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Bannangkoon K, Hongsakul K, Tubtawee T. Lipiodol accumulation patterns and their impact on survival outcomes in transarterial chemoembolization for hepatocellular carcinoma: a single institution retrospective analysis. Sci Rep 2024; 14:18979. [PMID: 39152197 PMCID: PMC11329683 DOI: 10.1038/s41598-024-69993-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 08/12/2024] [Indexed: 08/19/2024] Open
Abstract
Conventional Transarterial chemoembolization (TACE) using Lipiodol is a pivotal therapeutic modality for hepatocellular carcinoma (HCC). The link between Lipiodol accumulation patterns and patient survival outcomes remains underexplored. This study assesses the impact of these patterns on the prognosis of HCC patients undergoing TACE. We evaluated HCC patients treated with selective TACE between July 2015 and March 2020, classifying post-procedure Lipiodol accumulation observed on CT scans into four distinct patterns: homogeneous, heterogeneous, defective, and deficient. We analyzed cumulative local tumor recurrence (LTR), progression-free survival (PFS), and overall survival (OS) rates across these groups. Univariate and multivariate logistic regression analyses were performed to identify potential prognostic factors influencing PFS and OS. Among 124 HCC nodules, the distribution of Lipiodol patterns was: 65 homogeneous, 24 heterogeneous, 10 defective, and 25 deficient. Median PFS was 33.2, 9.1, 1.1, and 1.0 months, respectively, while median OS spanned 54.8, 44.5, 25.0, and 29.1 months for these groups. A significant difference in survival was found only between the homogeneous and defective patterns (hazard ratio, 2.33; confidence interval 1.25-4.36). Multivariate analyses revealed nonhomogeneous patterns as significant predictors of shorter PFS (HR 6.45, p < 0.001) and OS (HR 1.73, p = 0.033). Nonhomogeneous Lipiodol patterns in HCC following TACE significantly correlate with higher recurrence and decreased survival rates, especially with defective patterns. Early detection of these patterns may guide timely intervention strategies, potentially enhancing survival outcomes for patients with HCC.
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Affiliation(s)
- Kittipitch Bannangkoon
- Department of Radiology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, 90110, Thailand.
| | - Keerati Hongsakul
- Department of Radiology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, 90110, Thailand
| | - Teeravut Tubtawee
- Department of Radiology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, 90110, Thailand
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Asmundo L, Ambrosini V, Mojtahed A, Fanti S, Ferrone C, Hesami M, Sertic M, Najmi Z, Furtado FS, Dhami RS, Anderson MA, Samir A, Sharma A, Campana D, Ursprung S, Nikolau K, Domachevsky L, Blake MA, Norris EC, Clark JW, Catalano OA. Imaging of Neuroendocrine Neoplasms; Principles of Treatment Strategies. What Referring Clinicians Want to Know. J Comput Assist Tomogr 2024; 48:628-639. [PMID: 38626751 DOI: 10.1097/rct.0000000000001619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/18/2024]
Abstract
ABSTRACT Neuroendocrine neoplasms (NENs) are a diverse group of tumors that express neuroendocrine markers and primarily affect the lungs and digestive system. The incidence of NENs has increased over time due to advancements in imaging and diagnostic techniques. Effective management of NENs requires a multidisciplinary approach, considering factors such as tumor location, grade, stage, symptoms, and imaging findings. Treatment strategies vary depending on the specific subtype of NEN. In this review, we will focus on treatment strategies and therapies including the information relevant to clinicians in order to undertake optimal management and treatment decisions, the implications of different therapies on imaging, and how to ascertain their possible complications and treatment effects.
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Affiliation(s)
| | | | - Amirkasra Mojtahed
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | | | - Cristina Ferrone
- Department of Surgery, Cedar-Sinai Health System, Los Angeles, CA
| | - Mina Hesami
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Madeleine Sertic
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Zahra Najmi
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Felipe S Furtado
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Ranjodh S Dhami
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Mark A Anderson
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Anthony Samir
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Amita Sharma
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Davide Campana
- Department of Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
| | - Stephan Ursprung
- Department of Radiology, University Hospital Tuebingen, Tuebingen, Germany
| | - Konstantin Nikolau
- Department of Radiology, University Hospital Tuebingen, Tuebingen, Germany
| | - Liran Domachevsky
- Department of Nuclear Medicine, The Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Michael A Blake
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Evan C Norris
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Jeffrey W Clark
- Department of Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Onofrio A Catalano
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
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Mendiratta-Lala M, Aslam A, Bai HX, Chapiro J, De Baere T, Miyayama S, Chernyak V, Matsui O, Vilgrain V, Fidelman N. Ethiodized oil as an imaging biomarker after conventional transarterial chemoembolization. Eur Radiol 2024; 34:3284-3297. [PMID: 37930412 PMCID: PMC11126446 DOI: 10.1007/s00330-023-10326-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 08/10/2023] [Accepted: 08/20/2023] [Indexed: 11/07/2023]
Abstract
Conventional transarterial chemoembolization (cTACE) utilizing ethiodized oil as a chemotherapy carrier has become a standard treatment for intermediate-stage hepatocellular carcinoma (HCC) and has been adopted as a bridging and downstaging therapy for liver transplantation. Water-in-oil emulsion made up of ethiodized oil and chemotherapy solution is retained in tumor vasculature resulting in high tissue drug concentration and low systemic chemotherapy doses. The density and distribution pattern of ethiodized oil within the tumor on post-treatment imaging are predictive of the extent of tumor necrosis and duration of response to treatment. This review describes the multiple roles of ethiodized oil, particularly in its role as a biomarker of tumor response to cTACE. CLINICAL RELEVANCE: With the increasing complexity of locoregional therapy options, including the use of combination therapies, treatment response assessment has become challenging; Ethiodized oil deposition patterns can serve as an imaging biomarker for the prediction of treatment response, and perhaps predict post-treatment prognosis. KEY POINTS: • Treatment response assessment after locoregional therapy to hepatocellular carcinoma is fraught with multiple challenges given the varied post-treatment imaging appearance. • Ethiodized oil is unique in that its' radiopacity can serve as an imaging biomarker to help predict treatment response. • The pattern of deposition of ethiodozed oil has served as a mechanism to detect portions of tumor that are undertreated and can serve as an adjunct to enhancement in order to improve management in patients treated with intraarterial embolization with ethiodized oil.
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Affiliation(s)
- Mishal Mendiratta-Lala
- Department of Radiology, University of Michigan Medicine, 1500 E Medical Center Dr., UH B2 A209R, Ann Arbor, MI, 48109, USA.
| | - Anum Aslam
- Department of Radiology, University of Michigan Medicine, 1500 E Medical Center Dr., UH B2 A209R, Ann Arbor, MI, 48109, USA
| | - Harrison X Bai
- Department of Radiology and Radiological Sciences, John Hopkins University, 601 N Caroline St, Baltimore, MD, 21287, USA
| | - Julius Chapiro
- Department of Radiology & Biomedical Imaging Yale University School of Medicine, 300 Cedar Street - TAC N312A, New Haven, CT, 06520, USA
| | - Thiery De Baere
- Gustave Roussy University of Paris Saclay, Villejuif, France
- Interventional Radiology, Gustave Roussy Cancer Center, Villejuif, France
- Département d'Anesthésie, Chirurgie et Imagerie Interventionnelle, Gustave Roussy Cancer Center, Villejuif, France
| | - Shiro Miyayama
- Department of Diagnostic Radiology, Fukui-ken Saiseikai Hospital 7-1, Funabashi, Wadanaka-cho, Fukui, 918-8503, Japan
| | - Victoria Chernyak
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York City, NY, USA
| | - Osamu Matsui
- Department of Radiology, Kananzawa University, Japan, 2-21-9 Asahi-machi, Kanazawa, 920-0941, Japan
| | - Valerie Vilgrain
- Department of Radiology, Hospital Beaujon APHP.Nord, Université Paris Cité, CRI INSERM 1149, Paris, France
| | - Nicholas Fidelman
- University of California San Francisco, 505 Parnassus Avenue, Room M-361, San Francisco, CA, 94143, USA
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Langenbach MC, Vogl TJ, Said G, Scholtz JE, Hammerstingl R, Gruber-Rouh T. Lipiodol as a Predictive Indicator for Therapy Response to Transarterial Chemoembolization of Hepatocellular Carcinoma. Cancer Biother Radiopharm 2024; 39:196-202. [PMID: 33481646 DOI: 10.1089/cbr.2020.4137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: The predictive value of Lipiodol was evaluated for response evaluation of hepatocellular carcinoma (HCC) treated with conventional transarterial chemoembolization (cTACE) by analysis of the enhancement pattern during angiography and in postinterventional computed tomography (CT). Materials and Methods: This retrospective study included 30 patients (mean age 63 years, range: 36 to 82 years, 22 males) with HCC. Patients received three Lipiodol-based cTACE sessions, each followed by an unenhanced CT within 24-h. Contrast-enhanced magnetic resonance imaging (MRI) was acquired before and after the treatment to determine tumor response. Lipiodol enhancement pattern, tumor vascularization, and density were evaluated by angiography and CT. Initial tumor size and response to cTACE were analyzed by MRI according to modified response evaluation criteria in solid tumors (mRECIST) in a 4-week follow-up. Results: Analysis of HCC lesions (68 lesions in 30 patients) during cTACE revealed clear visibility and hypervascularization in angiography as a potential independent parameter able to predict tumor response. A significant correlation was found for response measurements by volume (p = 0.012), diameter (p = 0.006), and according to mRECIST (p = 0.039). The amount of Lipiodol and enhancement pattern in postinterventional CT did not correlate with therapy response. Measurements of Hounsfield unit values after cTACE do not allow sufficient prediction of the tumor response. Conclusion: Hypervascularized HCC lesions with clear visibility after Lipiodol administration in the angiography respond significantly better to cTACE compared to hypo- or nonvascularized lesions.
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Affiliation(s)
- Marcel C Langenbach
- Institute for Diagnostic and Interventional Radiology, University Hospital Cologne, Cologne, Germany
- Institute for Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany
| | - Thomas J Vogl
- Institute for Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany
| | - Gulia Said
- Institute for Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany
| | - Jan-Erik Scholtz
- Institute for Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany
| | - Renate Hammerstingl
- Institute for Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany
| | - Tatjana Gruber-Rouh
- Institute for Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany
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Kudo M, Ueshima K, Saeki I, Ishikawa T, Inaba Y, Morimoto N, Aikata H, Tanabe N, Wada Y, Kondo Y, Tsuda M, Nakao K, Ito T, Hosaka T, Kawamura Y, Kuzuya T, Nojiri S, Ogawa C, Koga H, Hino K, Ikeda M, Moriguchi M, Hisai T, Yoshimura K, Furuse J, Arai Y. A Phase 2, Prospective, Multicenter, Single-Arm Trial of Transarterial Chemoembolization Therapy in Combination Strategy with Lenvatinib in Patients with Unresectable Intermediate-Stage Hepatocellular Carcinoma: TACTICS-L Trial. Liver Cancer 2024; 13:99-112. [PMID: 38344448 PMCID: PMC10857829 DOI: 10.1159/000531377] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 05/30/2023] [Indexed: 07/12/2024] Open
Abstract
INTRODUCTION Transarterial chemoembolization (TACE) is the standard treatment for unresectable intermediate-stage hepatocellular carcinoma (HCC), but recurrence after TACE is common. The present phase 2, prospective, multicenter, single-arm trial, the TACTICS-L trial, investigated the efficacy and safety of TACE plus lenvatinib (LEN), a drug that more strongly promotes vascular normalization and has a better objective response rate (ORR) than sorafenib (jRCTs031180074). METHODS Participants were patients with HCC who had not previously received systemic therapy, hepatic arterial infusion chemotherapy, or immunotherapy and who were ineligible for resection or percutaneous ablation therapy. LEN was to be administered 14-21 days before the first TACE, stopped 2 days before TACE, and resumed 3 days after TACE. Key inclusion criteria were unresectable HCC, Child-Pugh A liver function, 0-2 prior TACE sessions, tumor size ≤10 cm, number of tumors ≤10, and ECOG performance status 0-1. Key exclusion criteria were vascular invasion and extrahepatic spread. The primary endpoint was progression-free survival (PFS) by RECICL, and secondary endpoints were time to untreatable progression, ORR, overall survival (OS), and safety. RESULTS A total of 62 HCC patients were enrolled in this trial. The median age was 72 years, 77.4% of patients were men, and 95.2% had PS 0. The primary endpoint of median PFS was 28.0 months (90% confidence interval [CI] 25.1-31.0) after a minimum 24 months of follow-up. The secondary endpoint of median OS was not reached (90% CI 35.5 months-NR). LEN-TACE achieved a high response rate and high complete response (CR) rate (4 weeks after the first TACE: ORR 79.0%, CR rate 53.2%; best response: ORR 88.7%, CR rate 67.7%) by RECICL. Exploratory subgroup analyses showed that the characteristics of responders/nonresponders (ORR and CR rate) were similar and that LEN-TACE would be effective in all subgroups, including the population in whom TACE alone would be less likely to be curative (e.g., patients with the non-simple nodular type or a high tumor burden). The relative dose intensity of LEN before the first TACE was important for achieving higher CR rate/ORR by LEN-TACE. No new safety concerns were observed. CONCLUSION The results of this trial provide encouraging evidence, supporting the efficacy and favorable safety profile of LEN-TACE in patients who are ineligible for locoregional therapy.
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Affiliation(s)
- Masatoshi Kudo
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka-Sayama, Japan
| | - Kazuomi Ueshima
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka-Sayama, Japan
| | - Issei Saeki
- Department of Gastroenterology and Hepatology, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Toru Ishikawa
- Department of Gastroenterology, Saiseikai Niigata Hospital, Niigata, Japan
| | - Yoshitaka Inaba
- Department of Diagnostic and Interventional Radiology, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Naoki Morimoto
- Department of Medicine, Division of Gastroenterology, Jichi Medical University, Tochigi, Japan
| | - Hiroshi Aikata
- Department of Gastroenterology, Hiroshima Prefectural Hospital, Hiroshima, Japan
| | - Nobukazu Tanabe
- Department of Gastroenterology, National Hospital Organisation Sendai Medical Center, Sendai, Japan
| | - Yoshiyuki Wada
- Department of Hepato-Biliary-Pancreatic Surgery, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Yasuteru Kondo
- Department of Hepatology, Sendai Kousei Hospital, Sendai, Japan
| | - Masahiro Tsuda
- Department of Gastroenterological Oncology, Hyogo Cancer Center, Akashi, Japan
| | - Kazuhiko Nakao
- Department of Gastroenterology and Hepatology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Takanori Ito
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Tetsuya Hosaka
- Department of Hepatology, Toranomon Hospital Kajigaya, Kawasaki, Japan
| | | | - Teiji Kuzuya
- Department of Gastroenterology and Hepatology, Fujita Health University, Toyoake, Japan
| | - Shunsuke Nojiri
- Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Chikara Ogawa
- Department of Gastroenterology, Takamatsu Red Cross Hospital, Takamatsu, Japan
| | - Hironori Koga
- Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Kurume, Japan
| | - Keisuke Hino
- Digestive Disease Center, Shunan Memorial Hospital, Kudamatsu, Japan
| | - Masafumi Ikeda
- Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | - Michihisa Moriguchi
- Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine Graduate School of Medical Science, Kyoto, Japan
| | - Takashi Hisai
- Eisai Co. Ltd., Oncology Department, Medical HQs, Tokyo, Japan
| | - Kenichi Yoshimura
- Medical Center for Translational and Clinical Research, Hiroshima University Hospital, Hiroshima, Japan
| | - Junji Furuse
- Department of Gastroenterology and Hepatology, Kanagawa Cancer Center, Yokohama, Japan
| | - Yasuaki Arai
- Department of Diagnostic Radiology, National Cancer Center Hospital, Tokyo, Japan
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Niitsu H, Mizumoto M, Li Y, Nakamura M, Ishida T, Iizumi T, Saito T, Numajiri H, Makishima H, Nakai K, Oshiro Y, Maruo K, Sakurai H. Tumor Response on Diagnostic Imaging after Proton Beam Therapy for Hepatocellular Carcinoma. Cancers (Basel) 2024; 16:357. [PMID: 38254846 PMCID: PMC10814092 DOI: 10.3390/cancers16020357] [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: 12/14/2023] [Revised: 01/10/2024] [Accepted: 01/12/2024] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND Follow-up after treatment for hepatocellular carcinoma (HCC) can be mostly performed using dynamic CT or MRI, but there is no common evaluation method after radiation therapy. The purpose of this study is to examine factors involved in tumor reduction and local recurrence in patients with HCC treated with proton beam therapy (PBT) and to evaluate HCC shrinkage after PBT. METHODS Cases with only one irradiated lesion or those with two lesions irradiated simultaneously were included in this study. Pre- and post-treatment lesions were evaluated using Response Evaluation Criteria in Solid Tumors (RECIST) by measuring the largest diameter. RESULTS The 6-, 12-, and 24-month CR + PR rates after PBT were 33.1%, 57.5%, and 76.9%, respectively, and the reduction rates were 25.1% in the first 6 months, 23.3% at 6-12 months, and 14.5% at 13-24 months. Cases that reached CR/PR at 6 and 12 months had improved OS compared to non-CR/non-PR cases. CONCLUSIONS It is possible that a lesion that reached SD may subsequently transition to PR; it is reasonable to monitor progress with periodic imaging evaluations even after 1 year of treatment.
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Affiliation(s)
- Hikaru Niitsu
- Proton Medical Research Center, Department of Radiation Oncology, University of Tsukuba Hospital, Tsukuba 305-8576, Ibaraki, Japan; (H.N.); (Y.L.); (M.N.); (T.I.); (T.I.); (T.S.); (H.N.); (H.M.); (K.N.); (Y.O.); (H.S.)
| | - Masashi Mizumoto
- Proton Medical Research Center, Department of Radiation Oncology, University of Tsukuba Hospital, Tsukuba 305-8576, Ibaraki, Japan; (H.N.); (Y.L.); (M.N.); (T.I.); (T.I.); (T.S.); (H.N.); (H.M.); (K.N.); (Y.O.); (H.S.)
| | - Yinuo Li
- Proton Medical Research Center, Department of Radiation Oncology, University of Tsukuba Hospital, Tsukuba 305-8576, Ibaraki, Japan; (H.N.); (Y.L.); (M.N.); (T.I.); (T.I.); (T.S.); (H.N.); (H.M.); (K.N.); (Y.O.); (H.S.)
| | - Masatoshi Nakamura
- Proton Medical Research Center, Department of Radiation Oncology, University of Tsukuba Hospital, Tsukuba 305-8576, Ibaraki, Japan; (H.N.); (Y.L.); (M.N.); (T.I.); (T.I.); (T.S.); (H.N.); (H.M.); (K.N.); (Y.O.); (H.S.)
| | - Toshiki Ishida
- Proton Medical Research Center, Department of Radiation Oncology, University of Tsukuba Hospital, Tsukuba 305-8576, Ibaraki, Japan; (H.N.); (Y.L.); (M.N.); (T.I.); (T.I.); (T.S.); (H.N.); (H.M.); (K.N.); (Y.O.); (H.S.)
| | - Takashi Iizumi
- Proton Medical Research Center, Department of Radiation Oncology, University of Tsukuba Hospital, Tsukuba 305-8576, Ibaraki, Japan; (H.N.); (Y.L.); (M.N.); (T.I.); (T.I.); (T.S.); (H.N.); (H.M.); (K.N.); (Y.O.); (H.S.)
| | - Takashi Saito
- Proton Medical Research Center, Department of Radiation Oncology, University of Tsukuba Hospital, Tsukuba 305-8576, Ibaraki, Japan; (H.N.); (Y.L.); (M.N.); (T.I.); (T.I.); (T.S.); (H.N.); (H.M.); (K.N.); (Y.O.); (H.S.)
| | - Haruko Numajiri
- Proton Medical Research Center, Department of Radiation Oncology, University of Tsukuba Hospital, Tsukuba 305-8576, Ibaraki, Japan; (H.N.); (Y.L.); (M.N.); (T.I.); (T.I.); (T.S.); (H.N.); (H.M.); (K.N.); (Y.O.); (H.S.)
| | - Hirokazu Makishima
- Proton Medical Research Center, Department of Radiation Oncology, University of Tsukuba Hospital, Tsukuba 305-8576, Ibaraki, Japan; (H.N.); (Y.L.); (M.N.); (T.I.); (T.I.); (T.S.); (H.N.); (H.M.); (K.N.); (Y.O.); (H.S.)
| | - Kei Nakai
- Proton Medical Research Center, Department of Radiation Oncology, University of Tsukuba Hospital, Tsukuba 305-8576, Ibaraki, Japan; (H.N.); (Y.L.); (M.N.); (T.I.); (T.I.); (T.S.); (H.N.); (H.M.); (K.N.); (Y.O.); (H.S.)
| | - Yoshiko Oshiro
- Proton Medical Research Center, Department of Radiation Oncology, University of Tsukuba Hospital, Tsukuba 305-8576, Ibaraki, Japan; (H.N.); (Y.L.); (M.N.); (T.I.); (T.I.); (T.S.); (H.N.); (H.M.); (K.N.); (Y.O.); (H.S.)
- Department of Radiation Oncology, Tsukuba Medical Center Hospital, Tsukuba 305-8558, Ibaraki, Japan
| | - Kazushi Maruo
- Department of Biostatistics, Institute of Medicine, University of Tsukuba, Tsukuba 305-8576, Ibaraki, Japan;
| | - Hideyuki Sakurai
- Proton Medical Research Center, Department of Radiation Oncology, University of Tsukuba Hospital, Tsukuba 305-8576, Ibaraki, Japan; (H.N.); (Y.L.); (M.N.); (T.I.); (T.I.); (T.S.); (H.N.); (H.M.); (K.N.); (Y.O.); (H.S.)
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Lee CC, Hwang JI, Chang KH, Lin YC, Chao CC, Cheng TF, Chen YC, Hsueh KC. Comparison of contrast-enhanced ultrasonography and MRI results obtained by expert and novice radiologists indicating short-term response after transarterial chemoembolisation for hepatocellular carcinoma. Clin Radiol 2024; 79:e73-e79. [PMID: 37914602 DOI: 10.1016/j.crad.2023.09.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 08/21/2023] [Accepted: 09/21/2023] [Indexed: 11/03/2023]
Abstract
AIM To evaluate inter-reader agreement between novice and expert radiologists in assessing contrast-enhanced ultrasonography (CEUS) and magnetic resonance imaging (MRI) images for detecting viable tumours with different sizes after conventional transarterial chemoembolisation (cTACE). MATERIALS AND METHODS This prospective study included patients who had less than five hepatomas and who underwent cTACE. Hepatomas with one or two feeding arteries were selected as target lesions. CEUS and MRI were performed within 1 week after cTACE to evaluate viable tumours. RESULTS The expert group had higher kappa values in evaluating all tumour sizes via CEUS compared with MRI. The novice group had similar kappa values. In patients with tumours measuring ≤3 cm, the expert group had higher kappa values in reading CEUS compared with MRI images; however, in the novice group, the kappa value was lower in evaluating CEUS compared with MRI images. In patients with tumours measuring >3 cm, the expert and novice groups had good to excellent kappa values. The confidence level of the two groups in reading MRI images was high; however, the novice group had a lower confidence level. CONCLUSION CEUS is a convenient, cost-effective, and easy to apply imaging tool that can help interventionists perform early detection of viable hepatocellular carcinoma post-TACE. It has a higher inter-rater agreement in interpreting CEUS images compared with MRI images among expert radiologists even when they are extremely familiar with post-cTACE MRI images. In novice radiologists, there may be a learning curve to achieve good consistency in CEUS interpretation.
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Affiliation(s)
- C-C Lee
- Division of Interventional Radiology, Department of Medical Imaging, Tungs' Taichung Metroharbor Hospital, Taichung 43503, Taiwan
| | - J-I Hwang
- Division of Interventional Radiology, Department of Medical Imaging, Tungs' Taichung Metroharbor Hospital, Taichung 43503, Taiwan; Department of Radiology, National Defense Medical Center, Taipei 11490, Taiwan
| | - K-H Chang
- Department of Medical Research, Tungs' Taichung Metroharbor Hospital, Taichung Taiwan; Center for General Education, China Medical University, Taichung 404, Taiwan; General Education Center, Jen-Teh Junior College of Medicine, Nursing and Management, Miaoli 356, Taiwan; Department of Life Sciences and Ph.D. Program in Translational Medicine, National Chung Hsing University, Taichung 40227, Taiwan
| | - Y C Lin
- Division of Interventional Radiology, Department of Medical Imaging, Tungs' Taichung Metroharbor Hospital, Taichung 43503, Taiwan
| | - C C Chao
- Division of Interventional Radiology, Department of Medical Imaging, Tungs' Taichung Metroharbor Hospital, Taichung 43503, Taiwan
| | - T-F Cheng
- Division of Interventional Radiology, Department of Medical Imaging, Tungs' Taichung Metroharbor Hospital, Taichung 43503, Taiwan
| | - Y-C Chen
- Division of Interventional Radiology, Department of Medical Imaging, Tungs' Taichung Metroharbor Hospital, Taichung 43503, Taiwan; Department of Medical Research, Tungs' Taichung Metroharbor Hospital, Taichung Taiwan
| | - K-C Hsueh
- Division of Interventional Radiology, Department of Medical Imaging, Tungs' Taichung Metroharbor Hospital, Taichung 43503, Taiwan; Division of General Surgery, Department of Surgery, Tungs' Taichung Metroharbor Hospital, Taichung 43503, Taiwan; Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, 40227, Taiwan.
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Kim J, Gwon DI, Kim Y, Kim GH, Kim SH, Chu HH, Kim JH, Shin JH, Ko GY, Yoon HK. Preoperative Balloon-Occluded Transcatheter Arterial Chemoembolization Followed by Surgical Resection: Pathological Evaluation of Necrosis. Diseases 2023; 11:149. [PMID: 37987260 PMCID: PMC10660476 DOI: 10.3390/diseases11040149] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Revised: 10/13/2023] [Accepted: 10/22/2023] [Indexed: 11/22/2023] Open
Abstract
This study investigates the clinical and pathological outcomes of preoperative balloon-occluded transcatheter arterial chemoembolization (B-TACE) in patients with single hepatocellular carcinoma (HCC). The data are from 25 consecutive patients who underwent sequential treatment of subsegmental B-TACE and hepatic surgery for single HCC. Radiological and pathological evaluation of oily subsegmentectomy, defined as the iodized oil-laden necrotic area that includes the entire HCC and surrounding liver parenchyma, were performed. Subsegmental B-TACE was technically successful in all patients. The major and minor complication rates were 8% and 24%, respectively. On the first follow-up computed tomography (CT), oily subsegmentectomy was observed in 18 (72%) out of 25 patients. Apart from one patient showing a partial response, the remaining 24 (96%) patients showed a complete response. Pathological complete necrosis of the HCC was observed in 18 (72%) out of 25 patients with complete or extensive necrosis of the peritumoral liver parenchyma. The remaining seven patients without peritumoral parenchymal necrosis had extensive necrosis of the HCCs. In conclusion, preoperative B-TACE can be a safe and effective method for the treatment of single HCC and a good bridge treatment for subsequent surgical resection. In addition, oily subsegmentectomy itself on the CT can be a good predictor of pathological complete necrosis of the HCC. The findings obtained from this study would provide a potential role of B-TACE in the treatment strategy for single HCC.
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Affiliation(s)
- Jihoon Kim
- Department of Radiology, Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05502, Republic of Korea; (J.K.); (Y.K.); (G.H.K.); (S.H.K.); (H.H.C.); (J.H.K.); (J.H.S.); (G.-Y.K.); (H.-K.Y.)
- Ajou University Hospital, College of Medicine, Ajou University, Suwon 16499, Republic of Korea
| | - Dong Il Gwon
- Department of Radiology, Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05502, Republic of Korea; (J.K.); (Y.K.); (G.H.K.); (S.H.K.); (H.H.C.); (J.H.K.); (J.H.S.); (G.-Y.K.); (H.-K.Y.)
| | - Yonghun Kim
- Department of Radiology, Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05502, Republic of Korea; (J.K.); (Y.K.); (G.H.K.); (S.H.K.); (H.H.C.); (J.H.K.); (J.H.S.); (G.-Y.K.); (H.-K.Y.)
| | - Gun Ha Kim
- Department of Radiology, Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05502, Republic of Korea; (J.K.); (Y.K.); (G.H.K.); (S.H.K.); (H.H.C.); (J.H.K.); (J.H.S.); (G.-Y.K.); (H.-K.Y.)
| | - Seong Ho Kim
- Department of Radiology, Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05502, Republic of Korea; (J.K.); (Y.K.); (G.H.K.); (S.H.K.); (H.H.C.); (J.H.K.); (J.H.S.); (G.-Y.K.); (H.-K.Y.)
| | - Hee Ho Chu
- Department of Radiology, Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05502, Republic of Korea; (J.K.); (Y.K.); (G.H.K.); (S.H.K.); (H.H.C.); (J.H.K.); (J.H.S.); (G.-Y.K.); (H.-K.Y.)
| | - Jin Hyoung Kim
- Department of Radiology, Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05502, Republic of Korea; (J.K.); (Y.K.); (G.H.K.); (S.H.K.); (H.H.C.); (J.H.K.); (J.H.S.); (G.-Y.K.); (H.-K.Y.)
| | - Ji Hoon Shin
- Department of Radiology, Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05502, Republic of Korea; (J.K.); (Y.K.); (G.H.K.); (S.H.K.); (H.H.C.); (J.H.K.); (J.H.S.); (G.-Y.K.); (H.-K.Y.)
| | - Gi-Young Ko
- Department of Radiology, Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05502, Republic of Korea; (J.K.); (Y.K.); (G.H.K.); (S.H.K.); (H.H.C.); (J.H.K.); (J.H.S.); (G.-Y.K.); (H.-K.Y.)
| | - Hyun-Ki Yoon
- Department of Radiology, Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05502, Republic of Korea; (J.K.); (Y.K.); (G.H.K.); (S.H.K.); (H.H.C.); (J.H.K.); (J.H.S.); (G.-Y.K.); (H.-K.Y.)
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9
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Gwon DI, Kim GH, Chu HH, Kim JH, Ko GY, Yoon HK. Local Recurrence following Radiological Complete Response in Patients Treated with Subsegmental Balloon-Occluded Transcatheter Arterial Chemoembolization for Hepatocellular Carcinoma. Cancers (Basel) 2023; 15:4991. [PMID: 37894358 PMCID: PMC10605316 DOI: 10.3390/cancers15204991] [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: 09/15/2023] [Revised: 10/11/2023] [Accepted: 10/13/2023] [Indexed: 10/29/2023] Open
Abstract
The aim of this study was to determine the local recurrence (LR) rate and identify factors associated with LR in patients who achieve a radiological complete response (CR) after undergoing balloon-occluded transcatheter arterial chemoembolization (B-TACE) for hepatocellular carcinoma (HCC). From November 2017 to September 2021, 60 patients (44 men, 16 women; mean age, 63.5 years; range, 39-82 years) with 72 HCCs (mean diameter, 31 mm; range, 10-50 mm) who underwent subsegmental B-TACE were included in this retrospective study. Radiological and clinical evaluation of oily subsegmentectomy, defined as radiological CR of the HCC and peritumoral parenchymal necrosis, was performed. The CR rate was 97.2% (70 of 72 HCCs) at first follow-up (mean, 41 days; range, 14-110 days). Overall, 13 HCCs (19.7%) demonstrated LR at a mean of 29.8 months (range, 3-63 months) and cumulative LR rates were 1.5% 14.2% 21%, 21%, and 21% at 6, 12, 24, 36, and 48 months, respectively. In 28 (38.9%) of 72 HCCs, oily subsegmentectomy was achieved, tumor markers were normalized, and LR did not occur. The oily subsegmentectomy-positive group had a significantly lower LR rate than the oily subsegmentectomy-negative group (p = 0.001). Age ≥65 years (adjusted hazard ration (HR), 0.124; 95% confidence interval (CI), 0.037-0.412; p < 0.001) and peripheral location (adjusted HR, 0.112; 95% CI, 0.046-0.272; p < 0.001) were independent predictive factors of LR. Subsegmental B-TACE can be an effective method with a high initial CR rate and low LR incidence. Oily subsegmentectomy can be considered as an index of successful treatment because it did not demonstrate any LR.
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Affiliation(s)
- Dong Il Gwon
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Republic of Korea; (G.H.K.); (H.H.C.); (J.H.K.); (G.-Y.K.); (H.-K.Y.)
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10
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Ronot M, Dioguardi Burgio M, Gregory J, Hentic O, Vullierme MP, Ruszniewski P, Zappa M, de Mestier L. Appropriate use of morphological imaging for assessing treatment response and disease progression of neuroendocrine tumors. Best Pract Res Clin Endocrinol Metab 2023; 37:101827. [PMID: 37858478 DOI: 10.1016/j.beem.2023.101827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2023]
Abstract
Neuroendocrine tumors (NETs) are relatively rare neoplasms displaying heterogeneous clinical behavior, ranging from indolent to aggressive forms. Patients diagnosed with NETs usually receive a varied array of treatments, including somatostatin analogs, locoregional treatments (ablation, intra-arterial therapy), cytotoxic chemotherapy, peptide receptor radionuclide therapy (PRRT), and targeted therapies. To maximize therapeutic efficacy while limiting toxicity (both physical and economic), there is a need for accurate and reliable tools to monitor disease evolution and progression and to assess the effectiveness of these treatments. Imaging morphological methods, primarily relying on computed tomography (CT) and magnetic resonance imaging (MRI), are indispensable modalities for the initial evaluation and continuous monitoring of patients with NETs, therefore playing a pivotal role in gauging the response to treatment. The primary goal of assessing tumor response is to anticipate and weigh the benefits of treatments, especially in terms of survival gain. The World Health Organization took the pioneering step of introducing assessment criteria based on cross-sectional imaging. This initial proposal standardized the measurement of lesion sizes, laying the groundwork for subsequent criteria. The Response Evaluation Criteria in Solid Tumors (RECIST) subsequently refined and enhanced these standards, swiftly gaining acceptance within the oncology community. New treatments were progressively introduced, targeting specific features of NETs (such as tumor vascularization or expression of specific receptors), and achieving significant qualitative changes within tumors, although associated with minimal or paradoxical effects on tumor size. Several alternative criteria, adapted from those used in other cancer types and focusing on tumor viability, the slow growth of NETs, or refining the existing size-based RECIST criteria, have been proposed in NETs. This review article aims to describe and discuss the optimal utilization of CT and MRI for assessing the response of NETs to treatment; it provides a comprehensive overview of established and emerging criteria for evaluating tumor response, along with comparative analyses. Molecular imaging will not be addressed here and is covered in a dedicated article within this special issue.
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Affiliation(s)
- Maxime Ronot
- Université Paris-Cité, Centre de Recherche sur l'Inflammation, INSERM UMR1149, FHU MOSAIC, Paris, France; Université Paris-Cité, Department of Radiology, Beaujon Hospital (APHP.Nord), Clichy, France.
| | - Marco Dioguardi Burgio
- Université Paris-Cité, Centre de Recherche sur l'Inflammation, INSERM UMR1149, FHU MOSAIC, Paris, France; Université Paris-Cité, Department of Radiology, Beaujon Hospital (APHP.Nord), Clichy, France
| | - Jules Gregory
- Université Paris-Cité, Centre de Recherche sur l'Inflammation, INSERM UMR1149, FHU MOSAIC, Paris, France; Université Paris-Cité, Department of Radiology, Beaujon Hospital (APHP.Nord), Clichy, France
| | - Olivia Hentic
- Université Paris-Cité, Department of Pancreatology and Digestive Oncology, Beaujon Hospital (APHP.Nord), Clichy, France
| | | | - Philippe Ruszniewski
- Université Paris-Cité, Centre de Recherche sur l'Inflammation, INSERM UMR1149, FHU MOSAIC, Paris, France; Université Paris-Cité, Department of Pancreatology and Digestive Oncology, Beaujon Hospital (APHP.Nord), Clichy, France
| | - Magaly Zappa
- Department of Radiology, Cayenne University Hospital, Cayenne, Guyanne, France
| | - Louis de Mestier
- Université Paris-Cité, Centre de Recherche sur l'Inflammation, INSERM UMR1149, FHU MOSAIC, Paris, France; Université Paris-Cité, Department of Pancreatology and Digestive Oncology, Beaujon Hospital (APHP.Nord), Clichy, France
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11
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Chang PY, Lee RC, Liang PC, Liu YS, Chuang VP, Wu DK, Cheng YF, Huang JI, Tseng HS, Hung CF, Wu RH, Chern MC, Cheng HM, Wu CH, Cheng SM, Chiang CL, Liang HL. Multidisciplinary Taiwan consensus for the use of conventional TACE in hepatocellular carcinoma treatment. Front Oncol 2023; 13:1186674. [PMID: 37427137 PMCID: PMC10328116 DOI: 10.3389/fonc.2023.1186674] [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: 03/15/2023] [Accepted: 06/05/2023] [Indexed: 07/11/2023] Open
Abstract
Developed in early 1980s, transarterial chemoembolization (TACE) with Lipiodol was adopted globally after large-scale randomized control trials and meta-analyses proving its effectiveness were completed. Also known as "conventional TACE" (cTACE), TACE is currently the first-line treatment for patients with unresectable intermediate stage hepatocellular carcinoma (HCC) and delivers both ischemic and cytotoxic effects to targeted tumors. Although new technology and clinical studies have contributed to a more comprehensive understanding of when and how to apply this widely-adopted therapeutic modality, some of these new findings and techniques have yet to be incorporated into a guideline appropriate for Taiwan. In addition, differences in the underlying liver pathologies and treatment practices for transcatheter embolization between Taiwan and other Asian or Western populations have not been adequately addressed, with significant variations in the cTACE protocols adopted in different parts of the world. These mainly revolve around the amount and type of chemotherapeutic agents used, the type of embolic materials, reliance on Lipiodol, and the degree of selectiveness in catheter positioning. Subsequently, interpreting and comparing results obtained from different centers in a systematic fashion remain difficult, even for experienced practitioners. To address these concerns, we convened a panel of experts specializing in different aspects of HCC treatment to devise modernized recommendations that reflect recent clinical experiences, as well as cTACE protocols which are tailored for use in Taiwan. The conclusions of this expert panel are described herein.
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Affiliation(s)
- Pi-Yi Chang
- Department of Radiology, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Rheun-Chuan Lee
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Po-Chin Liang
- Department of Radiology, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan
| | - Yi-Sheng Liu
- Department of Medical Imagine, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Vicent P. Chuang
- Department of Radiology, Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan
| | - Ding-Kwo Wu
- Department of Radiology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Yu-Fan Cheng
- Department of Radiology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Jen-I. Huang
- Department of Radiology, Tungs’ Taichung Metroharbor Hospital, Taichung, Taiwan
| | - Hsiuo-Shan Tseng
- Department of Radiology, Cheng Hsin General Hospital, Taipei, Taiwan
| | - Chien-Fu Hung
- Department of Radiology, Chang−Gung Memorial Hospital, Taoyuan, Taiwan
| | - Reng-Hong Wu
- Department of Radiology, Chi Mei Medical Center, Tainan, Taiwan
| | - Ming-Chih Chern
- Department of Radiology, Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan
| | - Hua-Ming Cheng
- Department of Radiology, Chi Mei Medical Center, Tainan, Taiwan
| | - Chih-Horng Wu
- Department of Radiology, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan
| | - She-Meng Cheng
- Department of Radiology, MacKay Memorial Hospital, Taipei, Taiwan
| | - Chia-Ling Chiang
- Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Huei-Lung Liang
- Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
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12
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Chu HH, Gwon DI, Kim GH, Kim JH, Ko GY, Shin JH, Ko HK, Yoon HK. Balloon-occluded transarterial chemoembolization versus conventional transarterial chemoembolization for the treatment of single hepatocellular carcinoma: a propensity score matching analysis. Eur Radiol 2023; 33:2655-2664. [PMID: 36472699 DOI: 10.1007/s00330-022-09284-3] [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: 03/10/2022] [Revised: 08/29/2022] [Accepted: 11/06/2022] [Indexed: 12/12/2022]
Abstract
OBJECTIVES To compare the safety and efficacy of balloon-occluded transarterial chemoembolization (B-TACE) and conventional TACE (C-TACE) in treating single hepatocellular carcinoma (HCC). METHODS This single-center retrospective study included 523 patients who underwent C-TACE and 44 who underwent B-TACE as first-line treatment for single HCCs between November 2017 and December 2019. After propensity score matching (PSM), initial tumor response rates, local tumor progression (LTP), and major complication rates were evaluated in the 32 pairs of PSM matched population. RESULTS In the 32 pairs of PSM cohort, B-TACE showed distinct superiority over C-TACE in treating single HCCs, with significantly higher initial complete response (CR) rates (93.8% vs. 62.5%, p = 0.005). During a median follow-up of 37 months (range, 12.7-46.5 months), 13 patients (40.6%) who underwent B-TACE and 16 (50%) who underwent C-TACE showed LTP of treated lesions. Size-based sub-group analysis showed that the median times to LTP in patients with medium- to large-sized tumors (> 3 cm) were significantly longer in the B-TACE (27 months; 95% confidence interval [CI], 19.7-34.3 months) than in the C-TACE (13 months; 95% CI, 3.9-22.1 months) group (p = 0.019). The major complication rate was similar between the two groups. CONCLUSIONS B-TACE had a higher initial CR rate than C-TACE in treating single HCCs. Moreover, size-based subgroup analysis showed that time to LTP was significantly longer in patients with medium- to large-sized HCCs (> 3 cm) who underwent B-TACE rather than C-TACE. KEY POINTS • B-TACE was superior to C-TACE in treating single HCC, with a significantly higher initial complete response rate after one session of treatment. • In size-based subgroup analysis, time to LTP was significantly longer in patients with medium- to large-sized HCCs (>3 cm) who underwent B-TACE rather than C-TACE. • B-TACE should be considered an alternative treatment option for medium- to large-sized single HCCs (>3 cm) in patients with a nonresectable condition and those who prefer nonsurgical treatment.
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Affiliation(s)
- Hee Ho Chu
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea
| | - Dong Il Gwon
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea. .,Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-Gil, Songpa-Gu, Seoul, 05505, Republic of Korea.
| | - Gun Ha Kim
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea
| | - Jin Hyoung Kim
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea
| | - Gi-Young Ko
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea
| | - Ji Hoon Shin
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea
| | - Heung-Kyu Ko
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea
| | - Hyun-Ki Yoon
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea
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13
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Chiang CC, Yeh H, Lim SN, Lin WR. Transcriptome analysis creates a new era of precision medicine for managing recurrent hepatocellular carcinoma. World J Gastroenterol 2023; 29:780-799. [PMID: 36816628 PMCID: PMC9932421 DOI: 10.3748/wjg.v29.i5.780] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 11/23/2022] [Accepted: 01/10/2023] [Indexed: 02/06/2023] Open
Abstract
The high incidence of hepatocellular carcinoma (HCC) recurrence negatively impacts outcomes of patients treated with curative intent despite advances in surgical techniques and other locoregional liver-targeting therapies. Over the past few decades, the emergence of transcriptome analysis tools, including real-time quantitative reverse transcription PCR, microarrays, and RNA sequencing, has not only largely contributed to our knowledge about the pathogenesis of recurrent HCC but also led to the development of outcome prediction models based on differentially expressed gene signatures. In recent years, the single-cell RNA sequencing technique has revolutionized our ability to study the complicated crosstalk between cancer cells and the immune environment, which may benefit further investigations on the role of different immune cells in HCC recurrence and the identification of potential therapeutic targets. In the present article, we summarized the major findings yielded with these transcriptome methods within the framework of a causal model consisting of three domains: primary cancer cells; carcinogenic stimuli; and tumor microenvironment. We provided a comprehensive review of the insights that transcriptome analyses have provided into diagnostics, surveillance, and treatment of HCC recurrence.
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Affiliation(s)
- Chun-Cheng Chiang
- UPMC Hillman Cancer Center, University of Pittsburgh, Pittsburgh, PA 15232, United States
| | - Hsuan Yeh
- School of Medicine, University of Pittsburgh, Pittsburgh, PA 15213, United States
| | - Siew-Na Lim
- Department of Neurology, Linkou Chang Gung Memorial Hospital, Taoyuan 333, Taiwan
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Wey-Ran Lin
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
- Department of Gastroenterology and Hepatology, Linkou Chang Gung Memorial Hospital, Taoyuan 333, Taiwan
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14
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Lee SW, Yen CL, Cheng YC, Shun Yang S, Lee TY. The radiological prognostic factors of transcatheter arterial chemoembolization to hepatocellular carcinoma. Medicine (Baltimore) 2022; 101:e30875. [PMID: 36254047 PMCID: PMC9575733 DOI: 10.1097/md.0000000000030875] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Transcatheter arterial chemoembolization (TACE) is the recommended treatment modality for intermediate stage hepatocellular carcinoma (HCC). The aim of this study was to determine the HCC radiological characteristics associated with prognosis of patients with intermediate stage HCC receiving TACE. Patients with HCC BCLC stage B from January 2005 to December 2009 were collected. According to mRECIST criteria, patients with complete response and partial response were assigned to the objective response (OR) group, while those with stable disease and progressive disease were assigned to the nonobjective response (non-OR) group. Among a total of 128 enrolled patients, there were 66 (51.6%) and 62 (48.4%) patients in the OR group and non-OR group, respectively. The clinical parameters in the two groups were similar, although HCC size was smaller in the OR group. Logistic analysis found combined radiological characteristics including complete lipiodol retention, tumor feeding artery blockage, and no residual tumor blush were significant correlated with achievement of OR (odds ratio 2.46, 95% CI 1.08-5.61, P = .032). However, no radiological characteristics had significant strength to predict overall survival. Patients with OR after TACE had significantly longer survival time than those with non-OR. Combined characteristics of complete lipiodol retention, tumor feeding artery blockage, and no residual tumor blush had a positive impact on OR in TACE. In patients receiving TACE, those who achieved OR had a better overall survival.
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Affiliation(s)
- Shou-Wu Lee
- Division of Hepatology and Gastroenterology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Internal Medicine, Chung Shan Medical University, Taichung, Taiwan
- Department of Internal Medicine, Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Post-Baccalaureate Medicine, College of Medicine, Chung Hsing University, Taiwan
| | - Chieh-Ling Yen
- Division of Hepatology and Gastroenterology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Yu-Chi Cheng
- Koo Foundation Sun Yat-Sen Cncer Center Department of Radiology, Taipei, Taiwan
- Department of Internal Medicine, Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Sheng Shun Yang
- Division of Hepatology and Gastroenterology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Internal Medicine, Chung Shan Medical University, Taichung, Taiwan
- Department of Internal Medicine, Yang Ming Chiao Tung University, Taipei, Taiwan
- Institute of Biomedical Sciences, Chung Hsing University, Taichung, Taiwan
| | - Teng-Yu Lee
- Division of Hepatology and Gastroenterology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Internal Medicine, Chung Shan Medical University, Taichung, Taiwan
- *Correspondence: Teng-Yu Lee, Division of Hepatology and Gastroenterology, Department of Internal Medicine, Taichung Veterans General Hospital, 1650 Taiwan Boulevard, Sec. 4, Taichung 40705, Taiwan (e-mail: )
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15
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de Baere T, Ronot M, Chung JW, Golfieri R, Kloeckner R, Park JW, Gebauer B, Kibriya N, Ananthakrishnan G, Miyayama S. Initiative on Superselective Conventional Transarterial Chemoembolization Results (INSPIRE). Cardiovasc Intervent Radiol 2022; 45:1430-1440. [PMID: 35978174 PMCID: PMC9499883 DOI: 10.1007/s00270-022-03233-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 07/18/2022] [Indexed: 12/05/2022]
Abstract
Several publications show that superselective conventional TransArterial ChemoEmbolization (cTACE), meaning cTACE performed selectively with a microcatheter positioned as close as possible to the tumor, improves outcomes, maximizing the anti-tumoral effect and minimizing the collateral damages of the surrounding liver parenchyma. Recent recommendations coming from the European Association for the Study of the Liver (EASL) and European Society of Medical Oncology (ESMO) highlighted that TACE must be used in Hepatocellular Carcinoma (HCC) “selectively targetable” and “accessible to supraselective catheterization.” The goal of the manuscript is to better define such population and to standardize superselective cTACE (ss-cTACE) technique. An expert panel with extensive clinical-procedural experience in TACE, have come together in a virtual meeting to generate recommendations and express their consensus. Experts recommend that anytime cTACE is proposed, it should be ss-cTACE, preferably with a 1.5–2.0 Fr microcatheter. Ideally, ss-cTACE should be proposed to patients with less than five lesions and a maximum number of two segments involved, with largest tumor smaller than 5 cm. Angio Cone-Beam Computed Tomography (CBCT) should be used to detect enhancing tumors, tumor feeders and guide tumor targeting. Whole tumor volume should be covered to obtain the best response. Adding peritumoral margins is encouraged but not mandatory. The treatment should involve a water-in-oil emulsion, whose quality is assessable with the “drop test.” Additional particulate embolization should be systematically performed, as per definition of cTACE procedure. Non-contrast CBCT or Multi-Detector Computed Tomography (MDCT) combined with angiography has been considered the gold standard for imaging during TACE, and should be used to assess tumor coverage during the procedure. Experts convene that superselectivity decreases incidence of adverse effects and improves tolerance. Experts recommend contrast-enhanced Computed Tomography (CT) as initial imaging on first follow-up after ss-cTACE, and Magnetic Resonance Imaging (MRI) if remaining tumor viability cannot be confidently assessed on CT. If no response is obtained after two ss-cTACE sessions within six months, patient must be considered unsuitable for TACE and proposed for alternative therapy. Patients are best served by multidisciplinary decision-making, and Interventional Radiologists should take an active role in patient selection, treatment allocation, and post-procedural care.
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Affiliation(s)
- Thierry de Baere
- Institut Gustave Roussy, Service Radiodiagnostic et Imagerie Médicale, 39, rue Camille Desmoulins, 94800, Villejuif, France.
| | - Maxime Ronot
- Department of Medical Imaging, Beaujon University Hospital, Clichy, France
| | - Jin Wook Chung
- Department of Radiology, Seoul National University College of Medicine, Seoul, South Korea
| | - Rita Golfieri
- Unità Operativa Radiologia Universitaria (Pad 1, 2), Dipartimento delle Radiologie, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico S. Orsola-Malpighi, Bologna, Italy
| | - Roman Kloeckner
- Radiology Department, Mainz University: Johannes Gutenberg Universitat Mainz, Mainz, Germany
| | - Joong-Won Park
- Center for Liver and Pancreatobiliary Cancer, National Cancer Center (NCC), Goyang-si, South Korea
| | - Bernhard Gebauer
- Department of Diagnostic Radiology, Charité Universitätsmedizin Berlin, Campus Virchow-Klinikum: Charite, Berlin, Germany
| | - Nabil Kibriya
- Department of Radiology, Kings College Hospital, NHS Foundation Trust, London, UK
| | | | - Shiro Miyayama
- Department of Diagnostic Radiology, Fukui-Ken Saiseikai Hospital, Fukui, Japan
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16
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Gatti M, Maino C, Darvizeh F, Serafini A, Tricarico E, Guarneri A, Inchingolo R, Ippolito D, Ricardi U, Fonio P, Faletti R. Role of gadoxetic acid-enhanced liver magnetic resonance imaging in the evaluation of hepatocellular carcinoma after locoregional treatment. World J Gastroenterol 2022; 28:3116-3131. [PMID: 36051340 PMCID: PMC9331537 DOI: 10.3748/wjg.v28.i26.3116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 04/25/2022] [Accepted: 06/17/2022] [Indexed: 02/06/2023] Open
Abstract
Locoregional treatments, as alternatives to surgery, play a key role in the management of hepatocellular carcinoma (HCC). Liver magnetic resonance imaging (MRI) enables a multiparametric assessment, going beyond the traditional dynamic computed tomography approach. Moreover, the use of hepatobiliary agents can improve diagnostic accuracy and are becoming important in the diagnosis and follow-up of HCC. However, the main challenge is to quickly identify classical responses to loco-regional treatments in order to determine the most suitable management strategy for each patient. The aim of this review is to provide a summary of the most common and uncommon liver MRI findings in patients who underwent loco-regional treatments for HCC, with a special focus on ablative therapies (radiofrequency, microwaves and cryoablation), trans-arterial chemoembolization, trans-arterial radio-embolization and stereotactic ablative radiotherapy techniques, considering the usefulness of gadoxetate disodium (Gd-EOB-DTPA) contrast agent.
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Affiliation(s)
- Marco Gatti
- Department of Surgical Sciences, University of Turin, Turin 10126, Italy
| | - Cesare Maino
- Department of Diagnostic Radiology, University of Milano-Bicocca, Monza 20900, Italy
- Department of Diagnostic Radiology, Ospedale San Gerardo, Monza 20900, Italy
| | - Fatemeh Darvizeh
- School of Medicine, Vita-Salute San Raffaele University, Milan 20121, Italy
| | | | - Eleonora Tricarico
- Department of Radiology, "F. Perinei" Hospital, Altamura (BA) 70022, Italy
| | | | - Riccardo Inchingolo
- Interventional Radiology Unit, “F. Miulli” Regional General Hospital, Acquaviva delle Fonti (BA) 70021, Italy
| | - Davide Ippolito
- Department of Diagnostic Radiology, University of Milano-Bicocca, Monza 20900, Italy
- Department of Diagnostic Radiology, Ospedale San Gerardo, Monza 20900, Italy
| | - Umberto Ricardi
- Department of Oncology, University of Turin, Turin 10126, Italy
| | - Paolo Fonio
- Department of Surgical Sciences, University of Turin, Turin 10126, Italy
| | - Riccardo Faletti
- Department of Surgical Sciences, University of Turin, Turin 10126, Italy
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17
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Can Posttransarterial Chemoembolization Volumetric Oil Deposition on Computed Tomography Predict Treatment Response on Magnetic Resonance Imaging in Leiomyosarcoma Metastases to the Liver? J Comput Assist Tomogr 2022; 46:327-332. [PMID: 35405712 DOI: 10.1097/rct.0000000000001294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To predict early tumor response to transarterial chemoembolization (TACE) based on volumetric oil deposition on posttreatment computed tomography (CT) in patients with leiomyosarcoma liver metastases. METHODS This retrospective lesion-by-lesion based study included 32 lesions. The volumetric percent enhancing tumor on pre-TACE and 1-month post-TACE venous phase magnetic resonance imaging (MRI), and the percent oil deposition on CT 1 day after TACE were calculated. The predicted post-TACE enhanced percentage was computed by subtracting percent oil deposition from baseline percent enhanced. RESULTS Mean percentage of viable tumor on pre-TACE MRI was 90.6% ± 9.3%. Mean oil deposition was calculated as 51.4% ± 26.2%. Mean percentage of measured residual tumor enhancement 1 month after TACE was 58.3% ± 27%, which correlates with predicted enhancement percentage of 43.9% ± 25.1% (r = 0.72, P < 0.001). A threshold of 35.5% for enhancement reduction was determined to predict tumor response with an accuracy of 78.1%. CONCLUSION Volumetric oil deposition on CT can predict residual enhancement on post-TACE MRI.
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Kudo M, Ikeda M, Ueshima K, Sakamoto M, Shiina S, Tateishi R, Nouso K, Hasegawa K, Furuse J, Miyayama S, Murakami T, Yamashita T, Kokudo N. Response Evaluation Criteria in Cancer of the liver version 6 (Response Evaluation Criteria in Cancer of the Liver 2021 revised version). Hepatol Res 2022; 52:329-336. [PMID: 35077590 DOI: 10.1111/hepr.13746] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 12/21/2021] [Accepted: 12/29/2021] [Indexed: 02/08/2023]
Abstract
Response Evaluation Criteria in Solid Tumors (RECIST) is inappropriate to assess the direct effects of treatment on hepatocellular carcinoma (HCC) by locoregional therapies, such as radiofrequency ablation or transarterial chemoembolization. Therefore, establishment of response evaluation criteria solely devoted to HCC is needed in clinical practice, as well as in clinical trials of HCC treatment, such as systemic therapies, which cause necrosis of the tumor. Response Evaluation Criteria in Cancer of the Liver (RECICL) was revised in 2021 by the Liver Cancer Study Group of Japan based on the 2019 version of RECICL, which was commonly used in Japan. The major revised points of the RECICL 2021 is inclusion of RECIST version 1.1 and modified RECIST as response evaluation criteria in systemic therapy for HCC. We hope this new treatment response criteria, RECICL, proposed by the Liver Cancer Study Group of Japan will benefit the HCC treatment response evaluation in the setting of daily clinical practice and clinical trials as well, not only in Japan, but also internationally.
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Affiliation(s)
- Masatoshi Kudo
- Department of Gastroenteology and Hepatology, Kindai University Faculty of Medicine, Osaka-Sayama, Japan.,National Center for Global Health and Medicine, Tokyo, Japan.,Chairperson of the Committee for Response Evaluation Criteria in Cancer of the Liver, Osaka-Sayama, Japan
| | - Masafumi Ikeda
- National Center for Global Health and Medicine, Tokyo, Japan.,Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | - Kazuomi Ueshima
- Department of Gastroenteology and Hepatology, Kindai University Faculty of Medicine, Osaka-Sayama, Japan.,National Center for Global Health and Medicine, Tokyo, Japan
| | - Michiie Sakamoto
- National Center for Global Health and Medicine, Tokyo, Japan.,Department of Pathology, Keio University School of Medicine, Tokyo, Japan
| | - Shuichiro Shiina
- Department of Gastroenterology, Juntendo University School of Medicine, Tokyo, Japan
| | - Ryosuke Tateishi
- Department of Gastroenterology, The University of Tokyo, Tokyo, Japan
| | - Kazuhiro Nouso
- Department of Gastroenterology, Okayama City Hospital, Okayama, Japan
| | - Kiyoshi Hasegawa
- Hepato-Biliary-Pancreatic Surgery Division, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Junji Furuse
- Department of Internal Medicine, Medical Oncology, School of Medicine, Kyorin University, Mitaka, Japan
| | - Shiro Miyayama
- Diagnostic Radiology, Fukuiken Saiseikai Hospital, Fukui, Japan
| | - Takamichi Murakami
- Diagnostic and Interventional Radiology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Tatsuya Yamashita
- Department of Gastroenterology, Kanazawa University, Graduate School of Medical Science, Kanazawa, Japan
| | - Norihiro Kokudo
- Committee for Response Evaluation Criteria in Cancer of the Liver, Liver Cancer Study Group of Japan, Osaka-Sayama, Japan.,Chairperson of the Committee for General Rules for the Clinical and Pathological Study of Primary Liver Cancer, Osaka-Sayama, Japan
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19
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Malpani R, Petty CW, Yang J, Bhatt N, Zeevi T, Chockalingam V, Raju R, Petukhova-Greenstein A, Santana JG, Schlachter TR, Madoff DC, Chapiro J, Duncan J, Lin M. Quantitative Automated Segmentation of Lipiodol Deposits on Cone Beam CT Imaging acquired during Transarterial Chemoembolization for Liver Tumors: A Deep Learning Approach. J Vasc Interv Radiol 2021; 33:324-332.e2. [PMID: 34923098 DOI: 10.1016/j.jvir.2021.12.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 12/01/2021] [Accepted: 12/07/2021] [Indexed: 11/16/2022] Open
Abstract
PURPOSE The purpose of this study was to show that a deep learning-based, automated model for Lipiodol segmentation on CBCT after cTACE performs closer to the "ground truth segmentation" than a conventional thresholding-based model. MATERIALS & METHODS This post-hoc analysis included 36 patients with a diagnosis of HCC or other solid liver tumor who underwent cTACE with an intra-procedural CBCT. Semi-automatic segmentation of Lipiodol were obtained. Then, a convolutional U-net model was used to output a binary mask that predicts Lipiodol deposition. A threshold value of signal intensity on CBCT was used to obtain a Lipiodol mask for comparison. Dice similarity coefficient (DSC), Mean-squared error (MSE), and Center of Mass (CM), and fractional volume ratios for both masks were obtained by comparing them to the ground truth (radiologist segmented Lipiodol deposits) to obtain accuracy metrics for the two masks. These results were used to compare the model vs. the threshold technique. RESULTS For all metrics, the U-net outperformed the threshold technique: DSC (0.65±0.17 vs. 0.45±0.22,p<0.001) and MSE (125.53±107.36 vs. 185.98±93.82,p=0.005). Difference between the CM predicted, and the actual CM was (15.31±14.63mm vs. 31.34±30.24mm,p<0.001), with lesser distance indicating higher accuracy. The fraction of volume present ([predicted Lipiodol volume]/[ground truth Lipiodol volume]) was 1.22±0.84vs.2.58±3.52,p=0.048 for our model's prediction and threshold technique, respectively. CONCLUSION This study showed that a deep learning framework could detect Lipiodol in CBCT imaging and was capable of outperforming the conventionally used thresholding technique over several metrics. Further optimization will allow for more accurate, quantitative predictions of Lipiodol depositions intra-procedurally.
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Affiliation(s)
- Rohil Malpani
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, 330 Cedar St. Tompkins East TE-2, New Haven, CT. 06520, USA
| | - Christopher W Petty
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, 330 Cedar St. Tompkins East TE-2, New Haven, CT. 06520, USA
| | - Junlin Yang
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, 330 Cedar St. Tompkins East TE-2, New Haven, CT. 06520, USA
| | - Neha Bhatt
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, 330 Cedar St. Tompkins East TE-2, New Haven, CT. 06520, USA
| | - Tal Zeevi
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, 330 Cedar St. Tompkins East TE-2, New Haven, CT. 06520, USA
| | - Vijay Chockalingam
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, 330 Cedar St. Tompkins East TE-2, New Haven, CT. 06520, USA
| | - Rajiv Raju
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, 330 Cedar St. Tompkins East TE-2, New Haven, CT. 06520, USA
| | - Alexandra Petukhova-Greenstein
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, 330 Cedar St. Tompkins East TE-2, New Haven, CT. 06520, USA
| | - Jessica Gois Santana
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, 330 Cedar St. Tompkins East TE-2, New Haven, CT. 06520, USA
| | - Todd R Schlachter
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, 330 Cedar St. Tompkins East TE-2, New Haven, CT. 06520, USA
| | - David C Madoff
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, 330 Cedar St. Tompkins East TE-2, New Haven, CT. 06520, USA
| | - Julius Chapiro
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, 330 Cedar St. Tompkins East TE-2, New Haven, CT. 06520, USA.
| | - James Duncan
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, 330 Cedar St. Tompkins East TE-2, New Haven, CT. 06520, USA
| | - MingDe Lin
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, 330 Cedar St. Tompkins East TE-2, New Haven, CT. 06520, USA; Visage Imaging, Inc., 12625 High Bluff Drive, Suite 205, San Diego, CA 92130, USA
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20
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Ebeling Barbier C, Heindryckx F, Lennernäs H. Limitations and Possibilities of Transarterial Chemotherapeutic Treatment of Hepatocellular Carcinoma. Int J Mol Sci 2021; 22:ijms222313051. [PMID: 34884853 PMCID: PMC8658005 DOI: 10.3390/ijms222313051] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 11/26/2021] [Accepted: 11/29/2021] [Indexed: 02/07/2023] Open
Abstract
Because diagnostic tools for discriminating between hepatocellular carcinoma (HCC) and advanced cirrhosis are poor, HCC is often detected in a stage where transarterial chemoembolization (TACE) is the best treatment option, even though it provides a poor survival gain. Despite having been used worldwide for several decades, TACE still has many limitations. First, there is a vast heterogeneity in the cellular composition and metabolism of HCCs as well as in the patient population, which renders it difficult to identify patients who would benefit from TACE. Often the delivered drug does not penetrate sufficiently selectively and deeply into the tumour and the drug delivery system is not releasing the drug at an optimal clinical rate. In addition, therapeutic effectiveness is limited by the crosstalk between the tumour cells and components of the cirrhotic tumour microenvironment. To improve this widely used treatment of one of our most common and deadly cancers, we need to better understand the complex interactions between drug delivery, local pharmacology, tumour targeting mechanisms, liver pathophysiology, patient and tumour heterogeneity, and resistance mechanisms. This review provides a novel and important overview of clinical data and discusses the role of the tumour microenvironment and lymphatic system in the cirrhotic liver, its potential response to TACE, and current and possible novel DDSs for locoregional treatment.
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Affiliation(s)
| | - Femke Heindryckx
- Department of Medical Cell Biology, Uppsala University, 751 23 Uppsala, Sweden;
| | - Hans Lennernäs
- Department of Pharmaceutical Biosciences, Uppsala University, 751 23 Uppsala, Sweden
- Correspondence: ; Tel.: +46-18-471-4317; Fax: +46-18-471-4223
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21
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Hazhirkarzar B, Tang H, Ghadimi M, Baghdadi A, Motaghi M, Wu Q, Shaghaghi M, Kamel I. Predicting early necrosis of colorectal liver metastases using volumetric enhancement on baseline MRI and oil deposition on post-cTACE unenhanced CT. Abdom Radiol (NY) 2021; 46:4610-4618. [PMID: 34089068 DOI: 10.1007/s00261-021-03133-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 04/19/2021] [Accepted: 05/21/2021] [Indexed: 01/05/2023]
Abstract
PURPOSE To predict tumor necrosis after conventional TACE (cTACE) in patients with colorectal liver metastasis (CRLM) based on volumetric oil deposition on CT one day after treatment. METHODS Thirty-four lesions in 20 men and 6 women were included in this IRB-approved HIPAA-compliant, retrospective lesion-by-lesion-based study. Semiautomatic volumetric segmentation of target lesions was performed on baseline MRI and post-treatment CT. Predicted percentage of tumor necrosis was defined as 100%-(%baseline MRI enhancement-%CT oil deposition). Necrosis on post-TACE MRI was measured after volumetric segmentation to assess the accuracy of predicting tumor necrosis. The relationship between predicted necrosis percent and post-cTACE measured necrosis percent on MRI was compared using Pearson correlation analysis. Inter-reader agreement was calculated by intraclass correlation coefficient (ICC) after using the same method. RESULTS Patients in this cohort had a mean age of 64 ± 14 years. Mean percentage of the viable tumor on pre-cTACE venous phase MRI was 58.5% ± 23.9%. Mean oil deposition was 19.8% ± 14.6%. Mean percentage of calculated necrosis one month after cTACE was 59.2% ± 22.7% on venous phase MRI, which had a significant correlation with predicted necrotic percentage of 61.3% ± 19.3% (r = 0.89, p < 0.0001). ICC for enhancement percentage on pre-cTACE and post-cTACE venous phase MRIs were 0.93 (95% CI 0.83, 0.97) and 0.86 (95% CI 0.66, 0.94), respectively. ICC for oil deposition was 0.92 (95% CI 0.81, 0.96). CONCLUSION Measuring oil deposition of the whole tumor on CT one day after cTACE can assist to predict post-cTACE tumor necrosis.
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Affiliation(s)
- Bita Hazhirkarzar
- Russell H. Morgan Department of Radiology and Radiological Sciences, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Hao Tang
- Russell H. Morgan Department of Radiology and Radiological Sciences, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Maryam Ghadimi
- Russell H. Morgan Department of Radiology and Radiological Sciences, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Azarakhsh Baghdadi
- Russell H. Morgan Department of Radiology and Radiological Sciences, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Mina Motaghi
- Russell H. Morgan Department of Radiology and Radiological Sciences, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Qingxia Wu
- Russell H. Morgan Department of Radiology and Radiological Sciences, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Mohammadreza Shaghaghi
- Russell H. Morgan Department of Radiology and Radiological Sciences, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Ihab Kamel
- Russell H. Morgan Department of Radiology and Radiological Sciences, School of Medicine, Johns Hopkins University, Baltimore, MD, USA.
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins Hospital, 600 North Wolfe Street, MRI 143, Baltimore, MD, 21287, USA.
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22
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Mao X, Guo Y, Wen F, Liang H, Sun W, Lu Z. Applying arterial enhancement fraction (AEF) texture features to predict the tumor response in hepatocellular carcinoma (HCC) treated with Transarterial chemoembolization (TACE). Cancer Imaging 2021; 21:49. [PMID: 34384496 PMCID: PMC8359085 DOI: 10.1186/s40644-021-00418-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 07/19/2021] [Indexed: 12/15/2022] Open
Abstract
Background To evaluate the application of Arterial Enhancement Fraction (AEF) texture features in predicting the tumor response in Hepatocellular Carcinoma (HCC) treated with Transarterial Chemoembolization (TACE) by means of texture analysis. Methods HCC patients treated with TACE in Shengjing Hospital of China Medical University from June 2018 to December 2019 were retrospectively enrolled in this study. Pre-TACE Contrast Enhanced Computed Tomography (CECT) and imaging follow-up within 6 months were both acquired. The tumor responses were categorized according to the modified RECIST (mRECIST) criteria. Based on the CECT images, Region of Interest (ROI) of HCC lesion was drawn, the AEF calculation and texture analysis upon AEF values in the ROI were performed using CT-Kinetics (C.K., GE Healthcare, China). A total of 32 AEF texture features were extracted and compared between different tumor response groups. Multi-variate logistic regression was performed using certain AEF features to build the differential models to predict the tumor response. The Receiver Operator Characteristic (ROC) analysis was implemented to assess the discriminative performance of these models. Results Forty-five patients were finally enrolled in the study. Eight AEF texture features showed significant distinction between Improved and Un-improved patients (p < 0.05). In multi-variate logistic regression, 9 AEF texture features were applied into modeling to predict “Improved” outcome, and 4 AEF texture features were applied into modeling to predict “Un-worsened” outcome. The Area Under Curve (AUC), diagnostic accuracy, sensitivity, and specificity of the two models were 0.941, 0.911, 1.000, 0.826, and 0.824, 0.711, 0.581, 1.000, respectively. Conclusions Certain AEF heterogeneous features of HCC could possibly be utilized to predict the tumor response to TACE treatment.
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Affiliation(s)
- Xiaonan Mao
- Department of Radiology, ShengJing hospital of China Medical University, 12# floor at 1# building, 39 Huaxiang Road, Shenyang City, 110000, Liaoning Province, China
| | - Yan Guo
- GE Healthcare (China), Shanghai, China
| | - Feng Wen
- Department of Radiology, ShengJing hospital of China Medical University, 12# floor at 1# building, 39 Huaxiang Road, Shenyang City, 110000, Liaoning Province, China
| | - Hongyuan Liang
- Department of Radiology, ShengJing hospital of China Medical University, 12# floor at 1# building, 39 Huaxiang Road, Shenyang City, 110000, Liaoning Province, China
| | - Wei Sun
- Department of Radiology, ShengJing hospital of China Medical University, 12# floor at 1# building, 39 Huaxiang Road, Shenyang City, 110000, Liaoning Province, China
| | - Zaiming Lu
- Department of Radiology, ShengJing hospital of China Medical University, 12# floor at 1# building, 39 Huaxiang Road, Shenyang City, 110000, Liaoning Province, China.
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23
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Park C, Gwon DI, Chu HH, Kim JW, Kim JH, Ko GY. Correlation of tumor response on CT with pathologically proven necrosis in hepatocellular carcinoma treated by conventional transcatheter arterial chemoembolization: threshold value of intratumoral Lipiodol accumulation predicting tumor necrosis. Abdom Radiol (NY) 2021; 46:3729-3737. [PMID: 33141259 DOI: 10.1007/s00261-020-02845-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 10/24/2020] [Accepted: 10/29/2020] [Indexed: 12/12/2022]
Abstract
PURPOSE To evaluate associations between pathology and CT assessments made according to the mRECIST in HCC treated by conventional TACE (cTACE), and to identify predictors of complete tumor necrosis. METHODS From March 2016 to July 2018, 83 patients with a total of 100 masses were retrospectively included. Patients underwent sequential cTACE and portal vein embolization, and later hepatic surgery. Evaluation of treatment response and measurement of baseline lipiodol accumulation as mean HU was performed on CT at the time point closest to the time of operation (mean, 54.5 days after cTACE). Significant predictors associated with complete necrosis were identified by multivariate analysis. The optimal cut-off HU value of lipiodol accumulation for prediction of complete necrosis was determined using a ROC analysis. RESULTS According to mRECIST, complete response (CR, n = 70) and partial response (n = 30) were classified. 34.3% (24/70) masses classified as CR according to mRECIST were found to have viable lesions on pathology. On multivariate analysis, mean HU of lipiodol accumulation was the only significant predictor of complete necrosis (p = .003, odds ratio 1.746, 95% CI 1.201-2.539). On ROC analysis, 460 HU as a cut-off value was significantly associated with complete necrosis (67.4% sensitivity, 75.0% specificity). CONCLUSIONS A threshold value for lipiodol accumulation > 460 HU was highly sensitive and specific for complete necrosis, even in complete response according to mRECIST. Therefore, if lipiodol accumulation is insufficient in post-TACE CT, recurrence should be monitored more sensitively.
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Affiliation(s)
- Chan Park
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-Gu, Seoul, 05505, South Korea
| | - Dong Il Gwon
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-Gu, Seoul, 05505, South Korea.
| | - Hee Ho Chu
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-Gu, Seoul, 05505, South Korea
| | - Jong Woo Kim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-Gu, Seoul, 05505, South Korea
| | - Jin Hyoung Kim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-Gu, Seoul, 05505, South Korea
| | - Gi-Young Ko
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-Gu, Seoul, 05505, South Korea
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24
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Lee SW, Lee TY, Cheng YC, Yen CL, Yang SS. The correlation with tumor radiological characteristics and prognosis of patients with early-stage hepatocellular carcinoma receiving transcatheter arterial chemoembolization. Medicine (Baltimore) 2021; 100:e26414. [PMID: 34190159 PMCID: PMC8257895 DOI: 10.1097/md.0000000000026414] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 06/02/2021] [Indexed: 01/04/2023] Open
Abstract
Transcatheter arterial chemoembolization (TACE) is a standard treatment modality for intermediate stage hepatocellular carcinoma (HCC). The aim of this study was to determine the tumor radiological characteristics associated with prognosis of patients with early-staged HCC receiving TACE.Patients with BCLC stage A HCC were enrolled at Taichung Veterans General Hospital from January 2005 to December 2009. According to mRECIST criteria, patients with or without complete response (CR) were assigned to either the CR group or the non-CR group. Clinical and radiological characteristics were compared between the two groups.In 40 enrolled patients, 24 (60%) were in the CR group, and 16 (40%) in the non-CR group. Clinical parameters were similar between the 2 groups. Radiological characteristics including complete lipidol retention and the absence of residual tumor blush were significantly correlated with achievement of CR in the patients with small-sized HCC. Patients with CR after TACE had a significantly longer overall survival than those without (31.29 vs 22.63 months, P = .021).Complete lipidol retention and the absence of residual tumor blush were correlated with the radiological complete tumor response of these patients with small-sized early-stage HCC receiving TACE.
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Affiliation(s)
- Shou-Wu Lee
- Division of Hepatology and Gastroenterology, Department of Internal Medicine, Taichung Veterans General Hospital
- Department of Internal Medicine, Chung Shan Medical University, Taichung
| | - Teng-Yu Lee
- Division of Hepatology and Gastroenterology, Department of Internal Medicine, Taichung Veterans General Hospital
- Department of Internal Medicine, Chung Shan Medical University, Taichung
| | - Yu-Chi Cheng
- Department of Radiology, Taipei Veterans General Hospital
- Department of Internal Medicine, Yang Ming University, Taipei, Taiwan
| | - Chieh-Ling Yen
- Division of Hepatology and Gastroenterology, Department of Internal Medicine, Taichung Veterans General Hospital
| | - Sheng Shun Yang
- Division of Hepatology and Gastroenterology, Department of Internal Medicine, Taichung Veterans General Hospital
- Department of Internal Medicine, Yang Ming University, Taipei, Taiwan
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Müller L, Stoehr F, Mähringer-Kunz A, Hahn F, Weinmann A, Kloeckner R. Current Strategies to Identify Patients That Will Benefit from TACE Treatment and Future Directions a Practical Step-by-Step Guide. J Hepatocell Carcinoma 2021; 8:403-419. [PMID: 34012930 PMCID: PMC8128497 DOI: 10.2147/jhc.s285735] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 04/21/2021] [Indexed: 12/11/2022] Open
Abstract
Treatment of hepatocellular carcinoma (HCC) depends on the stage of disease. In the Western Hemisphere, the Barcelona Clinic Liver Cancer classification (BCLC) is the preferred staging system. Approximately one-third of patients initially present with intermediate-stage disease. For these patients, transarterial chemoembolization (TACE) is the treatment of choice. However, the intermediate-stage comprises a heterogeneous subgroup of patients with considerable differences in tumor burden and liver function. In addition, differences in individual factors that are not captured by the BCLC framework, such as the tumor growth pattern, degree of hypervascularity, and vascular supply, complicate further evaluation of these patients. Due to these differences, not all patients benefit equally from TACE. Several tools and scoring systems have been devised to provide decision-making support. All of these have shown promising initial results but failed external evaluation and have not been translated to the clinic. Nevertheless, criteria for objectifying treatment decisions in daily clinical practice are needed in all stages of disease. Therefore, this review provides a concise practical step-by-step guide on current strategies for patient selection and decision-making, with a focus on TACE, to critically evaluate the existing decision-support tools and provide a summary of the latest updates in the field.
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Affiliation(s)
- Lukas Müller
- Department of Diagnostic and Interventional Radiology, University Medical Centre of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Fabian Stoehr
- Department of Diagnostic and Interventional Radiology, University Medical Centre of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Aline Mähringer-Kunz
- Department of Diagnostic and Interventional Radiology, University Medical Centre of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Felix Hahn
- Department of Diagnostic and Interventional Radiology, University Medical Centre of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Arndt Weinmann
- Department of Internal Medicine I, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Roman Kloeckner
- Department of Diagnostic and Interventional Radiology, University Medical Centre of the Johannes Gutenberg-University Mainz, Mainz, Germany
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Duration of response after DEB-TACE compared to lipiodol-TACE in HCC-naïve patients: a propensity score matching analysis. Eur Radiol 2021; 31:7512-7522. [PMID: 33871708 PMCID: PMC8452560 DOI: 10.1007/s00330-021-07905-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 02/17/2021] [Accepted: 03/16/2021] [Indexed: 02/08/2023]
Abstract
Objectives To retrospectively compare long-term outcomes of first-line drug-eluting particle (DEB)- transarterial chemoembolization (TACE) and lipiodol-TACE, in patients with unresectable hepatocellular (HCC). Methods We retrospectively reviewed our database to identify adult patients with treatment-naïve unresectable HCC, who underwent TACE from 2006 to 2013. Patients were excluded in the absence of complete medical records relative to first TACE, 1-month follow-up, and/or sufficient follow-up data. Periprocedural complications, duration of hospitalization, 1-month tumor response by mRECIST, time to tumor progression (TTP) and target tumor progression (TTTP), and overall survival (OS) were evaluated. Results Out of an initial series of 656 patients, 329 patients were excluded for unavailability of sufficient baseline and/or follow-up data. The remaining 327 patients underwent either lipiodol-TACE (n = 160) or DEB-TACE (n = 167). Patients treated with lipiodol-TACE had a significantly higher tumor burden. By propensity score, patients were matched according to baseline differences (BCLC stage, uninodular or multinodular HCC, and unilobar or bilobar HCC), resulting in 101 patients in each treatment group. Lipiodol-TACE was associated with a significantly higher incidence of adverse events (p = 0.03), and longer hospitalization (mean, 2.5 days vs 1.9 days; p = 0.03), while tumor response, TTP, and OS were comparable. In patients achieving 1-month complete response (CR) of target tumor, TTTP was significantly (p = 0.009) longer after DEB-TACE compared to lipiodol-TACE (median, 835 vs 353 days), resulting in a lower number of re-treatments during the entire follow-up (0.75 vs 1.6, p = 0.01). Conclusion Compared to lipiodol-TACE, DEB-TACE offers higher tolerability, reduced hospitalization, and more durable target tumor response after CR. Key Points • Compared to lipiodol-TACE, DEB-TACE is better tolerated and has reduced side effects, which translates into shorter hospitalization. • When complete radiological response according to the mRECIST is obtained 1 month after the procedure, DEB-TACE offers a more durable local tumor control compared to lipiodol-TACE. • In these patients, the longer duration of response after DEB-TACE translates into a lower number of re-interventions. Supplementary Information The online version contains supplementary material available at 10.1007/s00330-021-07905-x.
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Tsai YC, Shih JH, Hwang HE, Chiu NC, Lee RC, Tseng HS, Liu CA. Early prediction of 1-year tumor response of hepatocellular carcinoma with lipiodol deposition pattern through post-embolization cone-beam computed tomography during conventional transarterial chemoembolization. Eur Radiol 2021; 31:7464-7475. [PMID: 33765160 DOI: 10.1007/s00330-021-07843-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 02/13/2021] [Accepted: 02/25/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To evaluate whether parenchyma-to-lipiodol ratio (PLR) and lesion-to-lipiodol ratio (LLR) on C-arm cone-beam computed tomography (CBCT) can predict 1-year tumor response in patients with hepatocellular carcinoma (HCC) treated with conventional transcatheter arterial chemoembolization (cTACE). METHODS This retrospective analysis included 221 HCC target lesions within up-to-seven criteria in 80 patients who underwent cTACE with arterial-phase CBCT and unenhanced CBCT after cTACE from 2015 to 2018. PLR and LLR of every tumor slice were obtained through mean density division of liver parenchyma and tumor enhancement with intratumoral lipiodol deposition. The cutoff values (COVs) of maximal PLR and LLR of every tumor were analyzed using Youden's index. The reliability of COV, correlations between the related parameters, and 1-year progression were assessed through interobserver agreement and multivariate analysis. COV validity was verified using the chi-square test and Cramer's V coefficient (V) in the validation cohort. RESULTS Standard COVs of PLR and LLR were 0.149 and 1.4872, respectively. Interobserver agreement of COV for PLR and LLR was near perfect (kappa > 0.9). Multivariate analysis suggested that COV of PLR is an independent predictor (odds ratio = 1.23532×1014, p = 4.37×10-7). COV of PLR showed strong consistency, correlation with 1-year progression in prediction model (V = 0.829-0.776; p < 0.0001), and presented as an effective predictor in the validation cohort (V = 0.766; p < 0.0001). CONCLUSION The COV of PLR (0.149) assessed through immediate post-embolization CBCT is an objective, effective, and approachable predictor of 1-year HCC progression after cTACE. KEY POINTS • The maximal PLR value indicates the least lipiodol-distributed region in an HCC tumor. The maximal LLR value indicates the least lipiodol-deposited region in the tumor due to incomplete lipiodol delivery. PLR and LLR are concepts like signal-to-noise ratio to characterize the lipiodol retention pattern objectively to predict 1-year tumor progression immediately without any quantification software for 3D image analysis immediately after cTACE treatment. • COV of PLR can facilitate the early prediction of tumor progression/recurrence and indicate the section of embolized HCC, providing the operator's good targets for sequential cTACE or combined ablation. • The validation cohort in our study verified standard COVs of PLR and LLR. The validation process was more convincing and delicate than that of previous retrospective studies.
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Affiliation(s)
- Yin-Chen Tsai
- Department of Radiology, Taipei Veterans General Hospital, No. 201, Sec. 2, Shipai Rd., Beitou District, Taipei, Taiwan.,School of Medicine, National Yang Ming Chiao Tung University, No. 155, Sec. 2, Linong Street, Taipei, 112, Taiwan
| | - Jou-Ho Shih
- Department of Genetics, Stanford University School of Medicine, Stanford University, Stanford, CA, 94305, USA
| | - Hsuen-En Hwang
- Department of Radiology, Taipei Veterans General Hospital, No. 201, Sec. 2, Shipai Rd., Beitou District, Taipei, Taiwan.,School of Medicine, National Yang Ming Chiao Tung University, No. 155, Sec. 2, Linong Street, Taipei, 112, Taiwan
| | - Nai-Chi Chiu
- Department of Radiology, Taipei Veterans General Hospital, No. 201, Sec. 2, Shipai Rd., Beitou District, Taipei, Taiwan.,School of Medicine, National Yang Ming Chiao Tung University, No. 155, Sec. 2, Linong Street, Taipei, 112, Taiwan
| | - Rheun-Chuan Lee
- Department of Radiology, Taipei Veterans General Hospital, No. 201, Sec. 2, Shipai Rd., Beitou District, Taipei, Taiwan.,School of Medicine, National Yang Ming Chiao Tung University, No. 155, Sec. 2, Linong Street, Taipei, 112, Taiwan
| | - Hsiou-Shan Tseng
- School of Medicine, National Yang Ming Chiao Tung University, No. 155, Sec. 2, Linong Street, Taipei, 112, Taiwan.,Department of Medical Imaging, Cheng Hsin General Hospital, No. 45, Cheng Hsin St., Beitou District, Taipei, Taiwan
| | - Chien-An Liu
- Department of Radiology, Taipei Veterans General Hospital, No. 201, Sec. 2, Shipai Rd., Beitou District, Taipei, Taiwan. .,School of Medicine, National Yang Ming Chiao Tung University, No. 155, Sec. 2, Linong Street, Taipei, 112, Taiwan.
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Choi SY, Kim KA, Choi W, Kwon Y, Cho SB. Usefulness of Cone-Beam CT-Based Liver Perfusion Mapping for Evaluating the Response of Hepatocellular Carcinoma to Conventional Transarterial Chemoembolization. J Clin Med 2021; 10:jcm10040713. [PMID: 33670213 PMCID: PMC7916929 DOI: 10.3390/jcm10040713] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 02/05/2021] [Accepted: 02/07/2021] [Indexed: 12/12/2022] Open
Abstract
We investigated the cone beam computed tomography (CBCT)-based-liver-perfusion-mapping usefulness during transarterial chemoembolization (TACE) in hepatocellular carcinoma (HCC) to access treatment response and predict outcomes. From October 2016 to September 2018, 42 patients with HCCs scheduled for conventional TACE were prospectively enrolled. Three reviewers evaluated the unenhanced and contrast-enhanced CBCT and CBCT-based-liver-perfusion-mapping of each tumor. Parenchymal blood volume (PBV) was measured. The operator’s judgment on the technical results was recorded. Response outcome was determined on follow-up CT or magnetic resonance imaging, according to the modified Response Evaluation Criteria in Solid Tumors. Diagnostic performance for detection of a viable tumor was evaluated using multiple logistic regression with C-statistics. CBCT-based-liver-perfusion-mapping and the maximum PBV of the tumor were significant in multiple logistic regression analysis of response (p < 0.0001, p = 0.0448, respectively), with C-statistics of 0.9540 and 0.7484, respectively. Diagnostic accuracy of operator’s judgment was 79.66% (95%CI 69.39%–89.93%). Diagnostic performance of CBCT-based-liver-perfusion-mapping showed a high concordance in three reviewers. The mean PBV of tumor, maximum PBV of tumor, and mean PBV of liver significantly decreased after TACE (each p < 0.001). In ROC curve analysis, the AUC for prediction of residual tumor by the maximum PBV of tumor after TACE was 0.7523, with 80.8% sensitivity and 60.6% specificity.
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Affiliation(s)
- Sun Young Choi
- Department of Radiology, School of Medicine, Ewha Womans University, Seoul 07985, Korea;
- Correspondence: ; Tel.: +82-2-2650-5179
| | - Kyung Ah Kim
- Department of Radiology, St. Vincent’s Hospital, College of Medicine, Suwon 16247, Gyeonggi-do, Korea;
| | - Woosun Choi
- Department of Radiology, Chung-ang University Hospital, Seoul 06973, Korea;
| | - Yohan Kwon
- Department of Radiology, Ajou University Hospital, Suwon 16499, Gyeonggi-do, Korea;
| | - Soo Buem Cho
- Department of Radiology, School of Medicine, Ewha Womans University, Seoul 07985, Korea;
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Automated feature quantification of Lipiodol as imaging biomarker to predict therapeutic efficacy of conventional transarterial chemoembolization of liver cancer. Sci Rep 2020; 10:18026. [PMID: 33093524 PMCID: PMC7582153 DOI: 10.1038/s41598-020-75120-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 10/09/2020] [Indexed: 02/08/2023] Open
Abstract
Conventional transarterial chemoembolization (cTACE) is a guideline-approved image-guided therapy option for liver cancer using the radiopaque drug-carrier and micro-embolic agent Lipiodol, which has been previously established as an imaging biomarker for tumor response. To establish automated quantitative and pattern-based image analysis techniques of Lipiodol deposition on 24 h post-cTACE CT as biomarker for treatment response. The density of Lipiodol deposits in 65 liver lesions was automatically quantified using Hounsfield Unit thresholds. Lipiodol deposition within the tumor was automatically assessed for patterns including homogeneity, sparsity, rim, and peripheral deposition. Lipiodol deposition was correlated with enhancing tumor volume (ETV) on baseline and follow-up MRI. ETV on baseline MRI strongly correlated with Lipiodol deposition on 24 h CT (p < 0.0001), with 8.22% ± 14.59 more Lipiodol in viable than necrotic tumor areas. On follow-up, tumor regions with Lipiodol showed higher rates of ETV reduction than areas without Lipiodol (p = 0.0475) and increasing densities of Lipiodol enhanced this effect. Also, homogeneous (p = 0.0006), non-sparse (p < 0.0001), rim deposition within sparse tumors (p = 0.045), and peripheral deposition (p < 0.0001) of Lipiodol showed improved response. This technical innovation study showed that an automated threshold-based volumetric feature characterization of Lipiodol deposits is feasible and enables practical use of Lipiodol as imaging biomarker for therapeutic efficacy after cTACE.
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30
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Kudo M, Ueshima K, Ikeda M, Torimura T, Tanabe N, Aikata H, Izumi N, Yamasaki T, Nojiri S, Hino K, Tsumura H, Kuzuya T, Isoda N, Yasui K, Aino H, Ido A, Kawabe N, Nakao K, Wada Y, Yokosuka O, Yoshimura K, Okusaka T, Furuse J, Kokudo N, Okita K, Johnson PJ, Arai Y. Randomised, multicentre prospective trial of transarterial chemoembolisation (TACE) plus sorafenib as compared with TACE alone in patients with hepatocellular carcinoma: TACTICS trial. Gut 2020; 69:1492-1501. [PMID: 31801872 PMCID: PMC7398460 DOI: 10.1136/gutjnl-2019-318934] [Citation(s) in RCA: 406] [Impact Index Per Article: 101.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 10/16/2019] [Accepted: 10/27/2019] [Indexed: 02/06/2023]
Abstract
OBJECTIVE This trial compared the efficacy and safety of transarterial chemoembolisation (TACE) plus sorafenib with TACE alone using a newly established TACE-specific endpoint and pre-treatment of sorafenib before initial TACE. DESIGN Patients with unresectable hepatocellular carcinoma (HCC) were randomised to TACE plus sorafenib (n=80) or TACE alone (n=76). Patients in the combination group received sorafenib 400 mg once daily for 2-3 weeks before TACE, followed by 800 mg once daily during on-demand conventional TACE sessions until time to untreatable (unTACEable) progression (TTUP), defined as untreatable tumour progression, transient deterioration to Child-Pugh C or appearance of vascular invasion/extrahepatic spread. Co-primary endpoints were progression-free survival (PFS), which is not a conventional one but defined as TTUP, or time to any cause of death plus overall survival (OS). Multiplicity was adjusted by gatekeeping hierarchical testing. RESULTS Median PFS was significantly longer in the TACE plus sorafenib than in the TACE alone group (25.2 vs 13.5 months; p=0.006). OS was not analysed because only 73.6% of OS events were reached. Median TTUP (26.7 vs 20.6 months; p=0.02) was also significantly longer in the TACE plus sorafenib group. OS at 1 year and 2 years in TACE plus sorafenib group and TACE alone group were 96.2% and 82.7% and 77.2% and 64.6%, respectively. There were no unexpected toxicities. CONCLUSION TACE plus sorafenib significantly improved PFS over TACE alone in patients with unresectable HCC. Adverse events were consistent with those of previous TACE combination trials. TRIAL REGISTRATION NUMBER NCT01217034.
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Affiliation(s)
- Masatoshi Kudo
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka-Sayama, Japan
| | - Kazuomi Ueshima
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka-Sayama, Japan
| | - Masafumi Ikeda
- Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | - Takuji Torimura
- Department of Gastroenterology and Hepatology, Kurume University School of Medicine, Kurume, Japan
| | - Nobukazu Tanabe
- Department of Gastroenterology, National Hospital Organisation Sendai Medical Center, Sendai, Japan
| | - Hiroshi Aikata
- Department of Gastroenterology and Metabolism, Hiroshima University, Hiroshima, Japan
| | - Namiki Izumi
- Department of Gastroenterology, Musashino Red Cross Hospital, Tokyo, Japan
| | - Takahiro Yamasaki
- Department of Gastroenterology and Hepatology, Yamaguchi University Graduate School of Medicine, Ube-Yamaguchi, Japan
| | - Shunsuke Nojiri
- Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Keisuke Hino
- Department of Hepatology and Pancreatology, Kawasaki Medical School, Kurashiki, Japan
| | - Hidetaka Tsumura
- Department of Gastroenterology and Hepatology, Hyogo Cancer Center, Akashi, Japan
| | - Teiji Kuzuya
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Norio Isoda
- Department of Medicine, Division of Gastroenterology, Jichi Medical University, Shimotsuke, Japan
| | - Kohichiroh Yasui
- Department of Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Hajime Aino
- Division of Gastroenterology, Department of Medicine, Social Insurance Tagawa Hospital, Tagawa, Japan
| | - Akio Ido
- Department of Gastroenterology and Hepatology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Naoto Kawabe
- Department of Liver, Biliary Tract and Pancreas Diseases, Fujita Health University School of Medicine, Aichi, Japan
| | - Kazuhiko Nakao
- Department of Gastroenterology and Hepatology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Yoshiyuki Wada
- Department of Hepato-Biliary-Pancreatic Surgery, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Osamu Yokosuka
- Department of Gastroenterology, School of Medicine, Chiba University, Chiba, Japan
| | - Kenichi Yoshimura
- Center for Integrated Medical Research, Hiroshima University, Hiroshima, Japan
| | - Takuji Okusaka
- Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Junji Furuse
- Department of Medical Oncology, Kyorin University Faculty of Medicine, Mitaka, Japan
| | - Norihiro Kokudo
- Department of Surgery, National Center for Global Health and Medicine, Tokyo, Japan
| | - Kiwamu Okita
- Deapartment of Medicine, Shunan Memorial Hospital, Kudamatsu, Yamaguchi, Japan
| | - Philip James Johnson
- Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, UK
| | - Yasuaki Arai
- Department of Diagnostic Radiology, National Cancer Center Hospital, Tokyo, Japan
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31
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Maas M, Beets-Tan R, Gaubert JY, Gomez Munoz F, Habert P, Klompenhouwer LG, Vilares Morgado P, Schaefer N, Cornelis FH, Solomon SB, van der Reijd D, Bilbao JI. Follow-up after radiological intervention in oncology: ECIO-ESOI evidence and consensus-based recommendations for clinical practice. Insights Imaging 2020; 11:83. [PMID: 32676924 PMCID: PMC7366866 DOI: 10.1186/s13244-020-00884-5] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 05/20/2020] [Indexed: 12/19/2022] Open
Abstract
Interventional radiology plays an important and increasing role in cancer treatment. Follow-up is important to be able to assess treatment success and detect locoregional and distant recurrence and recommendations for follow-up are needed. At ECIO 2018, a joint ECIO-ESOI session was organized to establish follow-up recommendations for oncologic intervention in liver, renal, and lung cancer. Treatments included thermal ablation, TACE, and TARE. In total five topics were evaluated: ablation in colorectal liver metastases (CRLM), TARE in CRLM, TACE and TARE in HCC, ablation in renal cancer, and ablation in lung cancer. Evaluated modalities were FDG-PET-CT, CT, MRI, and (contrast-enhanced) ultrasound. Prior to the session, five experts were selected and performed a systematic review and presented statements, which were voted on in a telephone conference prior to the meeting by all panelists. These statements were presented and discussed at the ECIO-ESOI session at ECIO 2018. This paper presents the recommendations that followed from these initiatives. Based on expert opinions and the available evidence, follow-up schedules were proposed for liver cancer, renal cancer, and lung cancer. FDG-PET-CT, CT, and MRI are the recommended modalities, but one should beware of false-positive signs of residual tumor or recurrence due to inflammation early after the intervention. There is a need for prospective preferably multicenter studies to validate new techniques and new response criteria. This paper presents recommendations that can be used in clinical practice to perform the follow-up of patients with liver, lung, and renal cancer who were treated with interventional locoregional therapies.
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Affiliation(s)
- Monique Maas
- Dept of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Regina Beets-Tan
- Dept of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Jean-Yves Gaubert
- Dept of Radiology, CHU Hospital Timone, Marseille, France.,Aix Marseille Univ, LIIE, Marseille, France
| | - Fernando Gomez Munoz
- Dept of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.,Dept of Radiology, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Paul Habert
- Dept of Radiology, CHU Hospital Timone, Marseille, France.,Aix Marseille Univ, LIIE, Marseille, France
| | | | | | - Niklaus Schaefer
- Dept of Radiology, Lausanne University Hospital, Lausanne, Switzerland
| | | | - Stephen B Solomon
- Dept of Radiology, Memorial Sloan Kettering Cancer Center, New York, USA
| | | | - Jose Ignacio Bilbao
- Dept of Radiology, University Clinic of Navarra, Calle Benjamín de Tudela, 2, 31008, Pamplona, Navarra, Spain.
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Gupta P, Kalra N, Gulati A, Dev V, Gorsi U, Cheluvashetty SB, Kumar-M P, Duseja A, Singh V, Dhiman RK, Sandhu MS. Response Assessment Following Image-Guided Therapy of Hepatocellular Carcinoma. JOURNAL OF CLINICAL INTERVENTIONAL RADIOLOGY ISVIR 2020. [DOI: 10.1055/s-0040-1708579] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
AbstractImage-guided locoregional therapies have an important role in the management of patients with hepatocellular carcinoma (HCC). Recent advances in the ablative as well as endovascular therapies have expanded the role of interventional radiologists in the treatment of HCC. Following image-guided therapy, an accurate response assessment is vital. Knowledge regarding normal postprocedure changes and subtle signs of residual or recurrent disease is important. In this review, we discuss various response evaluation criteria currently employed for HCC. We also discuss the postprocedure imaging features suggestive of residual disease or recurrence and imaging biomarkers for response assessment.
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Affiliation(s)
- Pankaj Gupta
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Naveen Kalra
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Ajay Gulati
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Vishnu Dev
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Ujjwal Gorsi
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Sreedhara B. Cheluvashetty
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Praveen Kumar-M
- Department of Pharmacology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Ajay Duseja
- Department of Hepatology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Virendra Singh
- Department of Hepatology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Radha K. Dhiman
- Department of Hepatology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Manavjit Singh Sandhu
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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Nam JY, Choe AR, Sinn DH, Lee JH, Kim HY, Yu SJ, Kim YJ, Yoon JH, Lee JM, Chung JW, Choi SY, Lee JK, Baek SY, Lee HA, Kim TH, Yoo K. A differential risk assessment and decision model for Transarterial chemoembolization in hepatocellular carcinoma based on hepatic function. BMC Cancer 2020; 20:504. [PMID: 32487089 PMCID: PMC7268402 DOI: 10.1186/s12885-020-06975-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 05/18/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND The decision of transarterial chemoembolization (TACE) initiation and/or repetition remains challenging in patients with unresectable hepatocellular carcinoma (HCC). The aim was to develop a prognostic scoring system to guide TACE initiation/repetition. METHODS A total of 597 consecutive patients who underwent TACE as their initial treatment for unresectable HCC were included. We derived a prediction model using independent risk factors for overall survival (OS), which was externally validated in an independent cohort (n = 739). RESULTS Independent risk factors of OS included Albumin-bilirubin (ALBI) grade, maximal tumor size, alpha-fetoprotein, and tumor response to initial TACE, which were used to develop a scoring system ("ASAR"). C-index values for OS were 0.733 (95% confidence interval [CI] = 0.570-0.871) in the derivation, 0.700 (95% CI = 0.445-0.905) in the internal validation, and 0.680 (95% CI = 0.652-0.707) in the external validation, respectively. Patients with ASAR< 4 showed significantly longer OS than patients with ASAR≥4 in all three datasets (all P < 0.001). Among Child-Pugh class B patients, a modified model without TACE response, i.e., "ASA(R)", discriminated OS with a c-index of 0.788 (95% CI, 0.703-0.876) in the derivation, and 0.745 (95% CI, 0.646-0.862) in the internal validation, and 0.670 (95% CI, 0.605-0.725) in the external validation, respectively. Child-Pugh B patients with ASA(R) < 4 showed significantly longer OS than patients with ASA(R) ≥ 4 in all three datasets (all P < 0.001). CONCLUSIONS ASAR provides refined prognostication for repetition of TACE in patients with unresectable HCC. For Child-Pugh class B patients, a modified model with baseline factors might guide TACE initiation.
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Affiliation(s)
- Joon Yeul Nam
- Department of Internal Medicine, College of Medicine, Ewha Womans University, 1071, Anyangcheon-ro, Yangcheon-gu, Seoul, 07985 Republic of Korea
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, 101, Daehak-ro, Jongno-gu, Seoul, 03080 Republic of Korea
| | - A Reum Choe
- Department of Internal Medicine, College of Medicine, Ewha Womans University, 1071, Anyangcheon-ro, Yangcheon-gu, Seoul, 07985 Republic of Korea
| | - Dong Hyun Sinn
- Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jeong-Hoon Lee
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, 101, Daehak-ro, Jongno-gu, Seoul, 03080 Republic of Korea
| | - Hwi Young Kim
- Department of Internal Medicine, College of Medicine, Ewha Womans University, 1071, Anyangcheon-ro, Yangcheon-gu, Seoul, 07985 Republic of Korea
| | - Su Jong Yu
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, 101, Daehak-ro, Jongno-gu, Seoul, 03080 Republic of Korea
| | - Yoon Jun Kim
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, 101, Daehak-ro, Jongno-gu, Seoul, 03080 Republic of Korea
| | - Jung-Hwan Yoon
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, 101, Daehak-ro, Jongno-gu, Seoul, 03080 Republic of Korea
| | - Jeong Min Lee
- Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jin Wook Chung
- Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Sun Young Choi
- Department of Radiology, College of Medicine, Ewha Womans University, Seoul, Republic of Korea
| | - Jeong Kyong Lee
- Department of Radiology, College of Medicine, Ewha Womans University, Seoul, Republic of Korea
| | - Seung Yon Baek
- Department of Radiology, College of Medicine, Ewha Womans University, Seoul, Republic of Korea
| | - Hye Ah Lee
- Clinical Trial Center, Ewha Womans University Mokdong Hospital, Seoul, Republic of Korea
| | - Tae Hun Kim
- Department of Internal Medicine, College of Medicine, Ewha Womans University, 1071, Anyangcheon-ro, Yangcheon-gu, Seoul, 07985 Republic of Korea
| | - Kwon Yoo
- Department of Internal Medicine, College of Medicine, Ewha Womans University, 1071, Anyangcheon-ro, Yangcheon-gu, Seoul, 07985 Republic of Korea
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Gregory J, Dioguardi Burgio M, Corrias G, Vilgrain V, Ronot M. Evaluation of liver tumour response by imaging. JHEP Rep 2020; 2:100100. [PMID: 32514496 PMCID: PMC7267412 DOI: 10.1016/j.jhepr.2020.100100] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 03/10/2020] [Accepted: 03/10/2020] [Indexed: 12/12/2022] Open
Abstract
The goal of assessing tumour response on imaging is to identify patients who are likely to benefit - or not - from anticancer treatment, especially in relation to survival. The World Health Organization was the first to develop assessment criteria. This early score, which assessed tumour burden by standardising lesion size measurements, laid the groundwork for many of the criteria that followed. This was then improved by the Response Evaluation Criteria in Solid Tumours (RECIST) which was quickly adopted by the oncology community. At the same time, many interventional oncology treatments were developed to target specific features of liver tumours that result in significant changes in tumours but have little effect on tumour size. New criteria focusing on the viable part of tumours were therefore designed to provide more appropriate feedback to guide patient management. Targeted therapy has resulted in a breakthrough that challenges conventional response criteria due to the non-linear relationship between response and tumour size, requiring the development of methods that emphasize the appearance of tumours. More recently, research into functional and quantitative imaging has created new opportunities in liver imaging. These results have suggested that certain parameters could serve as early predictors of response or could predict later tumour response at baseline. These approaches have now been extended by machine learning and deep learning. This clinical review focuses on the progress made in the evaluation of liver tumours on imaging, discussing the rationale for this approach, addressing challenges and controversies in the field, and suggesting possible future developments.
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Key Words
- (c)TACE, (conventional) transarterial chemoembolisation
- (m)RECIST, (modified) Response Evaluation Criteria in Solid Tumours
- 18F-FDG, 18F-fluorodeoxyglucose
- 90Y, yttrium-90
- ADC, apparent diffusion coefficient
- APHE, arterial phase hyperenhancement
- CEUS, contrast-enhanced ultrasound
- CRLM, colorectal liver metastases
- DWI, diffusion-weighted imaging
- EASL
- EASL, European Association for the Study of the Liver criteria
- GIST, gastrointestinal stromal tumours
- HCC, hepatocellular carcinoma
- HU, Hounsfield unit
- Imaging
- LI-RADS
- LI-RADS, Liver Imaging Reporting And Data System
- Liver
- Metastases
- PD, progressive disease
- PET, positron emission tomography
- PR, partial response
- RECIST
- SD, stable disease
- SIRT, selective internal radiotherapy
- TR, treatment response
- Tumours
- WHO, World Health Organization
- mRECIST
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Affiliation(s)
- Jules Gregory
- Department of Radiology, APHP, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, France
- University of Paris, Paris, France
- INSERM U1149, CRI, Paris, France
| | - Marco Dioguardi Burgio
- Department of Radiology, APHP, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, France
- University of Paris, Paris, France
- INSERM U1149, CRI, Paris, France
| | - Giuseppe Corrias
- Department of Radiology, APHP, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, France
- University of Paris, Paris, France
- INSERM U1149, CRI, Paris, France
| | - Valérie Vilgrain
- Department of Radiology, APHP, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, France
- University of Paris, Paris, France
- INSERM U1149, CRI, Paris, France
| | - Maxime Ronot
- Department of Radiology, APHP, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, France
- University of Paris, Paris, France
- INSERM U1149, CRI, Paris, France
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Yamada R, Bassaco B, Bracewell S, Volin S, Collins H, Hannegan C, Guimarares M. Combined conventional transarterial chemoembolization with Mitomycin and percutaneous ablation for unresectable hepatocellular carcinoma. J Gastrointest Oncol 2020; 11:298-303. [PMID: 32399271 DOI: 10.21037/jgo.2019.01.07] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background Conventional transarterial chemoembolization (cTACE) has been the standard treatment for intermediate stage hepatocellular carcinoma (HCC). For early stage HCC, percutaneous ablation is a curative option. There is growing evidence to support combined therapy to improve tumor response and overall survival (OS) in patients with unresectable HCC. The goal of this study is to retrospectively review a single institution patient population who underwent the combined approach to determine its efficacy and safety, and possible predictive factors for OS and tumor response. Methods Retrospective analysis identified all patients that underwent c-TACE with Mitomycin followed by percutaneous ablation from 2011 to 2016 at our institution. Efficacy was assessed by OS, time to progression (TTP), and tumor response according to mRECIST criteria. Initial imaging was obtained 1 month after each treatment and after complete response was achieved, every 3 months for 2 years. Percentage of Lipiodol uptake was determined at 30-day follow-up with contrasted abdominal CT. Safety was assessed using Common Terminology Criteria for Adverse Events (CTCAE) v4.0. Multiple linear regressions were conducted to predict OS and number of progression-free survival days based on potential predictive factors. Results A total of 50 patients were identified. At 1-month follow-up, objective response (CR + PR) was achieved in 44 patients (88%). The median OS was 26.6 months and median TTP was 9.7 months (n=50). There was no statistically significant difference in median OS between patients with different lesion size (P=0.95), BCLC stage (P=0.84) or Lipiodol uptake (P=0.36). Higher albumin/bilirubin ratio was significantly correlated with improved OS (P=0.024). Conclusions Combined c-TACE and PTA is a safe and effective approach for patients with unresectable HCC. Elevated albumin/bilirubin ratio was a predictor for improved OS.
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Affiliation(s)
- Ricardo Yamada
- Division of Vascular & Interventional Radiology, Department of Radiology, Medical University of South Carolina, Charleston, SC, USA
| | - Beatriz Bassaco
- Division of Vascular & Interventional Radiology, Department of Radiology, Medical University of South Carolina, Charleston, SC, USA
| | - Stephen Bracewell
- Division of Vascular & Interventional Radiology, Department of Radiology, Medical University of South Carolina, Charleston, SC, USA
| | - Samuel Volin
- Division of Vascular & Interventional Radiology, Department of Radiology, Medical University of South Carolina, Charleston, SC, USA
| | - Heather Collins
- Division of Vascular & Interventional Radiology, Department of Radiology, Medical University of South Carolina, Charleston, SC, USA
| | - Christopher Hannegan
- Division of Vascular & Interventional Radiology, Department of Radiology, Medical University of South Carolina, Charleston, SC, USA
| | - Marcelo Guimarares
- Division of Vascular & Interventional Radiology, Department of Radiology, Medical University of South Carolina, Charleston, SC, USA
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Lipiodol retention pattern after TACE for HCC is a predictor for local progression in lesions with complete response. Cancer Imaging 2019; 19:75. [PMID: 31730491 PMCID: PMC6858631 DOI: 10.1186/s40644-019-0260-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 11/05/2019] [Indexed: 12/23/2022] Open
Abstract
Background To evaluate the predictive value of the lipiodol retention pattern for local progression of HCC with a complete response (CR) on CT according to mRECIST criteria after a first session of conventional chemoembolization (cTACE). Methods From January 2014 to May 2016 all consecutive patients undergoing a first cTACE session for HCC were identified. Inclusion criteria were the presence of ≤3 HCCs and available pre- and post-cTACE CT. Tumor response was classified according to mRECIST criteria. The analysis focused on tumors with a CR. The lipiodol retention pattern in these tumors was classified as complete (C-Lip, covering the entire tumor volume), or incomplete (I-Lip). Local progression was defined as the reappearance of areas of enhancement on arterial-phase images with washout on portal/delayed phase images within 2 cm from treated tumors on follow-up CT. Results The final population included 50 patients with 82 HCCs. A total of 46 (56%) HCCs were classified with a CR, including 16 (35%) with I-Lip, and 30 (65%) with C-Lip. After a median follow-up of 14 months (3.2–35.9 months), 15/16 (94%) and 10/30 (30%) of I-Lip and C-Lip HCCs showed local progression on CT, respectively (p < 0.001), with no significant difference in the time to progression (mean 11.1 ± 2 vs. 13.4 ± 3 months for I-Lip and C-Lip, respectively p = 0.51). Conclusions HCCs with incomplete lipiodol retention after a first cTACE session have a high risk of local progression even when there is a CR according to mRECIST, and should be considered to be incompletely treated.
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Zhang W, Xu AH, Wang W, Wu YH, Sun QL, Shu C. Radiological appearance of hepatocellular carcinoma predicts the response to trans-arterial chemoembolization in patients undergoing liver transplantation. BMC Cancer 2019; 19:1041. [PMID: 31690274 PMCID: PMC6833151 DOI: 10.1186/s12885-019-6265-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 10/15/2019] [Indexed: 12/14/2022] Open
Abstract
Background The ultimate goal of locoregional therapy (LRT) to the liver is to induce total tumor necrosis. Trans-arterial chemoembolization (TACE) is the mainstay bridging therapy for patients with hepatocellular carcinoma (HCC) waiting for liver transplantation (LT). However, tumor response rate is variable. The purpose of this study was to correlate HCC radiological appearance with level of tumor necrosis during explant analysis from patients undergoing LT who received pre-LT TACE. Methods From January 2000 to December 2018, a total of 66 patients with HCC who had been treated prior to LT by means of TACE were analyzed. Diagnosis of HCC was made based on AASLD guidelines and confirmed via histopathology explant analysis. Radiologic tumor response after TACE was based on modified Response Evaluation Criteria in Solid Tumors (mRECIST). Degree of tumor necrosis was determined by histopathology analysis of liver explants. HCC radiological appearances on CT before TACE were assessed and correlated with histological findings after LT. Results Eighty nine TACE procedures (1.35 ± 0.67; 1–4) were performed, of which 18 were repeated TACE (27.3%) procedures. In 56.1% of the patients, ≥90% (near-complete) tumor necrosis was achieved. Concordance between mRECIST criteria and pathology was observed in 63% of the patients, with an underestimation of tumor response in 18 (27%) patients and an overestimation in 6 (9.1%). Near-complete tumor necrosis upon pathological analysis was associated with tumor hyper-enhancement in the arterial phase (P = 0.002), “typical tumor enhancement” (P = 0.010) and smooth tumor margins (p = 0.011). The multivariate analysis showed that well circumscribed HCCs with smooth margins and arterial hyper-enhancement independently correlated with post-TACE near-complete histological tumor necrosis. Conclusions The well circumscribed HCC lesions with arterial hyper-enhancement are more susceptible to TACE than lesions with arterial phase iso or hypo-enhancement and lesions with infiltrative appearance. Pre-TACE CT imaging may ease the selection of an optimal treatment strategy for bridging patients with HCC to liver transplantation.
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Affiliation(s)
- Wei Zhang
- Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, 430030, China.
| | - An-Hui Xu
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wei Wang
- Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, 430030, China
| | - Yan-Hui Wu
- Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, 430030, China
| | - Qian-Ling Sun
- Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, 430030, China
| | - Chang Shu
- Surgery administrator office, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Kudo M, Ikeda M, Ueshima K, Sakamoto M, Shiina S, Tateishi R, Hasegawa K, Furuse J, Miyayama S, Murakami T, Yamashita T, Kokudo N. Response Evaluation Criteria in Cancer of the Liver version 5 (RECICL 2019 revised version). Hepatol Res 2019; 49:981-989. [PMID: 31231916 DOI: 10.1111/hepr.13394] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 06/17/2019] [Accepted: 06/19/2019] [Indexed: 12/31/2022]
Abstract
Response Evaluation Criteria in Solid Tumors (RECIST) is inappropriate to assess the direct effects of treatment on hepatocellular carcinoma (HCC) by locoregional therapies, such as radiofrequency ablation and transarterial chemoembolization. Therefore, establishment of response evaluation criteria solely devoted to HCC is needed in clinical practice, as well as in clinical trials of HCC treatment, such as systemic therapies, which cause necrosis of the tumor. Response Evaluation Criteria in Cancer of the Liver (RECICL) was revised in 2019 by the Liver Cancer Study Group of Japan based on the 2015 version of RECICL, which was commonly used in Japan. The major revised points of the RECICL 2019 are as follows: (i) CEA and CA19-9 have been newly added as tumor markers that should be recorded for use as criteria in the response evaluation for intrahepatic cholangiocarcinoma; (ii) the criteria now state that the details of molecular targeted therapy should be specified; and (iii) specific methods for overall evaluation are now described. Also, as an assessment of overall TE4 requires that TE4 is achieved in all nodules (even non-target lesions), the same calculation methods described above are used. We hope this new treatment response criteria, RECICL, proposed by the Liver Cancer Study Group of Japan will benefit the HCC treatment response evaluation in the setting of daily clinical practice and clinical trials as well, not only in Japan, but also internationally.
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Affiliation(s)
- Masatoshi Kudo
- Department of Gastroenteology and Hepatology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Masafumi Ikeda
- Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | - Kazuomi Ueshima
- Department of Gastroenteology and Hepatology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Michiie Sakamoto
- Department of Pathology, Keio University School of Medicine, Tokyo, Japan
| | - Shuichiro Shiina
- Department of Gastroenterology, Juntendo University, Tokyo, Japan
| | - Ryosuke Tateishi
- Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | - Kiyoshi Hasegawa
- Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Junji Furuse
- Department of Medical Oncology, Kyorin University Faculty of Medicine, Tokyo, Japan
| | - Shiro Miyayama
- Department of Diagnostic Radiology, Fukuiken Saiseikai Hospital, Fukui, Japan
| | - Takamichi Murakami
- Department of Diagnostic and Interventional Radiology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Tatsuya Yamashita
- Advanced preventive medical sciences research center, Kanazawa University, Kanazawa, Japan
| | - Norihiro Kokudo
- National Center for Global Health and Medicine, Tokyo, Japan
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Langenbach MC, Vogl TJ, von den Driesch I, Kaltenbach B, Scholtz JE, Hammerstingl RM, Gruber-Rouh T. Analysis of Lipiodol uptake in angiography and computed tomography for the diagnosis of malignant versus benign hepatocellular nodules in cirrhotic liver. Eur Radiol 2019; 29:6539-6549. [DOI: 10.1007/s00330-019-06297-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 05/15/2019] [Accepted: 05/29/2019] [Indexed: 02/08/2023]
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van Breugel JMM, Geschwind JF, Mirpour S, Savic LJ, Zhang X, Duran R, Lin M, Miszczuk M, Liapi E, Chapiro J. Theranostic application of lipiodol for transarterial chemoembolization in a VX2 rabbit liver tumor model. Am J Cancer Res 2019; 9:3674-3686. [PMID: 31281506 PMCID: PMC6587357 DOI: 10.7150/thno.32943] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 03/25/2019] [Indexed: 02/07/2023] Open
Abstract
The goal of this study was to investigate the role of Lipiodol as a tumor-specific imaging biomarker to determine therapeutic efficacy of cTACE and investigate its inter-dependency with tumor perfusion using radiological-pathological correlation in an animal model of liver cancer. METHODS A total of N=36 rabbits were implanted in the left lobe of the liver with VX2 tumors, treated with cTACE using doxorubicin suspended in Lipiodol, and randomly sacrificed at 24 h, 7 days, or 20 days post-TACE. Unenhanced and contrast-enhanced CT scans including a perfusion protocol were obtained before cTACE and immediately before sacrifice. Tumor vascularity and Lipiodol deposition within tumors and hepatic tissue (non-target deposits) were quantified using 3D quantitative assessment tools and measurements of arterial flow, portal flow, and perfusion index (PI). After sacrifice histologic staining, including hematoxylin and eosin (H&E), CD31, and Oil Red O (ORO) were performed on tumor and liver samples to evaluate necrosis, microvascular density (MVD), and Lipiodol retention over time. Transmission electron microscopy (TEM) was performed to assess Lipiodol deposition and clearance over time. RESULTS All cTACE procedures were carried out successfully except for one, which was excluded from further analysis. Twenty-four hours post-TACE, tumor PI (p=0.04) was significantly decreased, which was maintained at 7 days (p=0.003), but not at 20 days (p=0.4). A strong correlation (R2 = 0.894) was found between the volume of enhancing tumor tissue at baseline and Lipiodol-positive tumor volume post-TACE. Both ORO and TEM showed deposition of Lipiodol across all imaging time points within the VX2 tumors. However, gradual and ultimately near-complete Lipiodol washout was observed over time in the non-tumoral liver. MVD decreased between 24 h and 7 days post-TACE, and then increased 20 days post-TACE (both p<0.01). CONCLUSIONS Our data provide radiology-pathology evidence for the function of Lipiodol as a theranostic, tumor-specific drug delivery agent because it is both imageable and tumor-seeking, whereby it is preferentially taken up and retained by tumor cells. Those tumor-specific functions also enable Lipiodol to act as an imaging biomarker for the therapeutic efficacy of cTACE. Together with volumetric quantification of tumor vascularization on CT, Lipiodol could be used as a predictor of a patient's response to cTACE and contribute to the therapeutic management of patients with liver cancer.
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Yamada R, Bassaco B, Bracewell S, Gillen K, Kocher M, Collins H, Anderson MB, Guimaraes M. Long-term follow-up after conventional transarterial chemoembolization (c-TACE) with mitomycin for hepatocellular carcinoma (HCC). J Gastrointest Oncol 2019; 10:348-353. [PMID: 31032104 DOI: 10.21037/jgo.2019.01.01] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Background Conventional transarterial chemoembolization (c-TACE) is a common treatment for unresectable hepatocellular carcinoma (HCC). It is associated with increased overall survival (OS) when compared to conservative management. The purpose of this study is to analyze all c-TACE with mitomycin in patients with HCC at a single institution to determine safety, efficacy, and prognostic factors in a long-term follow-up. Methods Retrospective analysis of patients with HCC treated only with c-TACE with Mitomycin between 2007 and 2012. Efficacy was determined by OS at 1, 3, and 5 years, censored by date of death or last known follow-up. Treatment response was assessed according to mRECIST criteria and the degree of lipiodol uptake by the lesions was assessed by CT at 1-month follow-up. Prognostic factors were analyzed by multiple linear regression analysis, significance levels set at 0.05. Results A total of 60 patients were identified. OS rate at 1, 3 and 5 years was 72.1%, 47.8% and 39.3%, respectively. Median OS was 15 months. Tumor response by mRECIST criteria was complete; objective response, defined as combination of complete response (CR) and partial response (PR) patients, was 76%. When stratified by tumor response, risk of death in patients with progressive disease in 5 years was significantly higher compared to patients with objective response [hazard ratio (HR): 2.531, 95% confidence interval (CI): 1.110-5.778, P=0.0273]. Lipiodol uptake analysis was available in 51 patients; there was no statistically significant difference in OS in patients with higher lipiodol uptake compared to less uptake (<50% versus >50% uptake; HR: 0.713, 95% CI: 0.316-1.611, P=0.4161]. Conclusions c-TACE with mitomycin was effective and safe in this long-term follow-up study. Risk of death was significantly higher in patients without objective tumor response.
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Affiliation(s)
- Ricardo Yamada
- Division of Vascular & Interventional Radiology, Department of Radiology, Medical University of South Carolina, Charleston, SC, USA
| | - Beatriz Bassaco
- Division of Vascular & Interventional Radiology, Department of Radiology, Medical University of South Carolina, Charleston, SC, USA
| | - Stephen Bracewell
- Division of Vascular & Interventional Radiology, Department of Radiology, Medical University of South Carolina, Charleston, SC, USA
| | - Kirkpatrick Gillen
- Division of Vascular & Interventional Radiology, Department of Radiology, Medical University of South Carolina, Charleston, SC, USA
| | - Madison Kocher
- Division of Vascular & Interventional Radiology, Department of Radiology, Medical University of South Carolina, Charleston, SC, USA
| | - Heather Collins
- Division of Vascular & Interventional Radiology, Department of Radiology, Medical University of South Carolina, Charleston, SC, USA
| | - Michael Bret Anderson
- Division of Vascular & Interventional Radiology, Department of Radiology, Medical University of South Carolina, Charleston, SC, USA
| | - Marcelo Guimaraes
- Division of Vascular & Interventional Radiology, Department of Radiology, Medical University of South Carolina, Charleston, SC, USA
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Combined Therapy with Transarterial Chemoembolization and Radiofrequency Ablation for Hepatocellular Carcinoma: Does the Degree of Ethiodized Oil Accumulation within the Tumor Affect the Therapeutic Efficacy? J Vasc Interv Radiol 2019; 30:370-379.e4. [PMID: 30819479 DOI: 10.1016/j.jvir.2018.09.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 09/06/2018] [Accepted: 09/10/2018] [Indexed: 01/03/2023] Open
Abstract
PURPOSE To evaluate the effects of the degree of ethiodized oil accumulation achieved by transarterial chemoembolization followed by radiofrequency (RF) ablation on the treatment efficacy for a single intermediate-sized hepatocellular carcinoma (HCC). MATERIALS AND METHODS A total of 153 consecutive patients who underwent chemoembolization and RF ablation for a single intermediate-sized HCC (2-5 cm) were included. On the basis of the degree of ethiodized oil accumulation in HCC on cone-beam CT images, patients who underwent chemoembolization and RF ablation were classified into 2 groups: compact accumulation (≥ 75%) and noncompact accumulation (< 75%). The rates of cumulative local tumor progression (LTP), disease-free survival (DFS), and overall survival (OS) were compared between groups. RESULTS Of the 153 patients, 89 were classified into the compact ethiodized oil accumulation group and 64 in the noncompact ethiodized oil accumulation group. There were no significant differences in patient demographic or HCC characteristics between groups except for the incidence of liver cirrhosis (P = .038) and the tumor margin morphology (P = .008). The cumulative LTP rate was significantly lower in the compact accumulation group than in the noncompact accumulation group (P = .013). There were no significant differences in the incidences of complications, DFS rates (P = .055), or OS rates (P = .184). CONCLUSIONS The degree of ethiodized oil accumulation does not play a role in decreasing the OS or DFS rate after chemoembolization and RF ablation for intermediate-sized HCC; however, it may contribute to reducing the rate of LTP.
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Kim KA, Choi SY, Kim MU, Baek SY, Park SH, Yoo K, Kim TH, Kim HY. The Efficacy of Cone-Beam CT–Based Liver Perfusion Mapping to Predict Initial Response of Hepatocellular Carcinoma to Transarterial Chemoembolization. J Vasc Interv Radiol 2019; 30:358-369. [DOI: 10.1016/j.jvir.2018.10.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 08/16/2018] [Accepted: 10/06/2018] [Indexed: 02/08/2023] Open
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Kudo M, Ikeda M, Ueshima K, Sakamoto M, Shiina S, Tateishi R, Hasegawa K, Furuse J, Miyayama S, Murakami T, Yamashita T, Kokudo N. Response Evaluation Criteria in Cancer of the Liver (RECICL 2019 revised version). ACTA ACUST UNITED AC 2019. [DOI: 10.2957/kanzo.60.55] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Masatoshi Kudo
- Committee for Response Evaluation Criteria in Cancer of the Liver, Liver Cancer Study Group of Japan
- Committee Chair, Liver Cancer Study Group of Japan
| | - Masafumi Ikeda
- Committee for Response Evaluation Criteria in Cancer of the Liver, Liver Cancer Study Group of Japan
| | - Kazuomi Ueshima
- Committee for Response Evaluation Criteria in Cancer of the Liver, Liver Cancer Study Group of Japan
| | - Michiie Sakamoto
- Committee for Response Evaluation Criteria in Cancer of the Liver, Liver Cancer Study Group of Japan
| | - Shuichiro Shiina
- Committee for Response Evaluation Criteria in Cancer of the Liver, Liver Cancer Study Group of Japan
| | - Ryosuke Tateishi
- Committee for Response Evaluation Criteria in Cancer of the Liver, Liver Cancer Study Group of Japan
| | - Kiyoshi Hasegawa
- Committee for Response Evaluation Criteria in Cancer of the Liver, Liver Cancer Study Group of Japan
| | - Junji Furuse
- Committee for Response Evaluation Criteria in Cancer of the Liver, Liver Cancer Study Group of Japan
| | - Shiro Miyayama
- Committee for Response Evaluation Criteria in Cancer of the Liver, Liver Cancer Study Group of Japan
| | - Takamichi Murakami
- Committee for Response Evaluation Criteria in Cancer of the Liver, Liver Cancer Study Group of Japan
| | - Tatsuya Yamashita
- Committee for Response Evaluation Criteria in Cancer of the Liver, Liver Cancer Study Group of Japan
| | - Norihiro Kokudo
- Committee for Response Evaluation Criteria in Cancer of the Liver, Liver Cancer Study Group of Japan
- Committee Chair of General Rules for the Clinical and Pathological Study of Primary Liver Cancer, Liver Cancer Study Group of Japan
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Raoul JL, Forner A, Bolondi L, Cheung TT, Kloeckner R, de Baere T. Updated use of TACE for hepatocellular carcinoma treatment: How and when to use it based on clinical evidence. Cancer Treat Rev 2018; 72:28-36. [PMID: 30447470 DOI: 10.1016/j.ctrv.2018.11.002] [Citation(s) in RCA: 344] [Impact Index Per Article: 57.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 11/09/2018] [Accepted: 11/10/2018] [Indexed: 02/07/2023]
Abstract
Hepatocellular carcinoma (HCC) is the most common primary liver cancer, representing the sixth leading cause of cancer and the third leading cause of cancer-related mortality. Patient stratification and treatment allocation are based on tumor stage, liver function, and performance status. According to the Barcelona Clinic Liver Cancer (BCLC) staging system, transarterial chemoembolization (TACE) is the first-line treatment for patients with intermediate stage HCC, including those with large or multinodular HCC, well-preserved liver function, and no cancer-related symptoms or evidence of vascular invasion or extrahepatic spread. Two TACE techniques have been used since 2004, conventional TACE (cTACE) and TACE with drug-eluting beads (DEB-TACE). cTACE was evidenced first to treat intermediate stage HCC patients. It combines the transcatheter delivery of chemotherapy using Lipiodol-based emulsion plus an embolizing agent to achieve strong cytotoxic and ischemic effects. Drug-eluting beads (DEBs) were developed in order to slowly release chemotherapeutic agents, and to increase ischemia intensity and duration. Recent advances allow TACE treatment of both early stage patients (i.e. those with a solitary nodule or up to 3 nodules under 3 cm) and some advanced stage patients. Here we review recent clinical evidence related to TACE treatment of patients with early, intermediate, and advanced stage HCC. Based on the 2014 TACE algorithm of Raoul et al., this international expert panel proposes an updated TACE algorithm and provides insights into TACE use for patients at any HCC stage.
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Affiliation(s)
- Jean-Luc Raoul
- Digestive Oncology, Institut de Cancérologie de l'Ouest, Boulevard Professeur Jacques Monod, 44805 Nantes-Saint Herblain, France.
| | - Alejandro Forner
- Barcelona Clinic Liver Cancer Group, Liver Unit, IDIBAPS, Hospital Clínic, University of Barcelona, Calle Villaroel 170, 08036 Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Avenida Monforte de Lemos, 28029 Madrid, Spain.
| | - Luigi Bolondi
- Unit of Internal Medicine, Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Via Zamboni 33, 40126 Bologna, Italy.
| | - Tan To Cheung
- Department of Surgery, The University of Hong Kong, Queen Mary Hospital, Pokfulam Road 102, Hong Kong Special Administrative Region
| | - Roman Kloeckner
- Department of Diagnostic and Interventional Radiology, Johannes Gutenberg-University Medical Centre, Langenbeckstraße 1, 55131 Mainz, Germany.
| | - Thierry de Baere
- Gustave Roussy-Cancer Campus, rue Edouard-Vaillant 114, 94 805 Villejuif Cedex, France.
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Jonczyk M, Collettini F, Geisel D, Schnapauff D, Böning G, Wieners G, Gebauer G. Radiation exposure during TACE procedures using additional cone-beam CT (CBCT) for guidance: safety and precautions. Acta Radiol 2018; 59:1277-1284. [PMID: 29490465 DOI: 10.1177/0284185118761203] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Background During transarterial chemoembolization (TACE), cone-beam computed tomography (CBCT) can be used for tumor and feeding vessel detection as well as postembolization CT imaging. However, there will be additional radiation exposure from CBCT. Purpose To evaluate the additional dose raised through CBCT-assisted guidance in comparison to TACE procedures guided with pulsed digital subtraction angiography (DSA) alone. Material and Methods In 70 of 140 consecutive patients undergoing TACE for liver cancer, CBCT was used to facilitate the TACE. Cumulative dose area product (DAP), cumulative kerma(air), DAP values of DSA, total and cine specific fluoroscopy times (FT) of 1375 DSA runs, and DAP of 91 CBCTs were recorded and analyzed using Spearman's correlation, Mann-Whitney U-test, and Kruskal-Wallis test. P values < 0.05 were considered significant. Results Additional CBCT increased DAP by 2% ( P = 0.737), kerma(air) by 24.6% ( P = 0.206), and FT by 0.02% ( P = 0.453). Subgroup analysis revealed that postembolization CBCT for detection of ethiodized oil deposits added more DAP to the procedure. Performing CBCT-assisted TACE, DSA until first CBCT contributed about 38% to the total DAP. Guidance CBCT acquisitions conduced to 6% of the procedure's DAP. Additional DSA for guidance after CBCT acquisition required approximately 46% of the mean DAP. The last DSA run for documentation purposes contributed about 10% of the DAP. Conclusion CBCT adds radiation exposure in TACE. However, the capability of CBCT to detect vessels and overlay in real-time during fluoroscopy facilitates TACE with resultant reduction of DAPs up to 46%.
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Affiliation(s)
- M Jonczyk
- Department of Radiology, Charité University Medicine Berlin, Berlin, Germany
- Berlin Institute of Health (BIH), Berlin, Germany
| | - F Collettini
- Department of Radiology, Charité University Medicine Berlin, Berlin, Germany
- Berlin Institute of Health (BIH), Berlin, Germany
| | - D Geisel
- Department of Radiology, Charité University Medicine Berlin, Berlin, Germany
| | - D Schnapauff
- Department of Radiology, Charité University Medicine Berlin, Berlin, Germany
| | - G Böning
- Department of Radiology, Charité University Medicine Berlin, Berlin, Germany
| | - G Wieners
- Department of Radiology, Charité University Medicine Berlin, Berlin, Germany
| | - G Gebauer
- Department of Radiology, Charité University Medicine Berlin, Berlin, Germany
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Vollherbst DF, Gockner T, Do T, Holzer K, Mogler C, Flechsig P, Harms A, Schlett CL, Pereira PL, Richter GM, Kauczor HU, Sommer CM. Computed tomography and histopathological findings after embolization with inherently radiopaque 40μm-microspheres, standard 40μm-microspheres and iodized oil in a porcine liver model. PLoS One 2018; 13:e0198911. [PMID: 29985928 PMCID: PMC6037373 DOI: 10.1371/journal.pone.0198911] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Accepted: 05/29/2018] [Indexed: 02/07/2023] Open
Abstract
Purpose The present study compared standard computed tomography (CT) and histopathological findings after endovascular embolization using a prototype of inherently radiopaque 40μm-microspheres with both standard 40μm-microspheres and iodized oil in a porcine liver model. Materials and methods Twelve pigs were divided into six study groups, of two pigs each. Four pigs were embolized with iodized oil alone and four with radiopaque microspheres; two animals in each group were sacrificed at 2 hours and two at 7 days. Two pigs were embolized with radiopaque microspheres and heparin and sacrificed at 7 days. Two pigs were embolized with standard microspheres and sacrificed at 2 hours. CT was performed before and after segmental embolization and before sacrifice at 7 days. The distribution of embolic agent, inflammatory response and tissue necrosis were assessed histopathologically. Results Radiopaque microspheres and iodized oil were visible on standard CT 2 hours and 7 days after embolization, showing qualitatively comparable arterial and parenchymal enhancement. Quantitatively, the enhancement was more intense for iodized oil. Standard microspheres, delivered without contrast, were not visible by imaging. Radiopaque and standard microspheres similarly occluded subsegmental and interlobular arteries and, to a lesser extent, sinusoids. Iodized oil resulted in the deepest penetration into sinusoids. Necrosis was always observed after embolization with microspheres, but never after embolization with iodized oil. The inflammatory response was mild to moderate for microspheres and moderate to severe for iodized oil. Conclusion Radiopaque 40μm-microspheres are visible on standard CT with qualitatively similar but quantitatively less intense enhancement compared to iodized oil, and with a tendency towards less of an inflammatory reaction than iodized oil. These microspheres also result in tissue necrosis, which was not observed after embolization with iodized oil. Both radiopaque and standard 40μm-microspheres are found within subsegmental and interlobar arteries, as well as in hepatic sinusoids.
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Affiliation(s)
- Dominik F. Vollherbst
- Department of Neuroradiology, University Hospital Heidelberg, Heidelberg, Germany
- Clinic for Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Theresa Gockner
- Clinic for Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany
- Clinic for Diagnostic and Interventional Radiology, University Hospital Mainz, Mainz, Germany
| | - Thuy Do
- Clinic for Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Kerstin Holzer
- Department of General Pathology, University Hospital Heidelberg, Heidelberg, Germany
| | - Carolin Mogler
- Institute of Pathology, Technical University Munich, Munich, Germany
| | - Paul Flechsig
- Clinic for Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany
- Department of Nuclear Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Alexander Harms
- Department of General Pathology, University Hospital Heidelberg, Heidelberg, Germany
| | - Christopher L. Schlett
- Clinic for Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Philippe L. Pereira
- Clinic for Radiology, Minimally-invasive Therapies and Nuclear Medicine, SLK Kliniken Heilbronn GmbH, Heilbronn, Germany
| | - Götz M. Richter
- Clinic for Diagnostic and Interventional Radiology, Klinikum Stuttgart, Stuttgart, Germany
| | - Hans U. Kauczor
- Clinic for Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Christof M. Sommer
- Clinic for Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany
- Clinic for Diagnostic and Interventional Radiology, Klinikum Stuttgart, Stuttgart, Germany
- * E-mail:
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Young S, Taylor AJ, Sanghvi T. Post Locoregional Therapy Treatment Imaging in Hepatocellular Carcinoma Patients: A Literature-based Review. J Clin Transl Hepatol 2018; 6:189-197. [PMID: 29951364 PMCID: PMC6018307 DOI: 10.14218/jcth.2017.00059] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 12/14/2017] [Accepted: 12/22/2017] [Indexed: 12/19/2022] Open
Abstract
Imaging plays a crucial role in the diagnosis of hepatocellular carcinoma (HCC) as well as in determining treatment efficacy, or complications, following therapy. Unlike other cancers, HCC is most commonly treated by locoregional therapies (LRTs) such as thermal ablation, transarterial chemoembolization, and transarterial radioembolization. These treatments can lead to changes on imaging that make determination of residual/recurrent disease difficult. This literature-based review discusses the expected postimaging findings following LRT.
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Affiliation(s)
- Shamar Young
- Department of Radiology, University of Minnesota, Minneapolis, MN, USA
| | - Andrew J. Taylor
- Department of Radiology, University of Minnesota, Minneapolis, MN, USA
- *Correspondence to: Andrew J. Taylor, Department of Radiology, University of Minnesota, 420 Delaware Street SE, MMC 292, Minneapolis, MN 55455, USA. Tel: +1-612-626-6638, Fax: +1-612-626-5505, E-mail:
| | - Tina Sanghvi
- Department of Radiology, University of Minnesota, Minneapolis, MN, USA
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Deschamps F, Harris KR, Moine L, Li W, Tselikas L, Isoardo T, Lewandowski RJ, Paci A, Huang N, de Baere T, Salem R, Larson AC. Pickering-Emulsion for Liver Trans-Arterial Chemo-Embolization with Oxaliplatin. Cardiovasc Intervent Radiol 2018; 41:781-788. [PMID: 29468287 DOI: 10.1007/s00270-018-1899-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 02/07/2018] [Indexed: 12/17/2022]
Abstract
PURPOSE Biodegradable polylactic-co-glycolic acid (PLGA) nanoparticles can adsorb at the water/oil interface to stabilize the emulsion (forming Pickering-emulsion). The purpose of this study was to compare the release profiles of oxaliplatin from Pickering-emulsion and Lipiodol-emulsion. MATERIALS/METHODS Pickering-emulsions and Lipiodol-emulsions were both formulated with oxaliplatin (5 mg/mL) and Lipiodol (water/oil ratio: 1/3). For Pickering-emulsion only, PLGA nanoparticles (15 mg/mL) were dissolved into oxaliplatin before formulation. In vitro release of oxaliplatin from both emulsions was evaluated. Then, oxaliplatin was selectively injected into left hepatic arteries of 18 rabbits bearing VX2 liver tumors using either 0.5 mL Pickering-emulsion (n = 10) or 0.5 mL Lipiodol-emulsion (n = 8). In each group, half of the rabbits were killed at 1 h and half at 24 h. Mass spectrometry was used to quantify drug pharmacokinetics in blood and resulting tissue (tumors, right, and left livers) oxaliplatin concentrations. RESULTS Pickering-emulsion demonstrated a slow oxaliplatin release compared to Lipiodol-emulsion (1.5 ± 0.2 vs. 12.0 ± 6% at 1 h and 15.8 ± 3.0 vs. 85.3 ± 3.3% at 24 h) during in vitro comparison studies. For animal model studies, the plasmatic peak (Cmax) and the area under the curve (AUC) were significantly lower with Pickering-emulsion compared to Lipiodol-emulsion (Cmax = 0.49 ± 0.14 vs. 1.08 ± 0.41 ng/mL, p = 0.01 and AUC = 19.8 ± 5.9 vs. 31.8 ± 14.9, p = 0.03). This resulted in significantly lower oxaliplatin concentrations in tissues at 1 h with Pickering-emulsion but higher ratio between tumor and left liver at 24 h (43.4 vs. 14.5, p = 0.04). CONCLUSION Slow release of oxaliplatin from Pickering-emulsion results in a significant decrease in systemic drug exposure and higher ratio between tumor and left liver oxaliplatin concentration at 24 h.
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Affiliation(s)
- Frederic Deschamps
- Département de radiologie Interventionnelle, Gustave Roussy, Université Paris-Saclay, 114 rue Edouard Vaillant, 94805, Villejuif, France. .,CNRS, UMR 8203, Université Paris-Saclay, Villejuif, France.
| | | | - Laurence Moine
- Institut Galien, CNRS, UMR 8612, Faculté de Pharmacie, Université Paris-Saclay, Châtenay-Malabry, France
| | - Weiguo Li
- Department of Radiology, Northwestern University, Chicago, USA
| | - Lambros Tselikas
- Département de radiologie Interventionnelle, Gustave Roussy, Université Paris-Saclay, 114 rue Edouard Vaillant, 94805, Villejuif, France
| | - Thomas Isoardo
- Institut Galien, CNRS, UMR 8612, Faculté de Pharmacie, Université Paris-Saclay, Châtenay-Malabry, France
| | | | - Angelo Paci
- CNRS, UMR 8203, Université Paris-Saclay, Villejuif, France
| | - Nicolas Huang
- Institut Galien, CNRS, UMR 8612, Faculté de Pharmacie, Université Paris-Saclay, Châtenay-Malabry, France
| | - Thierry de Baere
- Département de radiologie Interventionnelle, Gustave Roussy, Université Paris-Saclay, 114 rue Edouard Vaillant, 94805, Villejuif, France
| | - Riad Salem
- Department of Radiology, Northwestern University, Chicago, USA
| | - Andrew C Larson
- Department of Radiology, Northwestern University, Chicago, USA
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50
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Najmi Varzaneh F, Pandey A, Aliyari Ghasabeh M, Shao N, Khoshpouri P, Pandey P, Zarghampour M, Fouladi D, Liddell R, Anders RA, Kamel IR. Prediction of post-TACE necrosis of hepatocellular carcinoma usingvolumetric enhancement on MRI and volumetric oil deposition on CT, with pathological correlation. Eur Radiol 2018; 28:3032-3040. [PMID: 29383518 DOI: 10.1007/s00330-017-5198-9] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Revised: 11/10/2017] [Accepted: 11/16/2017] [Indexed: 01/15/2023]
Abstract
OBJECTIVE To investigate whether volumetric enhancement on baseline MRI and volumetric oil deposition on unenhanced CT would predict HCC necrosis and response post-TACE. METHOD Of 115 retrospective HCC patients (173 lesions) who underwent cTACE, a subset of 53 HCC patients underwent liver transplant (LT). Semiautomatic volumetric segmentation of target lesions was performed on dual imaging to assess the accuracy of predicting tumour necrosis after TACE in the whole cohort and at pathology in the LT group. Predicted percentage tumour necrosis is defined as 100 % - (%baseline MRI enhancement - %CT oil deposition). RESULTS Mean predicted tumour necrosis by dual imaging modalities was 61.5 % ± 31.6%; mean percentage tumour necrosis on follow-up MRI was 63.8 % ± 31.5 %. In the LT group, mean predicted tumour necrosis by dual imaging modalities was 77.6 % ± 27.2 %; mean percentage necrosis at pathology was 78.7 % ± 31.5 %. There was a strong significant correlation between predicted tumour necrosis and volumetric necrosis on MRI follow-up (r = 0.889, p<0.001) and between predicted tumour necrosis and pathological necrosis (r = 0.871, p<0.001). CONCLUSION Volumetric pre-TACE enhancement on MRI and post-TACE oil deposition in CT may accurately predict necrosis in treated HCC lesions. KEY POINTS • Imaging-based tumour response can assist in therapeutic decisions. • Lipiodol retention as carrier agent in cTACE is a tumour necrosis biomarker. • Predicting tumour necrosis with dual imaging potentially obviates immediate post-treatment MRI. • Predicting tumour necrosis would facilitate further therapeutic decisions in HCC post-cTACE. • Pre-TACE MRI and post-TACE CT predict necrosis in treated HCC.
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Affiliation(s)
- Farnaz Najmi Varzaneh
- The Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University, 600 North Wolfe Street, MRI 143, Baltimore, MD, 21287, USA
| | - Ankur Pandey
- The Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University, 600 North Wolfe Street, MRI 143, Baltimore, MD, 21287, USA
| | - Mounes Aliyari Ghasabeh
- The Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University, 600 North Wolfe Street, MRI 143, Baltimore, MD, 21287, USA
| | - Nannan Shao
- The Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University, 600 North Wolfe Street, MRI 143, Baltimore, MD, 21287, USA
| | - Pegah Khoshpouri
- The Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University, 600 North Wolfe Street, MRI 143, Baltimore, MD, 21287, USA
| | - Pallavi Pandey
- The Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University, 600 North Wolfe Street, MRI 143, Baltimore, MD, 21287, USA
| | - Manijeh Zarghampour
- The Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University, 600 North Wolfe Street, MRI 143, Baltimore, MD, 21287, USA
| | - Daniel Fouladi
- The Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University, 600 North Wolfe Street, MRI 143, Baltimore, MD, 21287, USA
| | - Robert Liddell
- The Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University, 600 North Wolfe Street, MRI 143, Baltimore, MD, 21287, USA
| | - Robert Albert Anders
- Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, MD, 21205, USA
| | - Ihab R Kamel
- The Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University, 600 North Wolfe Street, MRI 143, Baltimore, MD, 21287, USA.
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