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European Radiology

, Volume 25, Issue 2, pp 380–390 | Cite as

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

  • Celia Pamela Corona-Villalobos
  • Vivek Gowdra Halappa
  • Jean-Francois H. Geschwind
  • Susanne Bonekamp
  • Diane Reyes
  • David Cosgrove
  • Timothy M Pawlik
  • Ihab R KamelEmail author
Hepatobiliary-Pancreas

Abstract

Objective

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

Methods

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

Results

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

Conclusion

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

Key Points

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

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

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

Keywords

Volumetric functional MRI DEB-TACE Sorafenib Diffusion-weighted MRI Treatment response 

Abbreviations

HCC

Hepatocellular carcinoma

IAT

Intra-arterial therapies

DEB TACE

Doxorubicin-eluting bead–transarterial chemoembolization

RECIST

Response evaluation criteria in solid tumours

mRECIST

Modified RECIST

EASL

European association for study of liver disease

ADC

Apparent diffusion coefficient

DWI

Diffusion weighted imaging

MRI

Magnetic resonance imaging

CE-MRI

Contrast enhanced MRI

HAP

Hepatic arterial phase

PVP

Portal venous phase

CR

Complete response

PR

Partial response

SD

Stable disease

PD

Progressive disease

K-M

Kaplan Meier

AFP

Alpha fetoprotein

BCLC

Barcelona clinic liver cancer

ECOG

Eastern cooperative oncology group

Notes

Acknowledgments

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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Copyright information

© European Society of Radiology 2014

Authors and Affiliations

  • Celia Pamela Corona-Villalobos
    • 1
  • Vivek Gowdra Halappa
    • 2
  • Jean-Francois H. Geschwind
    • 3
  • Susanne Bonekamp
    • 2
  • Diane Reyes
    • 3
  • David Cosgrove
    • 4
  • Timothy M Pawlik
    • 5
  • Ihab R Kamel
    • 2
    Email author
  1. 1.The Russell H. Morgan Department of Radiology and Radiological SciencesJohns Hopkins University, School of MedicineBaltimoreUSA
  2. 2.The Russell H. Morgan Department of Radiology and Radiological Sciences, School of MedicineJohns Hopkins UniversityBaltimoreUSA
  3. 3.Department of Vascular and Interventional Radiology, School of MedicineJohns Hopkins UniversityBaltimoreUSA
  4. 4.Department of OncologyJohns Hopkins University, School of MedicineBaltimoreUSA
  5. 5.Department of Surgical OncologyJohns Hopkins University, School of MedicineBaltimoreUSA

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