Evaluation of Response in Malignant Tumors Treated With the Multitargeted Tyrosine Kinase Inhibitor Sorafenib: A Multitechnique Imaging Assessment

Maksimovic, Olga; Schraml, Christina; Hartmann, J. T.; Bitzer, Michael; Claussen, Claus D.; Pintoffl, Jan; Horger, Marius

doi:10.2214/ajr.09.2744

Cited by 33 publications

(27 citation statements)

References 13 publications

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“…On the other hand, SO treatment produces extensive but irregular tumor necrosis that can be difficult to identify and measure, and radiological evaluation is often based on an overall visual assessment rather than on accurate measurements. Nonetheless, recent studies have confirmed the usefulness of EASL and mRECIST in the identification of SO responders [11,12], although more recently new criteria based on tumor density, perfusion or diffusion have been proposed [14,16,17,18,19,20,21,38]. In particular, perfusion CT could provide a marker of early tumor response in HCC patients treated with SO [20].…”

Section: Discussionmentioning

confidence: 99%

“…Some authors have pointed out the usefulness of monitoring α-fetoprotein (AFP) levels, which might represent a more sensitive predictive parameter than radiological criteria [12,13,14,15]. In addition, determination of response based on changes in tumor density and perfusion parameters has been proposed, using contrast-enhanced ultrasound, perfusion CT and/or magnetic resonance spectral imaging [14,16,17,18,19,20,21]. Finally, some authors have underlined the need for volumetric assessment of tumor variations to increase accuracy and reproducibility in assessing tumor response in HCC patients [22,23,24].…”

Section: Introductionmentioning

confidence: 99%

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Identification of Responders to Sorafenib in Hepatocellular Carcinoma: Is Tumor Volume Measurement the Way Forward?

Bargellini

Scionti

Mismas³

et al. 2014

Oncology

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Objectives: Early assessment of hepatocellular carcinoma (HCC) response during sorafenib (SO) treatment is challenging, since tumor necrosis, extension and radiological appearance can be inhomogeneous. We evaluated the predictive value of different imaging criteria - such as Response Evaluation Criteria in Solid Tumors (RECIST) 1.1, European Association for the Study of the Liver (EASL), modified RECIST (mRECIST), tumor density and volume variations - in the early follow-up of SO treatment. Methods: The study included 22 patients. CT images from baseline and 2 months were reviewed to assess response according to RECIST 1.1, mRECIST, EASL, Choi's criteria (decreased tumor density by ≥15%) and arterial-enhancing tumor volume ratio; α-fetoprotein (AFP) variations were expressed as AFP ratio. Results: The response criteria and volume measurements were reproducible (k > 0.80). The overall disease control rate was 40.9% by EASL and mRECIST, and 27.3% by RECIST 1.1; a ≥15% decrease in tumor density was observed in 9 patients (40.9%). The mean volume ratio was 1.73 ± 2.12, the mean AFP ratio 14 ± 37. The 1-year survival rate was 65.9%. Volume ratio was the only predictive factor for survival, with 1-year cumulative survival rates of 90% for volume ratios ≤1.1 and of 45.4% for volume ratios >1.1 (p = 0.04). Conclusions: Tumor volume measurements are reproducible and might provide an early predictive marker of response in HCC patients treated with SO.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Identification of Responders to Sorafenib in Hepatocellular Carcinoma: Is Tumor Volume Measurement the Way Forward?

Bargellini

Scionti

Mismas³

et al. 2014

Oncology

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“…It provides quantitative data regarding perfusion parameters and differentiates diverse tumor tissues based on perfusion behavior [65]. Because perfusion parameters reflect tumor vascularity, this is regarded as a useful tool for monitoring the response to anti-angiogenic drug treatment [66][67][68][69] and local-regional treatment in HCC patients [70][71][72][73]. However, a major problem with perfusion CT is high radiation exposure, making it difficult to use this technique for HCC surveillance or serial examinations for the evaluation of treatment response [74,75].…”

Section: Dual Energy Ctmentioning

confidence: 99%

New Paradigm for Management of Hepatocellular Carcinoma by Imaging

Joo

Choi

2012

Liver Cancer

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Based on recent clinical practice guidelines, imaging is largely replacing pathology as the preferred diagnostic method for determination of hepatocellular carcinoma (HCC). A variety of imaging modalities, including ultrasound (US), computed tomography (CT), magnetic resonance imaging (MRI), nuclear medicine, and angiography, are currently used to examine patients with chronic liver disease and suspected HCC. Advancements in imaging techniques such as perfusion imaging, diffusion imaging, and elastography along with the development of new contrast media will further improve the ability to detect and characterize HCC. Early diagnosis of HCC is essential for prompt treatment, which may in turn improve prognosis. Considering the process of hepatocarcinogenesis, it is important to evaluate sequential changes via imaging which would help to differentiate HCC from premalignant or benign lesions. Recent innovations including multiphasic examinations, high-resolution imaging, and the increased functional capabilities available with contrast-enhanced US, multidetector row CT, and MRI have raised the standards for HCC diagnosis. Although hemodynamic features of nodules in the cirrhotic liver remain the main diagnostic criterion, newly developed cell-specific contrast agents have shown great possibilities for improved HCC diagnosis and may overcome the diagnostic dilemma associated with small or borderline hepatocellular lesions. In the 20th century paradigm of medical imaging, radiological diagnosis was based on morphological characteristics, but in the 21st century, a paradigm shift to include biomedical, physiological, functional, and genetic imaging is needed. A multidisciplinary team approach is necessary to foster an integrated approach to HCC imaging. By developing and combining new imaging modalities, all phases of HCC patient care, including screening, diagnosis, treatment, and therapy, can be dramatically improved.

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“…This technique enables the detection of early cellular necrosis [53]. DWI has been reported to be useful in monitoring treatment responses after chemotherapy, radioembolization, and chemoembolization [54][55][56][57][58][59][60][61][62]. The maximal lesion-to-parenchyma enhancement ratio of the iodine map can be achieved by subtraction of the background water density.…”

Section: Diffusion-weighted Imagingmentioning

confidence: 99%

“…Recent studies have reported the usefulness of perfusion CT for monitoring the response to antiangiogenic therapy and predicting outcomes in patients with HCC, which shows the feasibility of using perfusion parameters as in vivo biomarkers of tumor vascularity [55,[92][93][94]. Perfusion CT can also be used for detection of recurrence after radiofrequency ablation [95] and for patient selection and assessment of the early treatment response to transcatheter arterial chemoembolization (TACE) [96][97][98].…”

Section: ) Perfusion Ctmentioning

confidence: 99%

Recent Advances in CT and MR Imaging for Evaluation of Hepatocellular Carcinoma

et al. 2012

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Hepatocellular carcinoma (HCC) is one of the most common malignancies worldwide. Accurate diagnosis and assessment of disease extent are crucial for proper management of patients with HCC. Imaging plays a crucial role in early detection, accurate staging, and the planning of management strategies. A variety of imaging modalities are currently used in evaluating patients with suspected HCC; these include ultrasound, computed tomography (CT), magnetic resonance imaging (MRI), nuclear medicine, and angiography. Among these modalities, dynamic MRI and CT are regarded as the best imaging techniques available for the noninvasive diagnosis of HCC. Recent improvements in CT and MRI technology have made noninvasive and reliable diagnostic assessment of hepatocellular nodules possible in the cirrhotic liver, and biopsy is frequently not required prior to treatment. Until now, the major challenge for radiologists in imaging cirrhosis has been the characterization of small cirrhotic nodules smaller than 2 cm in diameter. Further technological advancement will undoubtedly have a major impact on liver tumor imaging. The increased speed of data acquisition in CT and MRI has allowed improvements in both spatial and temporal resolution, which have made possible a more precise evaluation of the hemodynamics of liver nodules. Furthermore, the development of new, tissue-specific contrast agents such as gadoxetic acid has improved HCC detection on MRI. In this review, we discuss the role of CT and MRI in the diagnosis and staging of HCC, recent technological advances, and the strengths and limitations of these imaging modalities.

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Evaluation of Response in Malignant Tumors Treated With the Multitargeted Tyrosine Kinase Inhibitor Sorafenib: A Multitechnique Imaging Assessment

Cited by 33 publications

References 13 publications

Identification of Responders to Sorafenib in Hepatocellular Carcinoma: Is Tumor Volume Measurement the Way Forward?

Identification of Responders to Sorafenib in Hepatocellular Carcinoma: Is Tumor Volume Measurement the Way Forward?

New Paradigm for Management of Hepatocellular Carcinoma by Imaging

Recent Advances in CT and MR Imaging for Evaluation of Hepatocellular Carcinoma

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