diameter) was seen in 25/36 (69%) HCCs, 14/25 (58%) metastases, and 7/7 (100%) of CCCs. Partial response followed by local recurrence (>20% increase in long diameter from nadir) occurred in 2/36 (6%) HCCs and 4/25 (17%) metastases. Liver parenchyma adjacent to the lesion demonstrated a prominent halo of delayed enhancement in 27/36 (78%) of HCCs, 19/21 (91%) of metastases, and 7/7 (100%) of CCCs. Conclusion. Sustainable radiological partial response to stereotactic radiotherapy is most frequent outcome seen in liver lesions. Prominent halo of delayed enhancement of the adjacent liver is frequent finding.

No MeSH data available.


Related in: MedlinePlus

Target lesion volume changes in hepatocellular carcinoma patients (each curve denotes an individual lesion). Most of the lesions show volume decrease most prominently soon after treatment, with some lesions demonstrating further slower volume decrease with time. In a few cases there was an increase in volume later on, corresponding to recurrence.
© Copyright Policy - open-access
Related In: Results  -  Collection


getmorefigures.php?uid=PMC4499630&req=5

fig2: Target lesion volume changes in hepatocellular carcinoma patients (each curve denotes an individual lesion). Most of the lesions show volume decrease most prominently soon after treatment, with some lesions demonstrating further slower volume decrease with time. In a few cases there was an increase in volume later on, corresponding to recurrence.

Mentions: Overall response grading had excellent agreement between the two observers (κ = 0.99). The HCC group included 32 patients with 36 hepatocellular carcinoma lesions. The patients were treated with mean total dose of 3189 ± 772 cGy (range 2000–4500 cGy), in median 3 (range 1–5) fractions with mean dose of 1058 ± 429 cGy (range 450–2400 cGy) per fraction. The mean lesion volume was 15346 ± 89083 cc (range 6–527306 cc, median 80 cc). The mean lesion coverage was 95 ± 1% (range 93–98%). The average prescription isodose was 78 ± 5% (range 66–86%). All subjects had at least one lesion with pathologic confirmation. In the cases with multiple lesions, if the imaging characteristics of the additional lesions were similar to their confirmed tumor, then the other lesions were assumed to have the same pathology (Table 1). All patients had liver cirrhosis. One patient was previously treated with RFA and two other patients have been previously treated with chemotherapy. No patients were treated with chemotherapy during stereotactic radiotherapy treatments. Patients clinical characteristics are described in Table 1. Complete response was seen in 4 lesions (11%), partial response in 25 lesions (69%), and partial response followed by local recurrence in 2 (6%). Complete response was seen in four lesions, with follow-up of 3, 12, 12, and 24 months, respectively. Recurrence occurred in 2 patients two and three months after treatment, respectively. The average decrease in lesion volume per month of follow-up was 24.5% (95% CI, 11.9–37.1) in the first 4 months, 9.8% per month (95% CI, 3.6–15.6), four to nine months after treatment, and 2.7% per month (95% CI, 0.7–4.7) thereafter. The difference between pretreatment and posttreatment volumes of the treated lesion was statistically significant (p < 0.001). The dynamics of the volume changes over the follow-up time can be seen in Figure 2. The average nonenhancing portion prior to treatment was 27 ± 37% and 59 ± 33% (p = 0.002) after treatment. Lack of enhancement within the lesion was seen usually on the first CT study performed between 15 to 45 days after treatment and persisted on the consequent studies, unless a recurrence occurred (Figure 3).


CT Imaging Findings after Stereotactic Radiotherapy for Liver Tumors.

Brook OR, Thornton E, Mendiratta-Lala M, Mahadevan A, Raptopoulos V, Brook A, Najarian R, Sheiman R, Siewert B - Gastroenterol Res Pract (2015)

Target lesion volume changes in hepatocellular carcinoma patients (each curve denotes an individual lesion). Most of the lesions show volume decrease most prominently soon after treatment, with some lesions demonstrating further slower volume decrease with time. In a few cases there was an increase in volume later on, corresponding to recurrence.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4499630&req=5

fig2: Target lesion volume changes in hepatocellular carcinoma patients (each curve denotes an individual lesion). Most of the lesions show volume decrease most prominently soon after treatment, with some lesions demonstrating further slower volume decrease with time. In a few cases there was an increase in volume later on, corresponding to recurrence.
Mentions: Overall response grading had excellent agreement between the two observers (κ = 0.99). The HCC group included 32 patients with 36 hepatocellular carcinoma lesions. The patients were treated with mean total dose of 3189 ± 772 cGy (range 2000–4500 cGy), in median 3 (range 1–5) fractions with mean dose of 1058 ± 429 cGy (range 450–2400 cGy) per fraction. The mean lesion volume was 15346 ± 89083 cc (range 6–527306 cc, median 80 cc). The mean lesion coverage was 95 ± 1% (range 93–98%). The average prescription isodose was 78 ± 5% (range 66–86%). All subjects had at least one lesion with pathologic confirmation. In the cases with multiple lesions, if the imaging characteristics of the additional lesions were similar to their confirmed tumor, then the other lesions were assumed to have the same pathology (Table 1). All patients had liver cirrhosis. One patient was previously treated with RFA and two other patients have been previously treated with chemotherapy. No patients were treated with chemotherapy during stereotactic radiotherapy treatments. Patients clinical characteristics are described in Table 1. Complete response was seen in 4 lesions (11%), partial response in 25 lesions (69%), and partial response followed by local recurrence in 2 (6%). Complete response was seen in four lesions, with follow-up of 3, 12, 12, and 24 months, respectively. Recurrence occurred in 2 patients two and three months after treatment, respectively. The average decrease in lesion volume per month of follow-up was 24.5% (95% CI, 11.9–37.1) in the first 4 months, 9.8% per month (95% CI, 3.6–15.6), four to nine months after treatment, and 2.7% per month (95% CI, 0.7–4.7) thereafter. The difference between pretreatment and posttreatment volumes of the treated lesion was statistically significant (p < 0.001). The dynamics of the volume changes over the follow-up time can be seen in Figure 2. The average nonenhancing portion prior to treatment was 27 ± 37% and 59 ± 33% (p = 0.002) after treatment. Lack of enhancement within the lesion was seen usually on the first CT study performed between 15 to 45 days after treatment and persisted on the consequent studies, unless a recurrence occurred (Figure 3).

Bottom Line: Partial response (>30% decrease in long diameter) was seen in 25/36 (69%) HCCs, 14/25 (58%) metastases, and 7/7 (100%) of CCCs.Conclusion.Prominent halo of delayed enhancement of the adjacent liver is frequent finding.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215, USA.

ABSTRACT
Purpose. To study radiological response to stereotactic radiotherapy for focal liver tumors. Materials and Methods. In this IRB-approved, HIPAA-compliant study CTs of 68 consecutive patients who underwent stereotactic radiotherapy for liver tumors between 01/2006 and 01/2010 were retrospectively reviewed. Two independent reviewers evaluated lesion volume and enhancement pattern of the lesion and of juxtaposed liver parenchyma. Results. 36 subjects with hepatocellular carcinoma (HCC), 25 with liver metastases, and seven with cholangiocarcinoma (CCC) were included in study. Mean follow-up time was 5.6 ± 7.1 months for HCC, 6.4 ± 5.1 months for metastases, and 10.1 ± 4.8 months for the CCC. Complete response was seen in 4/36 (11.1%) HCCs and 1/25 (4%) metastases. Partial response (>30% decrease in long diameter) was seen in 25/36 (69%) HCCs, 14/25 (58%) metastases, and 7/7 (100%) of CCCs. Partial response followed by local recurrence (>20% increase in long diameter from nadir) occurred in 2/36 (6%) HCCs and 4/25 (17%) metastases. Liver parenchyma adjacent to the lesion demonstrated a prominent halo of delayed enhancement in 27/36 (78%) of HCCs, 19/21 (91%) of metastases, and 7/7 (100%) of CCCs. Conclusion. Sustainable radiological partial response to stereotactic radiotherapy is most frequent outcome seen in liver lesions. Prominent halo of delayed enhancement of the adjacent liver is frequent finding.

No MeSH data available.


Related in: MedlinePlus