방사선의학 웹진

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Abstract
Objectives: Conventional radiologic response criteria inadequately address imaging features and delayed responses after radiation-based therapies, limiting clinical decisions. This study evaluated treatment response to radiation-based locoregional therapies using modified RECIST (mRECIST), LI-RADS treatment response algorithm (LR-TRA) v2017, and radiation LR-TRA v2024, assessed changes in response categories during follow-up, and evaluated their association with overall survival (OS).

Materials and methods: This single-center retrospective study included consecutive patients with hepatocellular carcinoma treated with transarterial radioembolization or external beam radiation therapy between 2011 and 2023. Two abdominal radiologists independently assessed the first radiologic response 3 months post-treatment using the mRECIST, LR-TRA v2017, and radiation LR-TRA v2024. The changes in the mRECIST and LR-TR categories during follow-up were evaluated. The Cox proportional hazard model was used to assess the association between response categories and OS.

Results: A total of 115 patients were included (66.6 ± 12.9 years; 73.9% [85/115] men). Complete response (CR), partial response, stable disease, and progressive disease (PD) based on the mRECIST were 36.5% (44/115), 26.1% (30/115), 17.4% (20/115), and 20% (26/115), respectively. In LR-TRA v2017, the nonviable, equivocal, and viable rates were 48.7% (56/115), 13% (15/115), and 38.3% (44/115), respectively. In LR-TRA v2024, the nonviable, nonprogressing, and viable rates were 47% (54/115), 51.3% (59/115), and 1.7% (2/115), respectively. During follow-up, the proportion of LR-TR nonprogressing decreased, while that of LR-TR nonviable increased over time. Achieving nonviable disease during follow-up was strongly associated with improved OS (p < 0.001).

Conclusion: Radiation LR-TRA v2024 effectively reflected a typical delayed response pattern after radiation-based therapy.

Affiliations

Hokun Kim 1, Bohyun Kim 2, Seok Hyun Son 3, Jeong Won Jang 4 5, Pil Soo Sung 4 5, Joon-Il Choi 1, Suho Kim 1, Jung Suk Oh 1, Ho Jong Chun 1
1Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea.
2Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea. kbh@catholic.ac.kr.
3Department of Radiation Oncology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea.
4Division of Gastroenterology and Hepatology, Department of Internal Medicine, Seoul St. Mary's Hospital, Seoul, South Korea.
5College of Medicine, The Catholic University Liver Research Center, The Catholic University of Korea, Seoul, South Korea.