Volumetric assessment of tumour response using functional MR imaging in patients with hepatocellular carcinoma treated with a combination of doxorubicin-eluting beads and sorafenib
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To prospectively assess treatment response using volumetric functional magnetic resonance imaging (MRI) metrics in patients with hepatocellular carcinoma (HCC) treated with the combination of doxorubicin-eluting bead–transarterial chemoembolization (DEB TACE) and sorafenib.
A single center study enrolled 41 patients treated with systemic sorafenib, 400 mg twice a day, combined with DEB TACE. All patients had a pre-treatment and 3–4 week post-treatment MRI. Anatomic response criteria (RECIST, mRECIST and EASL) and volumetric functional response (ADC, enhancement) were assessed. Statistical analyses included paired Student’s t-test, Kaplan-Meier curves, Cohen’s Kappa, and multivariate cox proportional hazard model.
Median tumour size by RECIST remained unchanged post-treatment (8.3 ± 4.1 cm vs. 8.1 ± 4.3 cm, p = 0.44). There was no significant survival difference for early response by RECIST (p = 0.93). EASL and mRECIST could not be analyzed in 12 patients. Volumetric ADC increased significantly (1.32 × 10−3 mm2/sec to 1.60 × 10−3 mm2/sec, p < 0.001), and volumetric enhancement decreased significantly in HAP (38.2 % to 17.6 %, p < 0.001) and PVP (76.6 % to 41.2 %, p < 0.005). Patients who demonstrated ≥ 65 % decrease PVP enhancement had significantly improved overall survival compared to non-responders (p < 0.005).
Volumetric PVP enhancement was demonstrated to be significantly correlated with survival in the combination of DEB TACE and sorafenib for patients with HCC, enabling precise stratification of responders and non-responders.
• PVP enhancement is significantly correlated with survival in responders (p < 0.005).
• There was no significant survival difference for early response using RECIST (p = 0.93).
• mRECIST or EASL could not assess tumour response in 29 % of patients.
KeywordsVolumetric functional MRI DEB-TACE Sorafenib Diffusion-weighted MRI Treatment response
- DEB TACE
Doxorubicin-eluting bead–transarterial chemoembolization
Response evaluation criteria in solid tumours
European association for study of liver disease
Apparent diffusion coefficient
Diffusion weighted imaging
Magnetic resonance imaging
Contrast enhanced MRI
Hepatic arterial phase
Portal venous phase
Barcelona clinic liver cancer
Eastern cooperative oncology group
The scientific guarantor of this publication is Dr. Ihab R. Kamel. The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. No complex statistical methods were necessary for this paper. Institutional Review Board approval was obtained. Written informed consent was obtained from all subjects (patients) in this study. Approval from the institutional animal care committee was not required because we did not study animal subjects. No study subjects or cohorts have been previously reported. This is a prospective study, a randomized controlled trial performed at one institution.
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