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01.02.2015 | Hepatobiliary-Pancreas

Volumetric assessment of tumour response using functional MR imaging in patients with hepatocellular carcinoma treated with a combination of doxorubicin-eluting beads and sorafenib

verfasst von: Celia Pamela Corona-Villalobos, Vivek Gowdra Halappa, Jean-Francois H. Geschwind, Susanne Bonekamp, Diane Reyes, David Cosgrove, Timothy M Pawlik, Ihab R Kamel

Erschienen in: European Radiology | Ausgabe 2/2015

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Abstract

Objective

To prospectively assess treatment response using volumetric functional magnetic resonance imaging (MRI) metrics in patients with hepatocellular carcinoma (HCC) treated with the combination of doxorubicin-eluting bead–transarterial chemoembolization (DEB TACE) and sorafenib.

Methods

A single center study enrolled 41 patients treated with systemic sorafenib, 400 mg twice a day, combined with DEB TACE. All patients had a pre-treatment and 3–4 week post-treatment MRI. Anatomic response criteria (RECIST, mRECIST and EASL) and volumetric functional response (ADC, enhancement) were assessed. Statistical analyses included paired Student’s t-test, Kaplan-Meier curves, Cohen’s Kappa, and multivariate cox proportional hazard model.

Results

Median tumour size by RECIST remained unchanged post-treatment (8.3 ± 4.1 cm vs. 8.1 ± 4.3 cm, p = 0.44). There was no significant survival difference for early response by RECIST (p = 0.93). EASL and mRECIST could not be analyzed in 12 patients. Volumetric ADC increased significantly (1.32 × 10⁻³ mm²/sec to 1.60 × 10⁻³ mm²/sec, p < 0.001), and volumetric enhancement decreased significantly in HAP (38.2 % to 17.6 %, p < 0.001) and PVP (76.6 % to 41.2 %, p < 0.005). Patients who demonstrated ≥ 65 % decrease PVP enhancement had significantly improved overall survival compared to non-responders (p < 0.005).

Conclusion

Volumetric PVP enhancement was demonstrated to be significantly correlated with survival in the combination of DEB TACE and sorafenib for patients with HCC, enabling precise stratification of responders and non-responders.

Key Points

• PVP enhancement is significantly correlated with survival in responders (p < 0.005).

• There was no significant survival difference for early response using RECIST (p = 0.93).

• mRECIST or EASL could not assess tumour response in 29 % of patients.

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Titel: Volumetric assessment of tumour response using functional MR imaging in patients with hepatocellular carcinoma treated with a combination of doxorubicin-eluting beads and sorafenib
verfasst von: Celia Pamela Corona-Villalobos
Vivek Gowdra Halappa
Jean-Francois H. Geschwind
Susanne Bonekamp
Diane Reyes
David Cosgrove
Timothy M Pawlik
Ihab R Kamel
Publikationsdatum: 01.02.2015
Verlag: Springer Berlin Heidelberg
Erschienen in: European Radiology / Ausgabe 2/2015
Print ISSN: 0938-7994
Elektronische ISSN: 1432-1084
DOI: https://doi.org/10.1007/s00330-014-3412-6

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Volumetric assessment of tumour response using functional MR imaging in patients with hepatocellular carcinoma treated with a combination of doxorubicin-eluting beads and sorafenib