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Figure 10. SBRT for repeated de novo HCC in a 63-year-old man with previous surgical resection of HCC. A: Axial arterial phase MRI image showed a 1.2-cm enhancing nodule in the right hepatic lobe, adjacent to the diaphragm; B: the patient received his first course of SBRT with a dose of 48 Gy in six fractions; C: axial arterial phase MRI image 4 years after SBRT demonstrated complete response of this right lobe lesion; D: axial arterial phase MRI image two years after the first SBRT showed a 1-cm enhancing nodule in the caudate lobe of the liver; E: the patient received a second course of SBRT with a dose of 48 Gy in six fractions; F: axial arterial phase MRI image 3 years after the second course of SBRT revealed complete response of the caudate lobe lesion; G: axial arterial phase MRI image 18 months after the second SBRT showed a 1.2-cm enhancing lesion in the right hepatic lobe, as well as an additional lesion at a lower level (not shown), suggesting de novo HCC; H: the patient received a third course of SBRT with a dose of 54 Gy in nine fractions. I: axial arterial phase MRI image one year after this SBRT revealed complete tumor response of the de novo lesion. SBRT: stereotactic body radiation therapy; HCC: hepatocellular carcinoma; MRI: magnetic resonance imaging