Imaging of Hepatocellular Carcinoma After Treatment with Yttrium-90 Microspheres

Keppke, Ana L.; Salem, Riad; Reddy, Denise; Huang, Jie; Jin, Jianhua; Larson, Andrew C.; Miller, Frank H.

doi:10.2214/ajr.06.0706

Cited by 106 publications

(83 citation statements)

References 28 publications

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“…For these reasons, those authors concluded that the use of combined size and necrosis criteria might lead to a more accurate assessment of response to Yttrium-90 radioembolization than size criteria alone. 29 In our study, RECIST criteria missed all CRs obtained by tumor necrosis and underestimated the extent of partial tumor response because of tissue necrosis. This finding was particularly relevant for patients who received percutaneous ablation.…”

Section: Discussionmentioning

confidence: 54%

Evaluation of tumor response after locoregional therapies in hepatocellular carcinoma

Forner

Ayuso

Varela

et al. 2009

Cancer

398

252

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The oxidation resistance proteins (OXR) help to protect eukaryotes from reactive oxygen species. The sole C‐terminal domain of the OXR, named TLDc is sufficient to perform this function. However, the mechanism by which oxidation resistance occurs is poorly understood. We present here the crystal structure of the TLDc domain of the oxidation resistance protein 2 from zebrafish. The structure was determined by X‐ray crystallography to atomic resolution (0.97Å) and adopts an overall globular shape. Two antiparallel β‐sheets form a central β‐sandwich, surrounded by two helices and two one‐turn helices. The fold shares low structural similarity to known structures. Proteins 2012. © 2012 Wiley Periodicals, Inc.

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Section: Discussionmentioning

confidence: 54%

Evaluation of tumor response after locoregional therapies in hepatocellular carcinoma

Forner

Ayuso

Varela

et al. 2009

Cancer

398

252

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“…This difference could be because RECIST evaluates only 1-dimensional tumor measurements and disregards the extent of the necrosis, which is the objective of all locoregional therapy used for HCC, including ablation and intraarterial procedures such as chemoembolization. Considering that a multivariate analysis of survival clearly demonstrated that the complete tumor necrosis was associated with significantly better survival (odds ratio, 1.83; 95% CI, 1.1-3.1; P 5 0.020) (37), the use of combined (size and necrosis) criteria might lead to a more accurate assessment of response to 90 Y radioembolization than criteria based on size alone (38).…”

Section: Discussionmentioning

confidence: 99%

Efficacy and Toxicity Related to Treatment of Hepatocellular Carcinoma with ⁹⁰Y-SIR Spheres: Radiobiologic Considerations

Strigari¹,

Sciuto²,

Rea³

et al. 2010

J Nucl Med

223

187

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Radioactive 90 Y-selective internal radiation (SIR) sphere therapy is increasingly used for the treatment of nonresectable hepatocellular carcinoma (HCC). However, the maximum delivered dose is limited by severe injury to the nontarget tissue, including liver parenchyma. Our study aimed to implement radiobiologic models for both tumor control probability (TCP) and normaltissue complication probability (NTCP) to describe more effectively local response and the liver toxicity rate, respectively. Methods: Patients with documented HCC, adequate bone marrow parameters, and regular hepatic and pulmonary function were eligible for the study. Patients who had pulmonary shunt greater than 20% of 99m Tc-labeled macroaggregated albumin or any uncorrectable delivery to the gastrointestinal tract, reverse blood flow out of the liver, or complete portal vein thrombosis were excluded. Patients received a planned activity of the 90 Y-SIR spheres, determined using the empiric body surface area method. The dose distribution was determined using posttreatment (3-dimensional) activity distribution and Monte Carlo dose voxel kernel calculations, and the mean doses to healthy liver and tumor were calculated for each patient. Response was defined according to Response Evaluation Criteria in Solid Tumors (RECIST) and recommendations of the European Association for the Study of the Liver (EASL). Criteria were used to assess possible liver toxicities. The parameters of TCP and NTCP models were established by direct maximization of the likelihood. Results: Seventy-three patients were treated. With an average dose of 110 Gy to the tumor, complete or partial response was observed in 74% and 55% of patients according to the EASL guideline and RECIST, respectively, and the predicted TCPs were 73% and 55%, respectively. With a median liver dose of 36 Gy (range, 6-78 Gy), the $grade 2 (G2), $grade 3 (G3), and $grade 4 (G4) liver toxicities were observed in 32% (23/73), 21% (15/73), and 11% (8/73) of patients, respectively. The parameters describing the $G2 liver toxicity data using the NTCP model were a tolerance dose of the whole organ leading to a 50% complication probability of 52 Gy (95% confidence interval, 44-61 Gy) and a slope of NTCP versus dose of 0.28 (95% confidence interval, 0.18-0.60), assuming n 5 1. Conclusion: The radiobiologic approach, based on patient-specific dosimetry, could improve the 90 Y-microsphere therapeutic approach of HCC, maintaining an acceptable liver toxicity.

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“…Until recently, tumor response to therapy has been measured using the standard Response Evaluation Criteria in Solid Tumors (RECIST), which relies on measurements of the greatest dimension of the target lesions (1). However, growing evidence has suggested that evaluation by RECIST may not be the best method for monitoring treatment response in hepatocellular carcinoma (2)(3)(4)(5)(6)(7)(8); the goal of effective locoregional and targeted therapies in hepatocellular carcinoma is to cause tumor necrosis (2,3,(7)(8)(9). As a result of this evidence, the American Association for the Study of Liver Diseases (AASLD) and the European Association for the Study of the Liver (EASL) have proposed the development of superior methods for assessing the response to therapy in hepatocellular carcinoma (3,10,11).…”

Section: Introductionmentioning

confidence: 99%

EASL- and mRECIST-Evaluated Responses to Combination Therapy of Sorafenib with Transarterial Chemoembolization Predict Survival in Patients with Hepatocellular Carcinoma

Liu

Wang

Chen

et al. 2014

Clinical Cancer Research

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Purpose: Published studies have not investigated the suitability of Response Evaluation Criteria in Solid Tumors (RECIST), European Association for the Study of the Liver (EASL) criteria, and modified RECIST (mRECIST) for assessing the response of patients with hepatocellular carcinoma to treatment with sorafenib combined with transarterial chemoembolization. Here, we aimed to define the earliest time at which the response to combination therapy could be accurately assessed and validate the prognostic value of these criteria at this early posttherapy time point.Experimental Design: A total of 114 consecutive patients with hepatocellular carcinoma receiving combination therapy were retrospectively enrolled. The therapy response at different time points was assessed using RECIST, EASL, and mRECIST. Cox regression analysis and Kaplan-Meier curves were used to assess overall survival (OS) in the responders and nonresponders.Results: At the third follow-up (median, 94 days; range, 89-102 days) after therapy, the response rates obtained using EASL (50.6%) and mRECIST (51.6%) were greater than that obtained using RECIST (16.5%). The agreement was strong between the mRECIST and EASL results (k ¼ 0.9) but weak between mRECIST and RECIST (k ¼ 0.3). The EASL and mRECIST responses significantly correlated with survival. Risk reductions of 52% and 50% were observed for EASL and mRECIST responders, respectively, compared with nonresponders. However, no significant association between the treatment response and survival was observed using RECIST.Conclusions: The earliest time to evaluate the response to combination therapy is 3 months (median, 94 days) after therapy. EASL and mRECIST responses are independent predictors for OS at this early time point.

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Imaging of Hepatocellular Carcinoma After Treatment with Yttrium-90 Microspheres

Abstract: Use of combined size and necrosis criteria may lead to more accurate assessment of response to 90Y therapy than use of size criteria alone. Imaging features after 90Y treatment, including size, necrosis, peripheral enhancing nodules, and thin rim enhancement, are described.

Cited by 106 publications

References 28 publications

Evaluation of tumor response after locoregional therapies in hepatocellular carcinoma

Evaluation of tumor response after locoregional therapies in hepatocellular carcinoma

Efficacy and Toxicity Related to Treatment of Hepatocellular Carcinoma with ⁹⁰Y-SIR Spheres: Radiobiologic Considerations

EASL- and mRECIST-Evaluated Responses to Combination Therapy of Sorafenib with Transarterial Chemoembolization Predict Survival in Patients with Hepatocellular Carcinoma

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Imaging of Hepatocellular Carcinoma After Treatment with Yttrium-90 Microspheres

Abstract: Use of combined size and necrosis criteria may lead to more accurate assessment of response to 90Y therapy than use of size criteria alone. Imaging features after 90Y treatment, including size, necrosis, peripheral enhancing nodules, and thin rim enhancement, are described.

Cited by 106 publications

References 28 publications

Evaluation of tumor response after locoregional therapies in hepatocellular carcinoma

Evaluation of tumor response after locoregional therapies in hepatocellular carcinoma

Efficacy and Toxicity Related to Treatment of Hepatocellular Carcinoma with 90Y-SIR Spheres: Radiobiologic Considerations

EASL- and mRECIST-Evaluated Responses to Combination Therapy of Sorafenib with Transarterial Chemoembolization Predict Survival in Patients with Hepatocellular Carcinoma

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Efficacy and Toxicity Related to Treatment of Hepatocellular Carcinoma with ⁹⁰Y-SIR Spheres: Radiobiologic Considerations