Objective To compare efficacy, survival outcome and prognostic factors of conventional transarterial chemoembolization (cTACE), drug-eluting beads TACE (DEB-TACE) and 90Yttrium-radioembolization (Y90) for the treatment of liver metastases from gastro-entero-pancreatic (GEP) neuroendocrine tumors (NELM). Methods This retrospective analysis included 192 patients (58.6years mean age, 56%men) with NELM treated with cTACE(N=122), DEB-TACE(N=26), or Y90(N=44) between 2000 and 2014. Radiologic response to therapy was assessed according to Response Evaluation Criteria in Solid Tumors (RECIST) and World Health Organization (WHO) using peri-procedural MR imaging. Survival analysis included Propensity score analysis (PSA), median overall survival (MOS), hepatic progression-free survival, Kaplan-Meier using log-rank test and the uni-and multivariate Cox proportional hazards model (MVA). Results MOS of the entire study population was 28.8months. As for cTACE, DEB-TACE and Y90, MOS was 33.8months, 21.7months and 23.6months, respectively. According to the MVA, cTACE demonstrated a significantly longer MOS as compared to DEB-TACE(p=.04) or Y90(p=.032). The five-year survival rate after initial cTACE, DEB-TACE and Y90 was 28.2%, 10.3% and 18.5%, respectively. Conclusions Upon PSA, our study suggests significant survival benefits for patients treated with cTACE as compared to DEB-TACE and Y90. This data supports the therapeutic decision for cTACE as the primary intra-arterial therapy option in patients with unresectable NELM until proven otherwise.

Introduction It remains controversial whether transarterial chemoembolization (TACE) should be performed in patients with advanced-stage hepatocellular carcinoma (HCC). The present large retrospective cohort study aimed to define the survival outcome following TACE of advanced HCC and to identify the prognostic factors. Methods 508 patients with Barcelona Clinic Liver Cancer (BCLC) C-stage HCC, Child-Pugh A/B were who were treated with TACE between November 1998 to December 2013 were identified. Results There was no significant difference in overall survival (OS) between patients with Eastern Cooperative Oncology Group (ECOG) 0 and those with ECOG ≥1 (10.5 months vs. 11.9 months, P=0.87). The median OS of patients without portal vein tumor thrombosis (PVTT) was longer than that of patients with PVTT (16.9 months vs. 6.1 months, P<0.001). Child-Pugh B class, PVTT, extrahepatic metastasis, tumor size ≥5 cm, number of tumors ≥3 and alpha-fetoprotein ≥ 400ng/dl were significantly associated with decreased survival and were used for determining the risk scores. All patients were divided into two groups (low-risk and high-risk groups) according to the cut-off value of 6.5 for risk scores. The patients with a value <6.5 (low-risk group) had significantly longer survival than those with >6.5 (high-risk group) (24.1 vs. 7.5 months, respectively; P<0.001). Conclusions TACE is an effective therapy for select patients with advanced stage HCC and may provide equal or improved survival as compared with reported outcomes with sorafenib. The results highlight the need for a differentiated approach to therapeutic recommendations for patients with BCLC C.

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This work addresses multi-class liver tissue classification from multi-parameter MRI in patients with hepatocellular carcinoma (HCC), and is among the first to do so. We propose a structured prediction framework to simultaneously classify parenchyma, blood vessels, viable tumor tissue, and necrosis, which overcomes limitations related to classifying these tissue classes individually and consecutively. A novel classification framework is introduced, based on the integration of multi-scale shape and appearance features to initiate the classification, which is iteratively refined by augmenting the feature space with both structured and rotationally invariant label context features. We study further the topic of rotationally invariant label context feature representations, and introduce a method for this purpose based on computing the energies of the spherical harmonic decompositions computed at different frequencies and radii. We test our method on full 3D multi-parameter MRI volumes from 47 patients with HCC and achieve promising results.