Therapeutic evaluation of sorafenib for hepatocellular carcinoma using contrast-enhanced ultrasonography: Preliminary result

Abstract

Abstract. The present study aimed to determine the usefulness of contrast-enhanced ultrasonography (CEUS) with Sonazoid in evaluating the therapeutic response to sorafenib for hepatocellular carcinoma (HCC). In total, 26 patients with advanced HCC who received sorafenib and were followed up by CEUS were enrolled in the present study. CEUS was performed prior to and within 2-4 weeks of treatment, and the images of the target lesion in the post-vascular phase with a re-injection method were analyzed. The presence (+) or absence (-) of intratumoral necrosis and the intratumoral vascular architecture on micro-flow imaging (MFI) were compared prior to and subsequent to treatment. Target lesions that exhibited non-enhancement after re-injection were considered to indicate intratumoral necrosis. The intratumoral vascular architecture was classified into three groups, as follows: Vd, the intratumoral vessels visually narrowed or decreased; Vnc, the vessels remained unchanged; and Vi, the vessels were thickened or increased. Survival curves were estimated using the Kaplan-Meier method and compared using the log rank test between the intratumoral necrosis (+) and (-) groups, and among the Vd, Vnc and Vi groups. P<0.05 was considered to indicate a statistically significant difference. The number of patients in the intratumoral necrosis (+) and (-) groups was 8 and 18 patients, respectively, and the median survival time (MST) was 7.2 months [95% confidence interval (CI), 2.2-12.2] and 9.5 months (95% CI, 5.1-13.8), respectively (P= 0.44). The MFI findings were observed in 11 patients in the Vd group, 10 patients in the Vnc group and 5 patients in the Vi group. The MSTs in the Vd, Vnc and Vi groups were 15.6 months (95% CI, 5.0-23.3), 11.0 months (95% CI, 3.5-17.6) and 3.6 months (95% CI: 1.2-6.0), respectively. The P-value for the differences between the Vd and Vnc groups, Vd and Vi groups, and Vnc and Vi groups were 0.78, 0.016 and 0.047, respectively, which indicated that the survival time decreased significantly in the Vi group. Evaluation of intratumoral vascular architecture using MFI demonstrates promise for assessing the therapeutic response to sorafenib in patients with HCC.

Outcome Results of Treatment with Selective Internal Radiation Therapy (SIRT) in Patients with Hepatocellular Carcinoma: A Single Center Experience

“…Interestingly, patients who received sorafenib initially, then SIRT upon progression responded similarly as patients who never received sorafenib, indicating that sorafenib treatment is still feasible after SIRT. This is in line with the mode of action of sorafenib which appears to have mainly normalization effects on the architecture of tumor vessels rather than inhibiting vascularization perse [14]. Further, patients who received sorafenib having progressed after SIRT had been performed had a markedly increased survival over the other cohorts.…”

The AFSUMB Consensus Statements and Recommendations for the Clinical Practice of Contrast-Enhanced Ultrasound using Sonazoid

“…However, the benefits of Sonazoid CEUS were recently reported, including its usefulness for evaluation and early detection of major adverse events [173]. It has been reported that analysis of the TIC and arrival time parametric imaging were useful for evaluating early response to sorafenib for advanced HCC [173,[178][179][180][181][182]. Although Sonazoid enables the evaluation of vascularity during systemic therapy that cannot be detected by CECT or contrast-enhanced MRI, Sonazoid may only be useful to evaluate treatment response if the number of HCCs is less than two or three.…”

Quantitative dynamic contrast-enhanced ultrasound may help predict the outcome of hepatocellular carcinoma after microwave ablation

“…In addition to the diagnostic value, CEUS is playing important roles in the assessment of therapeutic responses of HCC. It is reported that CEUS could evaluate the intra-tumor vascularization of HCC after antiangiogenic treatment [21], ablative therapies [22], and transarterial chemoembolization [23].…”