MRI-guided stereotactic ablative radiation therapy for metachronously recurrent pulmonary oligometastases from hepatocellular carcinoma after failure of systemic therapy

Abstract

Objectives. This article aims to evaluate the feasibility and effectiveness of MRI-guided stereotactic ablative radiotherapy (SABR) for metachronously recurrent pulmonary oligometastases from hepatocellular carcinoma (HCC) when systemic therapies prove ineffective. Case Presentation. A 47-year-old male with metastatic HCC underwent unsuccessful chemotherapy, targeted therapy, and immunotherapy. The patient had a history of 14 lung metastases, previously treated with respiratory non-gated SABR. However, five new lung metastases emerged, raising concerns about potential pulmonary toxicity. After administering oral capecitabine, tumor growth persisted. To address this, the patient received MRI-guided respiratory-gated SABR using a recently installed system. Outcome. MRI-guided respiratory-gated SABR was well-tolerated, with no radiation-induced adverse events reported during treatment and a six-month follow-up period. Imaging follow-up demonstrated complete tumor regression, and no new recurrences were observed. Conclusions. This case report suggests that MRI-guided SABR could be a viable option for managing metachronously recurrent pulmonary oligometastases from HCC, particularly after failed systemic therapies. The precise targeting achieved with minimal toxicity, utilizing a 1 mm margin without an internal target volume, showcases the potential of this approach. However, further scientific investigation is warranted to validate these findings, given the limited scope of this single case report. Nonetheless, MRI-guided SABR holds promise as a safe and effective local treatment modality for lung metastases in HCC patients.