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Yip et al. Hepatoma Res 2020;6:44 Hepatoma Research
DOI: 10.20517/2394-5079.2020.30

Review Open Access

Imaging assessment after SBRT for hepatocellular
carcinoma

Connie Yip , Tiffany Priyanthi Hennedige , Gary J. R. Cook , Vicky Goh 3
2
1
3
1 Radiation Oncology, National Cancer Centre Singapore, Singapore 169610, Singapore.
2 Oncologic Imaging, National Cancer Centre Singapore, Singapore 169610, Singapore.
3 Cancer Imaging, King’s College London, London WC2R 2LS, United Kingdom.
Correspondence to: Dr. Connie Yip, Radiation Oncology, National Cancer Centre Singapore, Singapore 169610, Singapore. E-mail:
connie.yip.s.p@singhealth.com.sg

How to cite this article: Yip C, Hennedige TP, Cook GJR, Goh V. Imaging assessment after SBRT for hepatocellular carcinoma.
Hepatoma Res 2020;6:44. http://dx.doi.org/10.20517/2394-5079.2020.30
Received: 24 Mar 2020 First Decision: 25 May 2020 Revised: 25 May 2020 Accepted: 26 May 2020 Published: 10 Jul 2020

Academic Editor: Su Pin Choo Copy Editor: Cai-Hong Wang Production Editor: Tian Zhang

Abstract
The use of stereotactic body radiotherapy (SBRT) in hepatocellular carcinoma (HCC) has increased over the past
few decades. Thus, accurate evaluation of post-SBRT treatment response is essential to avoid over-treatment
of responders as well as missing the opportunity to salvage non-responders. There are some intricate imaging
differences after liver SBRT compared to those observed after conventional fractionated radiotherapy and other
locoregional treatment. We aim to review the imaging changes that occur following SBRT for HCC and their
potential clinical implications.

Keywords: Imaging, liver, stereotactic body radiotherapy, hepatocellular carcinoma

INTRODUCTION
Radiation therapy for liver malignancies has evolved over the past few decades. In the past, radiation was
predominantly used as a palliative modality due to the limited tolerance of whole liver irradiation. However,
with the technological advances achieved with improved resolution of on-board imaging and the ability to
deliver highly conformal radiotherapy, we were then able to irradiate liver tumours with high precision and
limited bystander damage to normal tissues. Stereotactic body radiotherapy (SBRT) is characterised by high
dose per fraction, typically in the range of 5-25 Gy over 1-10 fractions, which is enabled by accurate tumour
localisation using daily image guidance. The adoption of SBRT has increased exponentially in primary and
[1-5]
secondary liver malignancies with promising local control rates and favourable toxicity profiles . SBRT has
also been shown to be a useful local therapy to bridge patients awaiting transplant in primary hepatocellular
[6]
carcinoma (HCC) .

© The Author(s) 2020. Open Access This article is licensed under a Creative Commons Attribution 4.0
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