Unresectable hepatocellular carcinoma: MR imaging after intraarterial therapy. part ii. response stratification using volumetric functional criteria after intraarterial therapy

Susanne Bonekamp, Vivek Gowdra Halappa, Jean François H Geschwind, Zhen Li, Celia Corona Villalobos, Diane Reyes, Nikhil Bhagat, David P. Cosgrove, Timothy M. Pawlik, Esteban Mezey, John Eng, Ihab R Kamel

Research output: Contribution to journalArticle

Abstract

Purpose: To assess whether volumetric functional magnetic resonance (MR) results 3-4 weeks after initial intraarterial therapy can aid accurate distinction between responders and nonresponders, to determine whether overall survival (OS) is improved, and to compare volumetric functional MR response with anatomic response criteria (Response Evaluation Criteria in Solid Tumors [RECIST], modified RECIST [mRECIST], European Association for the Study of the Liver [EASL]), as well as a1-fetoprotein [AFP] level. Materials and Methods: In this single-institution HIPAA-compliant retrospective, institutional review board-approved study, informed consent was waived; 143 patients with hepatocellular carcinoma underwent intraarterial therapy between October 2005 and February 2011. Volumetric functional MR response (25% or more increase in apparent diffusion coefficient, 65% or more decrease in enhancement) was stratified as follows: Dual-parameter responders fulfilled both criteria, single-parameter responders fulfilled one criterion, and those with stable disease (SD) fulfilled neither. RECIST, mRECIST, EASL, and AFP response criteria were determined. Kaplan-Meier technique, log-rank tests, and the Cox proportional hazards model were used to test whether OS was different per response. Results: OS differed significantly between single-parameter responders and dual-parameter responders (P = .01) and between singleparameter responders and those with SD (P = .001). Dualparameter responders' response improved OS compared with single-parameter responders; risk of death decreased (hazard ratio [HR] = 0.28, P = .01). In those with SD compared with single-parameter responders, risk of death increased (HR = 2.09, P = .001). RECIST, mRECIST, and EASL stratification was short of significant; most lesions were classified as SD. Baseline AFP level increased in 55 patients; AFP responders versus AFP nonresponders had decreased risk of death (HR = 0.36, P = .002). Agreement between anatomic response criteria and volumetric functional MR findings (k = 0.06-0.12) and between AFP response and imaging criteria (k = 20.04 to 0.14) was low. Conclusion: Volumetric functional MR response 3-4 weeks after initial intraarterial therapy showed improved OS. Volumetric functional MR was superior to current imaging (RECIST, mRECIST, and EASL) and biochemical (AFP level) response criteria.

Original languageEnglish (US)
Pages (from-to)431-439
Number of pages9
JournalRadiology
Volume268
Issue number2
DOIs
StatePublished - Aug 2013
Externally publishedYes

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Fetal Proteins
Hepatocellular Carcinoma
Magnetic Resonance Imaging
Magnetic Resonance Spectroscopy
Survival
Therapeutics
Liver
Health Insurance Portability and Accountability Act
Response Evaluation Criteria in Solid Tumors
Research Ethics Committees
Informed Consent
Proportional Hazards Models

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

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Unresectable hepatocellular carcinoma : MR imaging after intraarterial therapy. part ii. response stratification using volumetric functional criteria after intraarterial therapy. / Bonekamp, Susanne; Halappa, Vivek Gowdra; Geschwind, Jean François H; Li, Zhen; Corona Villalobos, Celia; Reyes, Diane; Bhagat, Nikhil; Cosgrove, David P.; Pawlik, Timothy M.; Mezey, Esteban; Eng, John; Kamel, Ihab R.

In: Radiology, Vol. 268, No. 2, 08.2013, p. 431-439.

Research output: Contribution to journalArticle

Bonekamp, Susanne ; Halappa, Vivek Gowdra ; Geschwind, Jean François H ; Li, Zhen ; Corona Villalobos, Celia ; Reyes, Diane ; Bhagat, Nikhil ; Cosgrove, David P. ; Pawlik, Timothy M. ; Mezey, Esteban ; Eng, John ; Kamel, Ihab R. / Unresectable hepatocellular carcinoma : MR imaging after intraarterial therapy. part ii. response stratification using volumetric functional criteria after intraarterial therapy. In: Radiology. 2013 ; Vol. 268, No. 2. pp. 431-439.
@article{eea79208308445089f0bc5f70ce4ae8f,
title = "Unresectable hepatocellular carcinoma: MR imaging after intraarterial therapy. part ii. response stratification using volumetric functional criteria after intraarterial therapy",
abstract = "Purpose: To assess whether volumetric functional magnetic resonance (MR) results 3-4 weeks after initial intraarterial therapy can aid accurate distinction between responders and nonresponders, to determine whether overall survival (OS) is improved, and to compare volumetric functional MR response with anatomic response criteria (Response Evaluation Criteria in Solid Tumors [RECIST], modified RECIST [mRECIST], European Association for the Study of the Liver [EASL]), as well as a1-fetoprotein [AFP] level. Materials and Methods: In this single-institution HIPAA-compliant retrospective, institutional review board-approved study, informed consent was waived; 143 patients with hepatocellular carcinoma underwent intraarterial therapy between October 2005 and February 2011. Volumetric functional MR response (25{\%} or more increase in apparent diffusion coefficient, 65{\%} or more decrease in enhancement) was stratified as follows: Dual-parameter responders fulfilled both criteria, single-parameter responders fulfilled one criterion, and those with stable disease (SD) fulfilled neither. RECIST, mRECIST, EASL, and AFP response criteria were determined. Kaplan-Meier technique, log-rank tests, and the Cox proportional hazards model were used to test whether OS was different per response. Results: OS differed significantly between single-parameter responders and dual-parameter responders (P = .01) and between singleparameter responders and those with SD (P = .001). Dualparameter responders' response improved OS compared with single-parameter responders; risk of death decreased (hazard ratio [HR] = 0.28, P = .01). In those with SD compared with single-parameter responders, risk of death increased (HR = 2.09, P = .001). RECIST, mRECIST, and EASL stratification was short of significant; most lesions were classified as SD. Baseline AFP level increased in 55 patients; AFP responders versus AFP nonresponders had decreased risk of death (HR = 0.36, P = .002). Agreement between anatomic response criteria and volumetric functional MR findings (k = 0.06-0.12) and between AFP response and imaging criteria (k = 20.04 to 0.14) was low. Conclusion: Volumetric functional MR response 3-4 weeks after initial intraarterial therapy showed improved OS. Volumetric functional MR was superior to current imaging (RECIST, mRECIST, and EASL) and biochemical (AFP level) response criteria.",
author = "Susanne Bonekamp and Halappa, {Vivek Gowdra} and Geschwind, {Jean Fran{\cc}ois H} and Zhen Li and {Corona Villalobos}, Celia and Diane Reyes and Nikhil Bhagat and Cosgrove, {David P.} and Pawlik, {Timothy M.} and Esteban Mezey and John Eng and Kamel, {Ihab R}",
year = "2013",
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T1 - Unresectable hepatocellular carcinoma

T2 - MR imaging after intraarterial therapy. part ii. response stratification using volumetric functional criteria after intraarterial therapy

AU - Bonekamp, Susanne

AU - Halappa, Vivek Gowdra

AU - Geschwind, Jean François H

AU - Li, Zhen

AU - Corona Villalobos, Celia

AU - Reyes, Diane

AU - Bhagat, Nikhil

AU - Cosgrove, David P.

AU - Pawlik, Timothy M.

AU - Mezey, Esteban

AU - Eng, John

AU - Kamel, Ihab R

PY - 2013/8

Y1 - 2013/8

N2 - Purpose: To assess whether volumetric functional magnetic resonance (MR) results 3-4 weeks after initial intraarterial therapy can aid accurate distinction between responders and nonresponders, to determine whether overall survival (OS) is improved, and to compare volumetric functional MR response with anatomic response criteria (Response Evaluation Criteria in Solid Tumors [RECIST], modified RECIST [mRECIST], European Association for the Study of the Liver [EASL]), as well as a1-fetoprotein [AFP] level. Materials and Methods: In this single-institution HIPAA-compliant retrospective, institutional review board-approved study, informed consent was waived; 143 patients with hepatocellular carcinoma underwent intraarterial therapy between October 2005 and February 2011. Volumetric functional MR response (25% or more increase in apparent diffusion coefficient, 65% or more decrease in enhancement) was stratified as follows: Dual-parameter responders fulfilled both criteria, single-parameter responders fulfilled one criterion, and those with stable disease (SD) fulfilled neither. RECIST, mRECIST, EASL, and AFP response criteria were determined. Kaplan-Meier technique, log-rank tests, and the Cox proportional hazards model were used to test whether OS was different per response. Results: OS differed significantly between single-parameter responders and dual-parameter responders (P = .01) and between singleparameter responders and those with SD (P = .001). Dualparameter responders' response improved OS compared with single-parameter responders; risk of death decreased (hazard ratio [HR] = 0.28, P = .01). In those with SD compared with single-parameter responders, risk of death increased (HR = 2.09, P = .001). RECIST, mRECIST, and EASL stratification was short of significant; most lesions were classified as SD. Baseline AFP level increased in 55 patients; AFP responders versus AFP nonresponders had decreased risk of death (HR = 0.36, P = .002). Agreement between anatomic response criteria and volumetric functional MR findings (k = 0.06-0.12) and between AFP response and imaging criteria (k = 20.04 to 0.14) was low. Conclusion: Volumetric functional MR response 3-4 weeks after initial intraarterial therapy showed improved OS. Volumetric functional MR was superior to current imaging (RECIST, mRECIST, and EASL) and biochemical (AFP level) response criteria.

AB - Purpose: To assess whether volumetric functional magnetic resonance (MR) results 3-4 weeks after initial intraarterial therapy can aid accurate distinction between responders and nonresponders, to determine whether overall survival (OS) is improved, and to compare volumetric functional MR response with anatomic response criteria (Response Evaluation Criteria in Solid Tumors [RECIST], modified RECIST [mRECIST], European Association for the Study of the Liver [EASL]), as well as a1-fetoprotein [AFP] level. Materials and Methods: In this single-institution HIPAA-compliant retrospective, institutional review board-approved study, informed consent was waived; 143 patients with hepatocellular carcinoma underwent intraarterial therapy between October 2005 and February 2011. Volumetric functional MR response (25% or more increase in apparent diffusion coefficient, 65% or more decrease in enhancement) was stratified as follows: Dual-parameter responders fulfilled both criteria, single-parameter responders fulfilled one criterion, and those with stable disease (SD) fulfilled neither. RECIST, mRECIST, EASL, and AFP response criteria were determined. Kaplan-Meier technique, log-rank tests, and the Cox proportional hazards model were used to test whether OS was different per response. Results: OS differed significantly between single-parameter responders and dual-parameter responders (P = .01) and between singleparameter responders and those with SD (P = .001). Dualparameter responders' response improved OS compared with single-parameter responders; risk of death decreased (hazard ratio [HR] = 0.28, P = .01). In those with SD compared with single-parameter responders, risk of death increased (HR = 2.09, P = .001). RECIST, mRECIST, and EASL stratification was short of significant; most lesions were classified as SD. Baseline AFP level increased in 55 patients; AFP responders versus AFP nonresponders had decreased risk of death (HR = 0.36, P = .002). Agreement between anatomic response criteria and volumetric functional MR findings (k = 0.06-0.12) and between AFP response and imaging criteria (k = 20.04 to 0.14) was low. Conclusion: Volumetric functional MR response 3-4 weeks after initial intraarterial therapy showed improved OS. Volumetric functional MR was superior to current imaging (RECIST, mRECIST, and EASL) and biochemical (AFP level) response criteria.

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