Radiological response predicts survival following transarterial chemoembolisation in patients with unresectable hepatocellular carcinoma

Kim, D. Y.; Ryu, Hojun; Choi, Jong Young; Park, J. Y.; Lee, Doo Young; Ahn, Sang Hoon; Chon, Chae Yoon; Han, Kwang Hyub

doi:10.1111/j.1365-2036.2012.05089.x

Cited by 87 publications

(66 citation statements)

References 34 publications

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“…However, as pathologic evaluations of treated lesions are available only in selected cases following resection, transplantation, or autopsy, one can suppose that response evaluation using dynamic MRI scan would be desirable for finer prognostification. Nevertheless, it is evident that complete lipiodol uptake remains a substantially favorable predictor, supported by many reports (12,20,(26)(27)(28)(29). Furthermore, in Republic of Korea, according to the reimbursement guidelines of the National Health Insurance Corporation, use of dynamic MRI scanning for response evaluation after HCC treatment remains limited to equivocal cases on dynamic CT scans.…”

Section: Discussionmentioning

confidence: 91%

Number of Target Lesions for EASL and Modified RECIST to Predict Survivals in Hepatocellular Carcinoma Treated with Chemoembolization

Kim

Kim²,

Kim³

et al. 2013

Clinical Cancer Research

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Purposes: To date, most studies about the optimal number of target lesions for enhancement criteria for hepatocellular carcinoma (HCC) have focused on cross-sectional analyses of concordance. We investigated the optimal number of target lesions for European Association for the Study of the Liver (EASL) and modified Response Evaluation Criteria in Solid Tumors (mRECIST) guidelines in predicting overall survival (OS).Experimental Design: We analyzed 254 consecutive treatment-na€ ve patients with HCC having at least 2 measurable target lesions undergoing transarterial chemoembolization. Kappa values for intermethod agreement of treatment responses were calculated for comparisons between use of maximum of 1, 2, 3, 4, or 5 targets versus use of all target lesions. Prognostic values of radiologic assessments according to number of target lesions for predicting OS were expressed as C-index.Results: By EASL and mRECIST guidelines, k values between responses assessing the longest 2, 3, 4, or 5 targets and assessing all targets were 0.924, 0.977, 1.000, or 1.000 and 0.907, 0.959, 1.000, or 1.000, respectively, whereas those between responses assessing only one target and assessing all target lesions were 0.723 and 0.666, respectively. C-index when measuring the longest 1, 2, 3, 4, 5, and all targets was similar, ranging from 0.739 to 0.749 for EASL criteria and from 0.750 to 0.759 for mRECIST. From Cox regression analyses, radiologic response from each calculation method showed independently significant effects on OS for both guidelines, regardless of number of target lesions.Conclusions: Prognostic values for predicting OS were similar regardless of number of target lesions. Assessing the 2 largest targets rather than only 1 index lesion could be recommended considering high concordances from cross-sectional analyses.

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Section: Discussionmentioning

confidence: 91%

Number of Target Lesions for EASL and Modified RECIST to Predict Survivals in Hepatocellular Carcinoma Treated with Chemoembolization

Kim

Kim²,

Kim³

et al. 2013

Clinical Cancer Research

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“…Clearly, hypervascular and nodular HCCs without portal/hepatic venous invasion, which are over Milan criteria (single ≤5 cm, three nodules ≤3 cm), are good candidates for TACE. However, incomplete treatment due to insufficient arterial supply or big size (>5 cm) usually results in treatment failure characterized by non-compact Lipiodol uptake within tumor or frequent recurrence [9]. What are the alternative modalities to treat HCC of intermediate stage?…”

Section: Intermediate Stage Hccmentioning

confidence: 99%

How to Improve Treatment Outcomes for Hepatocellular Carcinoma of Intermediate and Advanced Stage

Kim¹,

Han²

2012

Dig Dis

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Hepatocellular carcinoma (HCC) consists of heterogeneous tumors regarding morphology, biology, and underlying liver function. In intermediate stage HCC, a high rate of recurrence and unsatisfactory treatment outcome after transarterial chemoembolization (TACE) are usually due to a large size and high number of tumors. TACE using drug-eluting beads has an advantage of a higher concentration of chemotherapeutic agent in the tumor. It might be applied to the patients with advanced diseases such as bilobar or recurrent HCC, and poor liver function. Blocking angiogenic stimuli after TACE would be a rational approach and radioembolization with ⁹⁰Y is a novel interventional modality for intermediate stage HCC. The modest anti-cancer effect of sorafenib coupled with an adverse event is a hurdle to overcome in advanced HCC. External radiotherapy has achieved promising results in HCC with portal vein invasion. The role of internal radiation therapy with ⁹⁰Y is not yet clear in advanced HCC. The safety and efficacy of hepatic arterial infusion chemotherapy have been reported in several studies. However, as in external radiotherapy, a well-designed randomized result is lacking. An appropriate combination strategy based on baseline patient and tumor characteristics may increase the survival of patients with intermediate or advanced HCC.

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“…Standard TACE treatment for HCC has been performed using lipiodol and intra-arterial chemotherapy followed by embolization with Gelfoam particles. Doxorubicin and cisplatin are the widely used chemotherapeutic agents in TACE treatment (7,8). Lipiodol is generally mixed with chemotherapeutic agents in TACE treatment (7,8); however, lipiodol may mask the assessment of residual vascularity on computerized tomography (CT) imaging after TACE treatment (8).…”

Section: Introductionmentioning

confidence: 99%

“…Doxorubicin and cisplatin are the widely used chemotherapeutic agents in TACE treatment (7,8). Lipiodol is generally mixed with chemotherapeutic agents in TACE treatment (7,8); however, lipiodol may mask the assessment of residual vascularity on computerized tomography (CT) imaging after TACE treatment (8). The recently developed technique, drug-eluting beads (DEB)-based TACE, represents an advantageous technique over conventional TACE (cTACE), and promises an efficient treatment with minimum side effects as a result of delivering a higher dose of chemotherapeutic agent into the tumor area and diminishing its delivery into the systemic circulation.…”

Section: Introductionmentioning

confidence: 99%

Transarterial chemoembolization for treatment of hepatocellular carcinoma: A single center experience

İdilman

Peynircioğlu²,

Çil³

et al. 2013

Turk J Gastroenterol

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Radiological response predicts survival following transarterial chemoembolisation in patients with unresectable hepatocellular carcinoma

Abstract: SUMMARY BackgroundIt remains unclear whether initial compact lipiodol uptake after transarterial chemoembolisation (TACE) is associated with improved survival in patients with hepatocellular carcinoma (HCC).

Cited by 87 publications

References 34 publications

Number of Target Lesions for EASL and Modified RECIST to Predict Survivals in Hepatocellular Carcinoma Treated with Chemoembolization

Number of Target Lesions for EASL and Modified RECIST to Predict Survivals in Hepatocellular Carcinoma Treated with Chemoembolization

How to Improve Treatment Outcomes for Hepatocellular Carcinoma of Intermediate and Advanced Stage

Transarterial chemoembolization for treatment of hepatocellular carcinoma: A single center experience

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