fig9

Figure 9. SBRT for recurrent HCC at the surgical margin in a 63-year-old man. A: Axial arterial phase MRI image showed hyper enhancement of a 2.4 cm recurrent focus at the surgical margin (arrowhead). The patient received TACE for this recurrent lesion; B: axial arterial phase MRI image six months after TACE showed reduced size and hypovascularity of the lesion; C: axial arterial phase CT image 3 years after TACE demonstrated enlargement of the treated lesion to 2.9 cm; D: the patient received SBRT with a dose of 48 Gy in six fractions; E-G: CT images 40 days (E), 2 years (F), and 4 years (G) after SBRT showed complete tumor response; H: serum AFP levels are shown in relation to the treatment timeline. The elevated serum AFP prior to SBRT (53 µg/L) declined to normal (2.1 µg/L) after SBRT and remained within normal limits thereafter. SBRT: stereotactic body radiation therapy; HCC: hepatocellular carcinoma; MRI: magnetic resonance imaging; TACE: transarterial chemoembolization; CT: computed tomography; AFP: alpha-fetoprotein