Assessing radiographic treatment response to hepatocellular carcinoma following radiation therapy

For patients with HCC, the antitumor effect of RT (eg, SBRT or TARE) is not always accurately reflected by conventional bidimensional tumor measurements on radiographic studies. The antitumor effect of such therapies is more accurately evaluated based on the American College of Radiology's LI-TR criteria. These criteria should be applied with caution in patients who receive combination systemic therapy and RT.

CT: computed tomography; HCC: hepatocellular carcinoma; LI-RADS: Liver Imaging Reporting and Data System; LR-TR: LI-RADS treatment response; MRI: magnetic resonance imaging; RT: radiation therapy; SBRT: stereotactic body radiotherapy; TARE: transarterial radioembolization.

* Examples of no mass-like enhancement include complete disappearance of the lesion, no lesional enhancement, small perilesional enhancement, or parenchymal perfusional changes without mass-like enhancement.

¶ If the clinician is unsure about choosing between two categories (ie, LR-TR viable versus LR-TR nonprogressing; LR-TR nonviable versus LR-TR nonprogressing), they should choose LR-TR nonprogressing.

Adapted from: Springer: Kielar A, Fowler KJ, Lewis S, et al. Locoregional therapies for hepatocellular carcinoma and the new LI-RADS treatment response algorithm. Abdom Radiol (NY) 2018; 43:218.

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Assessing radiographic treatment response to hepatocellular carcinoma following radiation therapy