fig3

Figure 3. SBRT for unresectable HCC in a 47-year-old man. A: Axial and sagittal MRI images showed a hepatic lesion (arrowhead) near the inferior vena cava and main portal vein. The lesion enhanced in the arterial phase and washed out in the portal venous phase; B: the patient underwent SBRT with a dose of 45 Gy in six fractions; C: arterial phase MRI image 1.5 months after SBRT revealed dramatic regression of the lesion; D: arterial phase MRI image four months after SBRT demonstrated further reduction in size of the lesion, as well as necrosis of the targeted hypovascular lesion, consistent with a nonviable tumor; E-G: MRI images 1 year (E), 2 years (F), and 3 years (G) after SBRT showed progressive reduction in tumor size and complete hypovascularity of the lesion. These findings suggested a good tumor response; H: serum AFP levels are shown in relation to the treatment timeline. The elevated serum AFP level prior to SBRT (1,709 µg/L) declined to normal (< 20 µg/L) after SBRT and remained within normal limits thereafter. SBRT: stereotactic body radiation therapy; HCC: hepatocellular carcinoma; MRI: magnetic resonance imaging; AFP: alpha-fetoprotein