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Treatment of Liver Metastases Using an Internal Target Volume Method for Stereotactic Body Radiotherapy
Published on: May 8, 2018
Prognostic Value of MRI-Based Treatment Response Assessment Criteria in Hepatocellular Carcinoma After Stereotactic
Fan Zhou1,2, Lidi Ma1,2, Jiaqi Wei1,2
1Collaborative Innovation Center for Cancer Medicine, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-Sen University Cancer Center, Guangzhou, P. R. China.
Background:
Accurate imaging assessment of hepatocellular carcinoma (HCC) after stereotactic body radiotherapy (SBRT) remains challenging. Although LI-RADS CT/MRI Radiation Treatment Response Assessment (TRA v2024) was developed for this purpose, its prognostic value for survival stratification after SBRT remains to be validated.
Purpose:
To compare the prognostic performance of mid-term (3-6 months) and late-term (9-12 months) MRI-based treatment response assessed using modified RECIST (mRECIST), LI-RADS TRA v2017, and LI-RADS Radiation TRA v2024 in patients with HCC.
Study Type:
Retrospective cohort study.
Population:
125 patients with HCC underwent SBRT (111 males; mean age, 56.4 ± 10.8 years).
Field Strength/Sequence:
3.0 T; axial fat-suppressed fast spin-echo T2-weighted imaging, diffusion-weighted imaging, pre-contrast gradient recalled echo T1-weighted imaging, and contrast-enhanced late arterial phase, portal venous phase, and delayed/transitional phase.
Assessment:
Tumor response was independently evaluated by three radiologists using three treatment assessment methods. Ancillary features (AFs) were additionally recorded to assess their incremental prognostic value. Overall survival (OS) and progression-free survival (PFS) were analyzed according to response categories.
Statistical Tests:
Kolmogorov-Smirnov test, Intraclass correlation coefficients, Cohen's κ, Variance inflation factor analysis, Kaplan-Meier method, Log-rank tests with Bonferroni correction, Univariate and multivariable Cox regression analyses. Statistical significance was defined as p < 0.05.
Results:
At mid-term follow-up, LI-RADS Radiation TRA v2024 showed greater discrimination for PFS than mRECIST and LI-RADS TRA v2017, with no OS difference (p > 0.999). Across all three criteria, late-term response assessment yielded better prognostic stratification for PFS and OS than did mid-term evaluation. At the late-term follow-up, LI-RADS Radiation TRA v2024 was strongly associated with OS (HR = 15.80, 95% CI: 3.34-75.00) and PFS (HR = 6.31, 95% CI: 2.68-14.90). Adding AFs provided no further prognostic improvement.
Data Conclusion:
LI-RADS Radiation TRA v2024 demonstrates strong prognostic stratification after SBRT, particularly at late-term MRI evaluation.
Evidence Level:
3.
Technical Efficacy:
Stage 2.
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