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Li G, Yang S, Wang S, Jiang R, Xu X. Diagnostic Value of Dynamic 18F-Fluorodeoxyglucose Positron Emission Tomography-Computed Tomography ( 18F-FDG PET-CT) in Cervical Lymph Node Metastasis of Nasopharyngeal Cancer. Diagnostics (Basel) 2023; 13:2530. [PMID: 37568893 PMCID: PMC10417831 DOI: 10.3390/diagnostics13152530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 07/21/2023] [Accepted: 07/26/2023] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND AND PURPOSE Dynamic 18F-FDG PET-CT scanning can accurately quantify 18F-FDG uptake and has been successfully applied in diagnosing and evaluating therapeutic effects in various malignant tumors. There is no conclusion as to whether it can accurately distinguish benign and malignant lymph nodes in nasopharyngeal cancer. The main purpose of this study is to reveal the diagnostic value of dynamic PET-CT in cervical lymph node metastasis of nasopharyngeal cancer through analysis. METHOD We first searched for cervical lymph nodes interested in static PET-CT, measured their SUV-Max values, and found the corresponding lymph nodes in magnetic resonance images before and after treatment. The valid or invalid groups were included according to the changes in lymph node size before and after treatment. If the change in the product of the maximum diameter and maximum vertical transverse diameter of the lymph node before and after treatment was greater than or equal to 50%, they would be included in the valid group. If the change was less than 50%, they would be included in the invalid group. Their Ki values were measured on dynamic PET-CT and compared under different conditions. Then, we conducted a correlation analysis between various factors and Ki values. Finally, diagnostic tests were conducted to compare the sensitivity and specificity of Ki and SUV-Max. RESULT We included 67 cervical lymph nodes from different regions of 51 nasopharyngeal cancer patients and divided them into valid and invalid groups based on changes before treatment. The valid group included 50 lymph nodes, while the invalid group included 17. There wer significant differences (p < 0.001) between the valid and the invalid groups in SUV-Max, Ki-Mean, and Ki-Max values. When the SUV-Max was ≤4.5, there was no significant difference in the Ki-Mean and Ki-Max between the two groups (p > 0.05). When the SUV-Max was ≤4.5 and pre-treatment lymph nodes were <1.0 cm, the valid group had significantly higher Ki-Mean (0.00910) and Ki-Maximum (0.01004) values than the invalid group (Ki-Mean = 0.00716, Ki-Max = 0.00767) (p < 0.05). When the SUV-Max was ≤4.5, the pre-treatment lymph nodes < 1.0 cm, and the EBV DNA replication normal, Ki-Mean (0.01060) and Ki-Max (0.01149) in the valid group were still significantly higher than the invalid group (Ki-Mean = 0.00670, Ki-Max = 0.00719) (p < 0.05). The correlation analysis between different factors (SUV-Max, T-stage, normal EB virus DNA replication, age, and pre-treatment lymph node < 1.0 cm) and the Ki value showed that SUV-Max and a pre-treatment lymph node < 1.0 cm were related to Ki-Mean and Ki-Max. Diagnostic testing was conducted; the AUC value of the SUV-Max value was 0.8259 (95% confidence interval: 0.7296-0.9222), the AUC value of the Ki-Mean was 0.8759 (95% confidence interval: 0.7950-0.9567), and the AUC value of the Ki-Max was 0.8859 (95% confidence interval: 0.8089-0.9629). After comparison, it was found that there was no significant difference in AUC values between Ki-Mean and SUV-Max (p = 0.220 > 0.05), and there was also no significant difference in AUC values between Ki max and SUV-Max (p = 0.159 > 0.05). By calculating the Youden index, we identified the optimal cut-off value. It was found that the sensitivity of SUV-Max was 100% and the specificity was 66%, the sensitivity of Ki-Mean was 100% and the specificity was 70%, and the sensitivity of Ki-Max was 100% and the specificity was 72%. After Chi-Square analysis, it was found that there was no significant difference in specificity between Ki-Mean and SUV-Max (p = 0.712), and there was also no significant difference in specificity between Ki-Max and SUV-Max (p = 0.755). CONCLUSION Dynamic PET-CT has shown a significant diagnostic value in diagnosing cervical lymph node metastasis of nasopharyngeal cancer, especially for the small SUV value, and lymph nodes do not meet the metastasis criteria before treatment, and EBV DNA replication is normal. Although the diagnostic accuracy, sensitivity, and specificity of dynamic PET-CT were not significantly different from traditional static PET-CT, the dynamic PET-CT had a more accurate tendency.
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Affiliation(s)
- Guanglie Li
- Department of Head and Neck Oncology, The Fifth Hospital of Sun Yat-sen University, Zhuhai 519000, China; (G.L.); (S.W.)
| | - Shuai Yang
- Department of Radiotherapy Physics, The Fifth Hospital of Sun Yat-sen University, Zhuhai 519000, China;
| | - Siyang Wang
- Department of Head and Neck Oncology, The Fifth Hospital of Sun Yat-sen University, Zhuhai 519000, China; (G.L.); (S.W.)
| | - Renwei Jiang
- Department of Radiotherapy Physics, The Fifth Hospital of Sun Yat-sen University, Zhuhai 519000, China;
| | - Xiwei Xu
- Department of Head and Neck Oncology, The Fifth Hospital of Sun Yat-sen University, Zhuhai 519000, China; (G.L.); (S.W.)
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Bajaj G, Sundaram K, Jambhekar K, Ram R. Imaging After Locoregional Therapy for Hepatocellular Carcinoma with Emphasis on LIRADS Treatment Response Assessment Criteria. Semin Ultrasound CT MR 2021; 42:318-331. [PMID: 34130846 DOI: 10.1053/j.sult.2021.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Radiologists play an essential role in assessing hepatocellular carcinoma treatment response and help guide further clinical management of patients. Interpretation of treatment response after locoregional therapy is challenging. The post-treatment imaging findings vary and depend on the type of treatment, the degree of treatment response, time interval after treatment and several other factors. Given the widespread use of local-regional therapies, understanding the appearance of treated lesions has become crucial to allow for a more accurate interpretation of post-treatment imaging. Several response criteria including the recently introduced Liver Imaging Reporting and Data System (LI-RADS) treatment response algorithm (TRA) are currently used to assess treatment response. This review article describes the imaging assessment of HCC treatment response after several locoregional therapies using various response assessment criteria, emphasizing the LI-RADS treatment algorithm.
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Affiliation(s)
- Gitanjali Bajaj
- Associate professor of Radiology, University of Arkansas for Medical Sciences, Little Rock, AR.
| | - Karthik Sundaram
- Assistant Professor of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Kedar Jambhekar
- Professor of Radiology, University of Arkansas for Medical Sciences, AR
| | - Roopa Ram
- Associate professor of Radiology, University of Arkansas for Medical Sciences, Little Rock, AR
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Patella F, Pesapane F, Fumarola E, Zannoni S, Brambillasca P, Emili I, Costa G, Anderson V, Levy EB, Carrafiello G, Wood BJ. Assessment of the response of hepatocellular carcinoma to interventional radiology treatments. Future Oncol 2019; 15:1791-1804. [PMID: 31044615 DOI: 10.2217/fon-2018-0747] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
According to Barcelona Clinic Liver Cancer (BCLC) guidelines, interventional radiology procedures are valuable treatment options for many hepatocellular carcinomas (HCCs) that are not amenable to resection or transplantation. Accurate assessment of the efficacy of therapies at earlier stages enables completion of treatment, optimal follow-up and to prevent potentially unnecessary treatments, side effects and costly failure. The goal of this review is to summarize and describe the radiological strategies that have been proposed to predict survival and to stratify HCC responses after interventional radiology therapies. New techniques currently in development are also described.
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Affiliation(s)
- Francesca Patella
- Postgraduate School of Radiodiagnostics, University of Milan, Milan, Italy.,Center for Interventional Oncology, National Cancer Institute, NIH, Bethesda, MD, USA
| | - Filippo Pesapane
- Postgraduate School of Radiodiagnostics, University of Milan, Milan, Italy.,Center for Interventional Oncology, National Cancer Institute, NIH, Bethesda, MD, USA
| | - Enrico Fumarola
- Postgraduate School of Radiodiagnostics, University of Milan, Milan, Italy.,Center for Interventional Oncology, National Cancer Institute, NIH, Bethesda, MD, USA
| | - Stefania Zannoni
- Postgraduate School of Radiodiagnostics, University of Milan, Milan, Italy
| | | | - Ilaria Emili
- Postgraduate School of Radiodiagnostics, University of Milan, Milan, Italy
| | - Guido Costa
- Università degli Studi di Milano, Postgraduate School of General Surgery, Milan, Italy
| | - Victoria Anderson
- Center for Interventional Oncology, National Cancer Institute, NIH, Bethesda, MD, USA
| | - Elliot B Levy
- Center for Interventional Oncology, National Cancer Institute, NIH, Bethesda, MD, USA
| | | | - Bradford J Wood
- Center for Interventional Oncology, National Cancer Institute, NIH, Bethesda, MD, USA
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Mora RA, Ali R, Gabr A, Abouchaleh N, Asadi AA, Kallini JR, Miller FH, Yaghmai V, Mouli S, Thornburg B, Desai K, Riaz A, Lewandowski RJ, Salem R. Pictorial essay: imaging findings following Y90 radiation segmentectomy for hepatocellular carcinoma. Abdom Radiol (NY) 2018; 43:1723-1738. [PMID: 29147766 DOI: 10.1007/s00261-017-1391-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Transarterial radioembolization is a novel therapy that has gained rapid clinical acceptance for the treatment of hepatocellular carcinoma (HCC). Segmental radioembolization [also termed radiation segmentectomy (RS)] is a technique that can deliver high doses (> 190 Gy) of radiation selectively to the hepatic segment(s) containing the tumor. The aim of this comprehensive review is to provide an illustrative summary of the most relevant imaging findings encountered after radiation segmentectomy. A 62-patient cohort of Child-Pugh A patients with solitary HCC < 5 cm in size was identified. A comprehensive retrospective imaging review was done by interventional radiology staff at our institution. Important imaging findings were reported and illustrated in a descriptive account. For the purposes of completeness, specific patients outside our initial cohort with unique educational imaging features that also underwent segmentectomy were included in this pictorial essay. This review shows that response assessment after RS requires a learning curve with common drawbacks that can lead to false-positive interpretations and secondary unnecessary treatments. It is important to recognize that treatment responses and pathological changes both are time dependent. Findings such as benign geographical enhancement and initial benign pathological enhancement can easily be misinterpreted. Capsular retraction and segmental atrophy are some other examples of unique post-RS response that are not seen in any other treatment.
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Affiliation(s)
- Ronald A Mora
- Department of Radiology, Section of Interventional Radiology, Northwestern Memorial Hospital, Robert H. Lurie Comprehensive Cancer Center, 676 N. St. Clair, Suite 800, Chicago, IL, 60611, USA
| | - Rehan Ali
- Department of Radiology, Section of Interventional Radiology, Northwestern Memorial Hospital, Robert H. Lurie Comprehensive Cancer Center, 676 N. St. Clair, Suite 800, Chicago, IL, 60611, USA
| | - Ahmed Gabr
- Department of Radiology, Section of Interventional Radiology, Northwestern Memorial Hospital, Robert H. Lurie Comprehensive Cancer Center, 676 N. St. Clair, Suite 800, Chicago, IL, 60611, USA
| | - Nadine Abouchaleh
- Department of Radiology, Section of Interventional Radiology, Northwestern Memorial Hospital, Robert H. Lurie Comprehensive Cancer Center, 676 N. St. Clair, Suite 800, Chicago, IL, 60611, USA
| | - Ali Al Asadi
- Department of Radiology, Section of Interventional Radiology, Northwestern Memorial Hospital, Robert H. Lurie Comprehensive Cancer Center, 676 N. St. Clair, Suite 800, Chicago, IL, 60611, USA
| | - Joseph Ralph Kallini
- Department of Radiology, Section of Interventional Radiology, Northwestern Memorial Hospital, Robert H. Lurie Comprehensive Cancer Center, 676 N. St. Clair, Suite 800, Chicago, IL, 60611, USA
| | - Frank H Miller
- Department of Radiology, Section of Body Imaging, Northwestern Memorial Hospital, Robert H. Lurie Comprehensive Cancer Center, Chicago, IL, USA
| | - Vahid Yaghmai
- Department of Radiology, Section of Body Imaging, Northwestern Memorial Hospital, Robert H. Lurie Comprehensive Cancer Center, Chicago, IL, USA
| | - Samdeep Mouli
- Department of Radiology, Section of Interventional Radiology, Northwestern Memorial Hospital, Robert H. Lurie Comprehensive Cancer Center, 676 N. St. Clair, Suite 800, Chicago, IL, 60611, USA
| | - Bartley Thornburg
- Department of Radiology, Section of Interventional Radiology, Northwestern Memorial Hospital, Robert H. Lurie Comprehensive Cancer Center, 676 N. St. Clair, Suite 800, Chicago, IL, 60611, USA
| | - Kush Desai
- Department of Radiology, Section of Interventional Radiology, Northwestern Memorial Hospital, Robert H. Lurie Comprehensive Cancer Center, 676 N. St. Clair, Suite 800, Chicago, IL, 60611, USA
| | - Ahsun Riaz
- Department of Radiology, Section of Interventional Radiology, Northwestern Memorial Hospital, Robert H. Lurie Comprehensive Cancer Center, 676 N. St. Clair, Suite 800, Chicago, IL, 60611, USA
| | - Robert J Lewandowski
- Department of Radiology, Section of Interventional Radiology, Northwestern Memorial Hospital, Robert H. Lurie Comprehensive Cancer Center, 676 N. St. Clair, Suite 800, Chicago, IL, 60611, USA
- Department of Surgery, Division of Transplantation, Comprehensive Transplant Center, Northwestern University, Chicago, IL, USA
- Department of Medicine, Division of Hematology and Oncology, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, USA
| | - Riad Salem
- Department of Radiology, Section of Interventional Radiology, Northwestern Memorial Hospital, Robert H. Lurie Comprehensive Cancer Center, 676 N. St. Clair, Suite 800, Chicago, IL, 60611, USA.
- Department of Surgery, Division of Transplantation, Comprehensive Transplant Center, Northwestern University, Chicago, IL, USA.
- Department of Medicine, Division of Hematology and Oncology, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, USA.
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Cai WL, Hong GB. Quantitative image analysis for evaluation of tumor response in clinical oncology. Chronic Dis Transl Med 2018; 4:18-28. [PMID: 29756120 PMCID: PMC5938243 DOI: 10.1016/j.cdtm.2018.01.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Indexed: 12/13/2022] Open
Abstract
The objective, accurate, and standardized evaluation of tumor response to treatment is an indispensable procedure in clinical oncology. Compared to manual measurement, computer-assisted linear measurement can significantly improve the accuracy and reproducibility of tumor burden quantification. For irregular-shaped and infiltrating or diffuse tumors, which are difficult to quantify by linear measurement, computer-assisted volumetric measurement may provide a more objective and sensitive quantification to evaluate tumor response to treatment than linear measurement does. In the evaluation of tumor response to novel oncologic treatments such as targeted therapy, changes in overall tumor size do not necessarily reflect tumor response to therapy due to the presence of internal necrosis or hemorrhages. This leads to a new generation of imaging biomarkers to evaluate tumor response by using texture analysis methods, also called radiomics. Computer-assisted texture analysis technology offers a more comprehensive and in-depth imaging biomarker to evaluate tumor response. The application of computer-assisted quantitative imaging analysis techniques not only reduces the inaccuracy and improves the reliability in tumor burden quantification, but facilitates the development of more comprehensive and intelligent approaches to evaluate treatment response, and hence promotes precision imaging in the evaluation of tumor response in clinical oncology. This article summarizes the state-of-the-art technical developments and clinical applications of quantitative imaging analysis in evaluation of tumor response in clinical oncology.
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Affiliation(s)
- Wen-Li Cai
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Guo-Bin Hong
- Department of Radiology, The Fifth Affiliated Hospital of Sun Yat-Sen University, Zhuhai, Guangdong 519000, China
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Schicho A, Pereira PL, Michalik K, Beyer LP, Stroszczynski C, Wiggermann P. Safety and efficacy of transarterial chemoembolization with degradable starch microspheres (DSM-TACE) in the treatment of secondary liver malignancies. Onco Targets Ther 2018; 11:345-350. [PMID: 29391811 PMCID: PMC5769599 DOI: 10.2147/ott.s147852] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Purpose To evaluate the safety and efficacy of degradable starch microspheres (DSM) as embolic agents in transarterial chemoembolization (TACE) in the treatment of secondary liver metastases. Methods This was a national, multicenter observational study. Primary endpoints were safety and treatment response according to Modified Response Evaluation Criteria in Solid Tumors (mRECIST) criteria. Results A total of 77 DSM-TACE procedures were performed in 20 patients. Minor immediate adverse events (AEs) were epigastric pain with an incidence of 45.5% (35/77), and nausea and vomiting at an incidence of 23.4% (18/77). Delayed minor AEs were epigastric pain in 13/77 (16.9%) treatments and nausea and vomiting in 10 (13.0%) treatments. No severe AEs were documented. Therapeutic efficacy of DSM-TACE procedures according to mRECIST was as follows: complete response 0/77, partial response 17/77, stable disease 33/77 and progressive disease 6/77, no data was available for 21/77 treatments. Overall, objective response was achieved in 8 of 20 patients (40.0%). Conclusion DSM as embolic agent for TACE is safe in the treatment of liver metastases. An objective response in 40.0% of patients and disease control in 64.9% of procedures was achieved, and this should lead to further evaluation of DSM-TACE as treatment option for nonresectable liver metastases.
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Affiliation(s)
- Andreas Schicho
- Department of Radiology, University Hospital Regensburg, Regensburg
| | - Philippe L Pereira
- Department of Radiology, Minimal-invasive Therapies and Nuclear Medicine, SLK Kliniken Heilbronn, Heilbronn, Germany
| | | | - Lukas P Beyer
- Department of Radiology, University Hospital Regensburg, Regensburg
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Lewis H, Ghasabeh M, Khoshpouri P, Kamel I, Pawlik T. Functional hepatic imaging as a biomarker of primary and secondary tumor response to loco-regional therapies. Surg Oncol 2017; 26:411-422. [DOI: 10.1016/j.suronc.2017.08.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Accepted: 08/21/2017] [Indexed: 02/06/2023]
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Ghobrial FEI, Eldin MS, Razek AAKA, Atwan NI, Shamaa SSA. Computed Tomography Assessment of Hepatic Metastases of Breast Cancer with Revised Response Evaluation Criteria in Solid Tumors (RECIST) Criteria (Version 1.1): Inter-Observer Agreement. Pol J Radiol 2017; 82:593-597. [PMID: 29657622 PMCID: PMC5894063 DOI: 10.12659/pjr.902930] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Accepted: 01/24/2017] [Indexed: 12/29/2022] Open
Abstract
Background To assess inter-observer agreement of revised RECIST criteria (version 1.1) for computed tomography assessment of hepatic metastases of breast cancer. Material/Methods A prospective study was conducted in 28 female patients with breast cancer and with at least one measurable metastatic lesion in the liver that was treated with 3 cycles of anthracycline-based chemotherapy. All patients underwent computed tomography of the abdomen with 64-row multi- detector CT at baseline and after 3 cycles of chemotherapy for response assessment. Image analysis was performed by 2 observers, based on the RECIST criteria (version 1.1). Results Computed tomography revealed partial response of hepatic metastases in 7 patients (25%) by one observer and in 10 patients (35.7%) by the other observer, with good inter-observer agreement (k=0.75, percent agreement of 89.29%). Stable disease was detected in 19 patients (67.8%) by one observer and in 16 patients (57.1%) by the other observer, with good agreement (k=0.774, percent agreement of 89.29%). Progressive disease was detected in 2 patients (7.2%) by both observers, with perfect agreement (k=1, percent agreement of 100%). The overall inter-observer agreement in the CT-based response assessment of hepatic metastasis between the two observers was good (k=0.793, percent agreement of 89.29%). Conclusions We concluded that computed tomography is a reliable and reproducible imaging modality for response assessment of hepatic metastases of breast cancer according to the RECIST criteria (version 1.1).
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Affiliation(s)
- Fady Emil Ibrahim Ghobrial
- Department of Internal Medicine (Medical Oncology), Faculty of Medicine, Oncology Center Mansoura University, Mansoura, Egypt
| | - Manal Salah Eldin
- Department of Internal Medicine (Medical Oncology), Faculty of Medicine, Oncology Center Mansoura University, Mansoura, Egypt
| | | | - Nadia Ibrahim Atwan
- Department of Pathology, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Sameh Sayed Ahmed Shamaa
- Department of Internal Medicine (Medical Oncology), Faculty of Medicine, Oncology Center Mansoura University, Mansoura, Egypt
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Schicho A, Pereira PL, Pützler M, Michalik K, Albrecht T, Nolte-Ernsting C, Stroszczynski C, Wiggermann P. Degradable Starch Microspheres Transcatheter Arterial Chemoembolization (DSM-TACE) in Intrahepatic Cholangiocellular Carcinoma (ICC): Results from a National Multi-Center Study on Safety and Efficacy. Med Sci Monit 2017; 23:796-800. [PMID: 28192388 PMCID: PMC5319442 DOI: 10.12659/msm.902901] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Background The aim of this study was to evaluate the safety and efficacy of DSM (degradable starch microspheres) as an embolic agent in transarterial chemoembolization in the treatment of intrahepatic cholangiocellular carcinoma (ICC). Material/Methods This was a national, multi-center observational cohort study on the safety and efficacy of DSM-TACE using mitomycin, gemcitabine, cisplatin, doxorubicin, and carboplatin in palliative treatment of ICC. Recruitment period for the study was from January 2010 to June 2014. Primary endpoints were toxicity, safety, and response according to mRECIST criteria. Results Twenty-five DSM-TACE procedures in cases of advanced ICC were performed in seven patients. Nausea and vomiting occurred as adverse event (AE) in eight out of 25 treatments (32%), with seven of eight events (87.5%) associated with the use of gemcitabine. In 11 out of 25 treatments (44%) moderate, transient epigastric pain was registered as an adverse event (AE) within 24 hours of DSM-TACE. One case (1/25) of severe AE (4%) with thrombocytopenia led to discontinuation of the DSM-TACE-treatment. A total of 25 DSM-TACE procedures with complete clinical and imaging follow-up over a two-year-period were analyzed: objective response (OR) was achieved in three of 25 treatments (12%) Disease control (DC) was achieved in 44% (11/25) of treatments; progress was registered in 4% (1/25). Conclusions The use of DSM as an embolic agent for TACE is safe in the treatment of ICC. A standardized anti-emetic medication should be established, especially when using gemcitabine. Further prospective studies need to be conducted to find the most suitable, standardized DSM-TACE treatment regime.
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Affiliation(s)
- Andreas Schicho
- Department of Radiology, University Medical Center Regensburg, Regensburg, Germany
| | - Philippe L Pereira
- Department of Radiology, Minimal-invasive Therapies and Nuclear Medicine, SLK Kliniken Heilbronn, Heilbronn, Germany
| | - Manfred Pützler
- Department of Radiology and Nuclear Medicine, Raphaelsklinik Münster, Münster, Germany
| | - Katharina Michalik
- Department of Radiology, University Medical Center Regensburg, Regensburg, Germany
| | - Thomas Albrecht
- Department of Radiology, Vivantes Clinic Neukölln, Berlin, Germany
| | - Claus Nolte-Ernsting
- Department of Radiology, Evangelical Hospital Mülheim an der Ruhr, Mülheim an der Ruhr, Germany
| | | | - Philipp Wiggermann
- Department of Radiology, University Medical Center Regensburg, Regensburg, Germany
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Abstract
PURPOSE To discuss guidelines and salient imaging findings of solid tumors treated with common intra-arterial procedures used in interventional oncology. METHODS A meticulous literature search of PubMed-indexed articles was conducted. Key words included "imaging + embolization," "imaging + TACE," "imaging + radioembolization," "imaging + Y90," "mRECIST," and "EASL." Representative post-treatment cross-sectional images were obtained from past cases in this institution. RESULTS Intra-arterial therapy (IAT) in interventional oncology includes bland embolization, chemoembolization, and radioembolization. Solid tumors of the liver are the primary focus of these procedures. Cross-sectional CT and/or MR are the main modalities used to image tumors after treatment. Traditional size-based response criteria (WHO and RECIST) alone are of limited utility in determining response to IAT; tumoral necrosis and enhancement must be considered. Specifically for HCC, the EASL and mRECIST guidelines are becoming widely adopted response criteria to assess these factors. DWI, FDG-PET, and CEUS are modalities that play an adjunctive but controversial role. CONCLUSIONS Radiologists must be aware that the different forms of intra-arterial therapy yield characteristic findings on cross-sectional imaging. Knowledge of these findings is integral to accurate assessment of tumor response and progression.
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