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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

56-year-old male patient with cholangiocarcinoma. Axial CT at delayed phase showing hypodense treated cholangiocarcinoma without residual enhancement (arrow), accompanied by halo of hyperdensity (arrow heads).
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fig11: 56-year-old male patient with cholangiocarcinoma. Axial CT at delayed phase showing hypodense treated cholangiocarcinoma without residual enhancement (arrow), accompanied by halo of hyperdensity (arrow heads).

Mentions: There were 7 patients each with a single lesion. Patients clinical characteristics are described in Table 1. The patients were treated with mean total dose of 3100 ± 727 cGy (range 2400–4500 cGy), in 3 fractions with mean dose of 1033 ± 242 cGy (range 800–1500 cGy) per fraction. The mean lesion volume was 130 ± 110 cc, median 130 cc (range 21–234 cc). The mean lesion coverage was 96 ± 2% (range 94–98%). The average prescription isodose was 74 ± 4% (range 70–79%). Two patients were previously treated with chemotherapy, 1 patient with TACE, and 1 patient with RFA. During stereotactic radiotherapy patients were not treated with chemotherapy. Partial response was seen in all 7/7 patients (100%). The area without enhancement within the lesion was present in only 2/7 cases (29%). The difference between pretreatment and posttreatment volumes of the treated lesion was statistically significant (p = 0.05). The dynamics of the volume changes over the follow-up time can be seen in Figure 10. In all cases the liver surrounding the treated lesion was hyperdense on the portal venous phase (Figure 11). In all cases prior to treatment the liver around the lesion was isodense to the rest of the liver parenchyma. High attenuation of the adjacent liver parenchyma was seen on all postcontrast phases but was most prominent at the delayed phase and was seen on all follow-up studies. The appearance of the liver parenchyma after treatment was significantly different from before treatment (p < 0.001).


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)

56-year-old male patient with cholangiocarcinoma. Axial CT at delayed phase showing hypodense treated cholangiocarcinoma without residual enhancement (arrow), accompanied by halo of hyperdensity (arrow heads).
© Copyright Policy - open-access
Related In: Results  -  Collection

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

fig11: 56-year-old male patient with cholangiocarcinoma. Axial CT at delayed phase showing hypodense treated cholangiocarcinoma without residual enhancement (arrow), accompanied by halo of hyperdensity (arrow heads).
Mentions: There were 7 patients each with a single lesion. Patients clinical characteristics are described in Table 1. The patients were treated with mean total dose of 3100 ± 727 cGy (range 2400–4500 cGy), in 3 fractions with mean dose of 1033 ± 242 cGy (range 800–1500 cGy) per fraction. The mean lesion volume was 130 ± 110 cc, median 130 cc (range 21–234 cc). The mean lesion coverage was 96 ± 2% (range 94–98%). The average prescription isodose was 74 ± 4% (range 70–79%). Two patients were previously treated with chemotherapy, 1 patient with TACE, and 1 patient with RFA. During stereotactic radiotherapy patients were not treated with chemotherapy. Partial response was seen in all 7/7 patients (100%). The area without enhancement within the lesion was present in only 2/7 cases (29%). The difference between pretreatment and posttreatment volumes of the treated lesion was statistically significant (p = 0.05). The dynamics of the volume changes over the follow-up time can be seen in Figure 10. In all cases the liver surrounding the treated lesion was hyperdense on the portal venous phase (Figure 11). In all cases prior to treatment the liver around the lesion was isodense to the rest of the liver parenchyma. High attenuation of the adjacent liver parenchyma was seen on all postcontrast phases but was most prominent at the delayed phase and was seen on all follow-up studies. The appearance of the liver parenchyma after treatment was significantly different from before treatment (p < 0.001).

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