Multidisciplinary assessment of tumor response after internal and external radiation therapy for hepatocellular carcinoma

Treatment of hepatocellular carcinoma with both internal and external radiation therapy is becoming more common, with the recent incorporation of internal radiation therapy (transarterial radioembolization) into the Barcelona Clinic Liver guidelines. With the increasing use of radiation therapy for the treatment of liver cancer, it is essential to understand the expected imaging findings after therapy and establish a consensus on the management of these patients. Recent insights into the unique post-treatment imaging features of HCC treated with radiation have prompted updates to treatment response algorithms to improve inter-reader response assessment. One must understand the type of locoregional treatment, the time interval of post-treatment imaging and the sequence of the treatment strategy to provide an accurate treatment response assessment. Although imaging response systems attempt to predict treatment efficacy, many of these complex cases should be discussed in a multidisciplinary setting for management recommendations.