open access

Vol 22, No 2 (2017)
Special Issue Papers
Published online: 2017-03-01
Submitted: 2015-07-16
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Evaluation of response after SBRT for liver tumors

Raphael Tétreau, Carmen Llacer, Olivier Riou, Emmanuel Deshayes
DOI: 10.1016/j.rpor.2015.12.004
·
Rep Pract Oncol Radiother 2017;22(2):170-175.

open access

Vol 22, No 2 (2017)
Special Issue Papers
Published online: 2017-03-01
Submitted: 2015-07-16

Abstract

Stereotactic body radiotherapy (SBRT) has developed over the last few years for the treatment of primary and metastatic hepatic tumors. The tumoral and adjacent peritumoral modifications caused by this radiosurgery limit the evaluation of response by anatomic imaging and dimensional criteria alone, such as with RECIST. This suggests that it is of interest to also take into account the residual enhancement and hyper metabolism of these hepatic targets. We have reviewed the English language literature regarding the response of hepatic lesions treated by SBRT, and found that only seven articles were specifically concerned with this problem.

The response of the hepatocellular carcinoma after SBRT has been studied specifically with multiphase enhanced CT-scan. Criteria set by the European Association of Study of the Liver better estimate response at each time point of follow up than RECIST does. Non-enhancement, reflecting tumor necrosis, is additionally an early indicator of response with extended response in time and a best non-enhancement percentage is observed at 12 months. The response after treatment by SBRT of cholangiocarcinoma has not yet generated a specific report.

Use of RECIST criteria is also inadequate in the evaluation of response after SBRT for hepatic metastases. Response of liver metastases to SBRT is better assessed with a combination of size and enhancement pattern. The occurrence of a lobulated enhancement during follow up is efficient to predict local progression in a specific, reproducible, and sensitive way. Patients with FDG-avid hepatic metastases are also better evaluated with PET-CT and functional criteria than routine imaging and metric evaluation alone.

Abstract

Stereotactic body radiotherapy (SBRT) has developed over the last few years for the treatment of primary and metastatic hepatic tumors. The tumoral and adjacent peritumoral modifications caused by this radiosurgery limit the evaluation of response by anatomic imaging and dimensional criteria alone, such as with RECIST. This suggests that it is of interest to also take into account the residual enhancement and hyper metabolism of these hepatic targets. We have reviewed the English language literature regarding the response of hepatic lesions treated by SBRT, and found that only seven articles were specifically concerned with this problem.

The response of the hepatocellular carcinoma after SBRT has been studied specifically with multiphase enhanced CT-scan. Criteria set by the European Association of Study of the Liver better estimate response at each time point of follow up than RECIST does. Non-enhancement, reflecting tumor necrosis, is additionally an early indicator of response with extended response in time and a best non-enhancement percentage is observed at 12 months. The response after treatment by SBRT of cholangiocarcinoma has not yet generated a specific report.

Use of RECIST criteria is also inadequate in the evaluation of response after SBRT for hepatic metastases. Response of liver metastases to SBRT is better assessed with a combination of size and enhancement pattern. The occurrence of a lobulated enhancement during follow up is efficient to predict local progression in a specific, reproducible, and sensitive way. Patients with FDG-avid hepatic metastases are also better evaluated with PET-CT and functional criteria than routine imaging and metric evaluation alone.

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Keywords

SBRT; RECIST; mRECIST; CT; MRI; PET; HCC; PERCIST; EASL; FDG; SUV; Stereotactic body radiotherapy; Liver; Treatment effectiveness; Tomography; X-ray computed; Positron-emission tomography

About this article
Title

Evaluation of response after SBRT for liver tumors

Journal

Reports of Practical Oncology and Radiotherapy

Issue

Vol 22, No 2 (2017)

Pages

170-175

Published online

2017-03-01

DOI

10.1016/j.rpor.2015.12.004

Bibliographic record

Rep Pract Oncol Radiother 2017;22(2):170-175.

Keywords

SBRT
RECIST
mRECIST
CT
MRI
PET
HCC
PERCIST
EASL
FDG
SUV
Stereotactic body radiotherapy
Liver
Treatment effectiveness
Tomography
X-ray computed
Positron-emission tomography

Authors

Raphael Tétreau
Carmen Llacer
Olivier Riou
Emmanuel Deshayes

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