fig8

Figure 8. SBRT for residual tumor with incomplete iodized oil retention in a 54-year-old man who had undergone multiple cycles of TACE and chemotherapy. A: Original axial arterial phase MRI image showed a 7.5-cm enhancing mass in the hepatic hilar region, consistent with HCC; B: the lesion decreased substantially in size after six cycles of TACE. FDG PET/CT image demonstrated hypermetabolic activity in the region with incomplete iodized oil retention, consistent with residual viable tumor; C: arterial phase MRI image after multiple TACE cycles and chemotherapy but before SBRT showed no enhancement of the 1.8-cm liver lesion; D: the patient underwent SBRT for residual tumor with a dose of 55.5 Gy in 15 fractions; E: FDG PET/CT image 11 months after SBRT showed no metabolic activity; F: axial arterial phase MRI image 16 months after SBRT demonstrated reduced size and hypovascularity of the treated lesion; G: axial arterial phase MRI image 4 years after SBRT showed stable size and hypovascularity of the treated lesion; H: serum AFP levels are shown in relation to the treatment timeline. AFP further declined to normal after SBRT. SBRT: stereotactic body radiation therapy; HCC: hepatocellular carcinoma; MRI: magnetic resonance imaging; TACE: transarterial chemoembolization; AFP: alpha-fetoprotein; FDG: flurodeoxyglucose; PET: positron emission tomography; CT: computed tomography