Abstract
IntroductionThree-dimensional techniques for radiotherapy have expanded possibilities for partial volume liver radiotherapy. Characteristic, transient radiographic changes can occur in the absence of clinical radiation-induced liver disease after hepatic radiotherapy and must be distinguished from local recurrence.Case presentationIn this report, we describe computed tomography changes after chemoradiotherapy for cholangiocarcinoma as an example of collaboration to determine the clinical significance of the radiographic finding.ConclusionBecause of improved three-dimensional, conformal radiotherapy techniques, consultation across disciplines may be necessary to interpret post-treatment imaging findings.
Highlights
Three-dimensional techniques for radiotherapy have expanded possibilities for partial volume liver radiotherapy
Conformal radiotherapy (RT) techniques allow for the delivery of high radiation doses to fields encompassing partial liver volumes as a component of combined modality cancer treatment
We describe CT changes after chemoradiotherapy for cholangiocarcinoma as an example of the challenge of distinguishing treatment effect from disease recurrence
Summary
Conformal radiotherapy (RT) techniques allow for the delivery of high radiation doses to fields encompassing partial liver volumes as a component of combined modality cancer treatment. The patient was staged as IB (T2N0M0) cholangiocarcinoma, and was recommended to receive concurrent combined modality therapy consisting of capecitabine 1500 mg twice daily and external beam RT to a total dose of 50.4 Gy delivered in 28 daily fractions of 1.8 Gy. A CT was performed for RT treatment planning, and three-dimensional techniques were used to develop a four-field conformal plan. At this time, a CT scan of the abdomen and pelvis showed a low attenuation region in the liver with linear margins (Fig. 3A). In order to verify that the imaging abnormality corresponded to the radiation portal, the radiation treatment planning CT and the follow-up diagnostic CT were co-registered using anatomical landmarks to confirm that the low-density region corresponded to the 50.4 Gy isodose line. A CT scan obtained six months later (Fig. 3B) demonstrated nearly complete resolution of the previously observed post-RT hepatic parenchymal changes, with interval loss of hepatic volume and development of surface nodularity consistent with evolving post-RT changes with local fibrosis
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