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Figure 2. SBRT for very early-stage HCC in a 52-year-old man. Both surgical resection and RFA were considered difficult because the tumor was located in the center of the liver and was too small to be easily detected. A: Axial arterial phase MRI image showed hyper enhancement of an 0.8-cm liver nodule (arrowhead) located in the center of the right lobe of the liver. The patient was clinically diagnosed with very early-stage HCC based on the Barcelona Clinic Liver Cancer staging system; B: the patient received SBRT with a dose of 48 Gy in six fractions; C: axial arterial phase MRI image three months after SBRT demonstrated complete tumor response. Hypodensity in the radiation field (about 30 Gy) indicated the presence of radiation-induced focal liver injury; D: axial arterial phase MRI image 9 months after SBRT showed clear reduction in size of the area of radiation injury; E,F: axial arterial phase MRI images 26 months (E) and 56 months (F) after SBRT revealed complete regression of the tumor lesion; G: serum AFP levels are shown in relation to the treatment timeline. The elevated serum AFP level prior to SBRT dramatically declined to normal (< 20 µg/L) after SBRT, and remained within normal limits thereafter. SBRT: stereotactic body radiation therapy; HCC: hepatocellular carcinoma; RFA: radiofrequency ablation; MRI: magnetic resonance imaging; AFP: alpha-fetoprotein