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Response Assessment of Primary Liver Tumors to Novel Therapies: an Imaging Perspective

  • Review Article
  • Published:
Journal of Gastrointestinal Surgery

Abstract

The latest developments in cancer immunotherapy, namely the introduction of immune checkpoint inhibitors, have led to a fundamental change in advanced cancer treatments. Imaging is crucial to identify tumor response accurately and delineate prognosis in immunotherapy-treated patients. Simultaneously, advances in image acquisition techniques, notably functional and molecular imaging, have facilitated more accurate pretreatment evaluation, assessment of response to therapy, and monitoring for tumor recurrence. Traditional approaches to assessing tumor progression, such as RECIST, rely on changes in tumor size, while new strategies for evaluating tumor response to therapy, such as the mRECIST and the EASL, rely on tumor enhancement. Moreover, the assessment of tumor volume, enhancement, cellularity, and perfusion are some novel techniques that have been investigated. Validation of these novel approaches should rely on comparing their results with those of standard evaluation methods (EASL, mRECIST) while considering the ultimate outcome, which is patient survival. More recently, immunotherapy has been used in the management of primary liver tumors. However, little is known about its efficacy. This article reviews imaging modalities and techniques for assessing tumor response and survival in immunotherapy-treated patients with primary hepatic malignancies.

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Abbreviations

CCA :

Cholangiocarcinoma

CT :

Computed tomography

CTLA4 :

Cytotoxic T-lymphocyte-associated protein 4

DCA :

Decision curve analysis

DEB-TACE :

Drug-eluting beads trans-arterial chemoembolization

DNA :

Deoxyribonucleic acid

EASL :

European Association for the Study of the Liver

EP :

Early progression

FDG :

Fluorodeoxyglucose

HCC :

Hepatocellular carcinoma

ICI :

Immune-checkpoint inhibitors

ICIs :

Immune checkpoint inhibitors

ICC :

Intrahepatic cholangiocarcinoma

irRC :

Immune-related response criteria

mRECIST :

Modified Response Evaluation Criteria in Solid Tumors

MRI :

Magnetic resonance imaging

MTM :

Macrotrabecular-massive

PDL1 :

Programmed death ligand-1

PD-1/PD-L1 :

Programmed cell death protein 1/Programmed death-ligand 1

PD :

Progressive disease

PET :

Positron emission tomography

PFS :

Progression-free survival

Rad-score :

Radiomics score

RECIST :

Response Evaluation Criteria in Solid Tumors

SOC :

Standard of care

T-cell :

T-lymphocyte

TME :

Tumor micro environment

VEGF-A :

Vascular endothelial growth factor A

WHO :

World Health Organization.

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Authors and Affiliations

  1. Russell H. Morgan Department of Radiology and Radiological Sciences, School of Medicine, Johns Hopkins University, 600 North Wolfe Street, MRI 143, Baltimore, MD, 21287, USA

    Golnoosh Ansari, Mohammad Mirza-Aghazadeh-Attari, Alireza Mohseni, Seyedeh Panid Madani, Haneyeh Shahbazian & Ihab R. Kamel

  2. Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center, James Comprehensive Cancer Center, Columbus, OH, USA

    Timothy M. Pawlik

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  1. Golnoosh Ansari
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  2. Mohammad Mirza-Aghazadeh-Attari
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  3. Alireza Mohseni
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  4. Seyedeh Panid Madani
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  5. Haneyeh Shahbazian
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  6. Timothy M. Pawlik
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  7. Ihab R. Kamel
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Correspondence to Ihab R. Kamel.

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Ansari, G., Mirza-Aghazadeh-Attari, M., Mohseni, A. et al. Response Assessment of Primary Liver Tumors to Novel Therapies: an Imaging Perspective. J Gastrointest Surg 27, 2245–2259 (2023). https://doi.org/10.1007/s11605-023-05762-1

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  • DOI: https://doi.org/10.1007/s11605-023-05762-1

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