fig4

Figure 4. SBRT for HCC in a 99-year-old man for whom SBRT was chosen because of his age and comorbidities. A: Axial venous phase MRI image showed a 6-cm low-density lesion adjacent to the diaphragm (arrow); B: the patient underwent SBRT with a dose of 54 Gy in six fractions; C: axial arterial phase MRI image three months after SBRT demonstrated reduced size of the intrahepatic lesion and vascular enhancement (arrow); D,E: axial arterial phase MRI images 10 months (D) and 17 months (E) after SBRT showed further reduction in size of the tumor, which was hypovascular (arrows). The perilesional liver parenchyma in the enhanced phase appeared as ill-defined areas of enhancement, favoring SBRT-related changes; F: Serum AFP levels are shown in relation to the treatment timeline. AFP levels decreased to normal after SBRT. SBRT: stereotactic body radiation therapy; HCC: hepatocellular carcinoma; MRI: magnetic resonance imaging; AFP: alpha-fetoprotein