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Stereotactic Body Radiotherapy for Hepatocellular Carcinoma Resulting in a Durable Relapse-Free Survival: A Case Report

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ABSTRACT

The standard of care for localized hepatocellular carcinoma (HCC) is surgical resection. For patients who decline or who are unfit for surgery, stereotactic body radiotherapy (SBRT) is emerging as a viable treatment approach. We present a case of a 77-year-old female in whom an early stage HCC was incidentally discovered. Given her religious edicts as a devout Jehovah’s Witness and her subsequent desire to avoid a blood transfusion, she declined surgical resection or transplant due to the risk of hemorrhage. Ablative therapy was deemed inappropriate given the mass’s size and location adjacent to the inferior vena cava and diaphragm. She was treated with definitive SBRT to a total dose of 60 Gy administered in three 20 Gy fractions every other day. She had a complete response to the treatment and remains without evidence of disease after 39 months of follow-up. Her only treatment-related side effect is a persistent CTCAE Grade 1 myositis on her back overlying the treatment area. We report this case to add to the growing body of literature suggesting SBRT as an effective and safe alternative treatment modality for HCC.

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MRI Treatment ResponseFigure 3: Serial MRI images obtained before (upper row), 3 months after (middle row) and 39 months after (lower row) the SBRT treatment.Each row shows pre-contrast (left), arterial phase (middle) and delayed venous phase (right) MRI VIBE images.The upper row shows the classic appearance of HCC (white arrows): low signal intensity on pre-contrast image, prominent enhancement during the arterial phase, and decreased enhancement of the tumor on the delayed phase with persistent tumoral capsular enhancement.The middle row shows significant decrease in the size of the tumor, decreased enhancement during the arterial phase, and residual heterogeneous enhancement during the delayed phase.The lower row shows an ill-defined, non-mass-like area consistent with post-radiation fibrosis.
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FIG3: MRI Treatment ResponseFigure 3: Serial MRI images obtained before (upper row), 3 months after (middle row) and 39 months after (lower row) the SBRT treatment.Each row shows pre-contrast (left), arterial phase (middle) and delayed venous phase (right) MRI VIBE images.The upper row shows the classic appearance of HCC (white arrows): low signal intensity on pre-contrast image, prominent enhancement during the arterial phase, and decreased enhancement of the tumor on the delayed phase with persistent tumoral capsular enhancement.The middle row shows significant decrease in the size of the tumor, decreased enhancement during the arterial phase, and residual heterogeneous enhancement during the delayed phase.The lower row shows an ill-defined, non-mass-like area consistent with post-radiation fibrosis.

Mentions: Two months after the completion of SBRT, her liver lesion decreased in size (4.3 x 4.4 cm → 3.7 x 3.3 cm), and visible shrinkage continued on subsequent imaging (Figure 3).


Stereotactic Body Radiotherapy for Hepatocellular Carcinoma Resulting in a Durable Relapse-Free Survival: A Case Report
MRI Treatment ResponseFigure 3: Serial MRI images obtained before (upper row), 3 months after (middle row) and 39 months after (lower row) the SBRT treatment.Each row shows pre-contrast (left), arterial phase (middle) and delayed venous phase (right) MRI VIBE images.The upper row shows the classic appearance of HCC (white arrows): low signal intensity on pre-contrast image, prominent enhancement during the arterial phase, and decreased enhancement of the tumor on the delayed phase with persistent tumoral capsular enhancement.The middle row shows significant decrease in the size of the tumor, decreased enhancement during the arterial phase, and residual heterogeneous enhancement during the delayed phase.The lower row shows an ill-defined, non-mass-like area consistent with post-radiation fibrosis.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5120964&req=5

FIG3: MRI Treatment ResponseFigure 3: Serial MRI images obtained before (upper row), 3 months after (middle row) and 39 months after (lower row) the SBRT treatment.Each row shows pre-contrast (left), arterial phase (middle) and delayed venous phase (right) MRI VIBE images.The upper row shows the classic appearance of HCC (white arrows): low signal intensity on pre-contrast image, prominent enhancement during the arterial phase, and decreased enhancement of the tumor on the delayed phase with persistent tumoral capsular enhancement.The middle row shows significant decrease in the size of the tumor, decreased enhancement during the arterial phase, and residual heterogeneous enhancement during the delayed phase.The lower row shows an ill-defined, non-mass-like area consistent with post-radiation fibrosis.
Mentions: Two months after the completion of SBRT, her liver lesion decreased in size (4.3 x 4.4 cm → 3.7 x 3.3 cm), and visible shrinkage continued on subsequent imaging (Figure 3).

View Article: PubMed Central - HTML - PubMed

ABSTRACT

The standard of care for localized hepatocellular carcinoma (HCC) is surgical resection. For patients who decline or who are unfit for surgery, stereotactic body radiotherapy (SBRT) is emerging as a viable treatment approach. We present a case of a 77-year-old female in whom an early stage HCC was incidentally discovered. Given her religious edicts as a devout Jehovah’s Witness and her subsequent desire to avoid a blood transfusion, she declined surgical resection or transplant due to the risk of hemorrhage. Ablative therapy was deemed inappropriate given the mass’s size and location adjacent to the inferior vena cava and diaphragm. She was treated with definitive SBRT to a total dose of 60 Gy administered in three 20 Gy fractions every other day. She had a complete response to the treatment and remains without evidence of disease after 39 months of follow-up. Her only treatment-related side effect is a persistent CTCAE Grade 1 myositis on her back overlying the treatment area. We report this case to add to the growing body of literature suggesting SBRT as an effective and safe alternative treatment modality for HCC.

No MeSH data available.


Related in: MedlinePlus