Comparison of Existing Response Criteria in Patients with Hepatocellular Carcinoma Treated with Transarterial Chemoembolization Using a 3D Quantitative Approach

Abstract

Purpose To compare currently available non-three-dimensional methods (Response Evaluation Criteria in Solid Tumors [RECIST], European Association for Study of the Liver [EASL], modified RECIST [mRECIST[) with three-dimensional (3D) quantitative methods of the index tumor as early response markers in predicting patient survival after initial transcatheter arterial chemoembolization (TACE). Materials and Methods This was a retrospective single-institution HIPAA-compliant and institutional review board–approved study. From November 2001 to November 2008, 491 consecutive patients underwent intraarterial therapy for liver cancer with either conventional TACE or TACE with drug-eluting beads. A diagnosis of hepatocellular carcinoma (HCC) was made in 290 of these patients. The response of the index tumor on pre- and post-TACE magnetic resonance images was assessed retrospectively in 78 treatment-naïve patients with HCC (63 male; mean age, 63 years ± 11 [standard deviation]). Each response assessment method (RECIST, mRECIST, EASL, and 3D methods of volumetric RECIST [vRECIST] and quantitative EASL [qEASL]) was used to classify patients as responders or nonresponders by following standard guidelines for the uni- and bidimensional measurements and by using the formula for a sphere for the 3D measurements. The Kaplan-Meier method with the log-rank test was performed for each method to evaluate its ability to help predict survival of responders and nonresponders. Uni- and multivariate Cox proportional hazard ratio models were used to identify covariates that had significant association with survival. Results The uni- and bidimensional measurements of RECIST (hazard ratio, 0.6; 95% confidence interval [CI]: 0.3, 1.0; P = .09), mRECIST (hazard ratio, 0.6; 95% CI: 0.6, 1.0; P = .05), and EASL (hazard ratio, 1.1; 95% CI: 0.6, 2.2; P = .75) did not show a significant difference in survival between responders and nonresponders, whereas vRECIST (hazard ratio, 0.6; 95% CI: 0.3, 1.0; P = .04), qEASL (Vol) (hazard ratio, 0.5; 95% CI: 0.3, 0.9; P = .02), and qEASL (%) (hazard ratio, 0.3; 95% CI: 0.15, 0.60; P < .001) did show a significant difference between these groups. Conclusion The 3D-based imaging biomarkers qEASL and vRECIST were tumor response criteria that could be used to predict patient survival early after initial TACE and enabled clear identification of nonresponders.

Response Evaluation of Malignant Liver Lesions After TACE/SIRT: Comparison of Manual and Semi-Automatic Measurement of Different Response Criteria in Multislice CT

“…The segmentation of liver lesions in MRI examinations is also firmly established and usually involves a semi-automatic, volume-based approach [25,26]. On the other hand, reliable segmentation of liver lesions in CT -with its lower soft-tissue-contrast -is a more demanding task and has been addressed only recently [24,27].…”

Validation of the Hong Kong Liver Cancer Staging System in Determining Prognosis of the North American Patients Following Intra-arterial Therapy

“…This was followed by injection of up to 4 mL of 100–300-μm microsphere particles (Embosphere; Biosphere Medical, Boston, Mass). For TACE with drug-eluting beads (DEB-TACE), patients received 2 mL of 100–300-μm-diameter microsphere particles (LC Beads; BioCompatibles, Surrey, England) loaded with 50 mg of doxorubicin hydrochloride (25 mg/mL) and mixed with nonionic contrast material (300 mg of iodine per milliliter, Oxilan; Guerbet, Bloomington, Ind) 21 .…”

The impact of antiangiogenic therapy combined with Transarterial Chemoembolization on enhancement based quantitative tumor response assessment in patients with hepatocellular carcinoma

“…Hepatocellular carcinoma (HCC) is the fifth most common cancer and the second most common cause of cancer-related death worldwide [1–3]. Most HCC patients present with intermediate or advanced stage disease, making curative treatments unattainable for most patients [4].…”

“…Loco-regional embolization therapies like TACE cause tumor infarction, thus fundamentally changing the appearance of the targeted tissue on contrast-enhanced MRI by causing non-homogenous enhancement patterns [1, 8]. In addition, early follow-up imaging after TACE usually does not demonstrate tumor shrinkage, making conventional diameter-based measurements obsolete.…”

“…In addition, early follow-up imaging after TACE usually does not demonstrate tumor shrinkage, making conventional diameter-based measurements obsolete. A plethora of published data demonstrates that unidimensional measurements such as Response Evaluation Criteria in Solid Tumors (RECIST) and modified RECIST (mRECIST), as well as bidimensional measurements like the World Health Organization (WHO) and the European Association for the Study of the Liver (EASL) criteria, are unreliable in the setting of TACE at an early time point [1, 9]. New 3D imaging biomarkers, such as the quantitative EASL [qEASL], have meanwhile been established to address the previously unmet need for robust tumor assessment techniques after TACE [1, 8, 10, 11].…”