fig6

Figure 6. SBRT for residual HCC after surgical resection in a 59-year-old man. A: Axial arterial phase MRI scan 6 years after initial surgery showed a 2.1-cm recurrent hyper-enhancing nodule adjacent to the inferior vein cava, located in the second hepatic hilar segment. The patient underwent TACE for the recurrent lesion; B: axial arterial phase CT image one month after TACE showed a hyper-enhancing lesion (arrow), with no lipiodol deposition. Then, the patient underwent hepatic wedge resection in May 2011; C: axial arterial phase CT image one month after surgery revealed residual tumor with hyper enhancement (arrow); D: the patient underwent SBRT with a dose of 50 Gy in five fractions in June 2011; E: axial arterial phase CT image 3 months after SBRT showed complete response of the target lesion; F,G: Axial arterial (F) and portal venous phases (G) CT images 13 months after SBRT showed persistent enhancement of the radiation field because of post-SBRT changes representing congestion and edema; H,I: Follow-up CT images 2 years (H) and 8 years (I) after SBRT demonstrated a normal liver. SBRT: stereotactic body radiation therapy; HCC: hepatocellular carcinoma; MRI: magnetic resonance imaging; TACE: transarterial chemoembolization; CT: computed tomography