Volumetric assessment of tumour response using functional MR imaging in patients with hepatocellular carcinoma treated with a combination of doxorubicin-eluting beads and sorafenib

Celia Pamela Corona-Villalobos, Vivek Gowdra Halappa, Jean Francois H Geschwind, Susanne Bonekamp, Diane Reyes, David Cosgrove, Timothy M. Pawlik, Ihab R Kamel

Research output: Contribution to journalArticle

Abstract

Objective: To prospectively assess treatment response using volumetric functional magnetic resonance imaging (MRI) metrics in patients with hepatocellular carcinoma (HCC) treated with the combination of doxorubicin-eluting bead–transarterial chemoembolization (DEB TACE) and sorafenib.

Methods: A single center study enrolled 41 patients treated with systemic sorafenib, 400 mg twice a day, combined with DEB TACE. All patients had a pre-treatment and 3–4 week post-treatment MRI. Anatomic response criteria (RECIST, mRECIST and EASL) and volumetric functional response (ADC, enhancement) were assessed. Statistical analyses included paired Student’s t-test, Kaplan-Meier curves, Cohen’s Kappa, and multivariate cox proportional hazard model.

Results: Median tumour size by RECIST remained unchanged post-treatment (8.3 ± 4.1 cm vs. 8.1 ± 4.3 cm, p = 0.44). There was no significant survival difference for early response by RECIST (p = 0.93). EASL and mRECIST could not be analyzed in 12 patients. Volumetric ADC increased significantly (1.32 × 10−3 mm2/sec to 1.60 × 10−3 mm2/sec, p <0.001), and volumetric enhancement decreased significantly in HAP (38.2 % to 17.6 %, p <0.001) and PVP (76.6 % to 41.2 %, p <0.005). Patients who demonstrated ≥ 65 % decrease PVP enhancement had significantly improved overall survival compared to non-responders (p <0.005).

Conclusion: Volumetric PVP enhancement was demonstrated to be significantly correlated with survival in the combination of DEB TACE and sorafenib for patients with HCC, enabling precise stratification of responders and non-responders.

Key Points: • PVP enhancement is significantly correlated with survival in responders (p <0.005).

• There was no significant survival difference for early response using RECIST (p = 0.93).

• mRECIST or EASL could not assess tumour response in 29 % of patients.

Original languageEnglish (US)
Pages (from-to)380-390
Number of pages11
JournalEuropean Radiology
Volume25
Issue number2
DOIs
StatePublished - 2014

Fingerprint

Doxorubicin
Hepatocellular Carcinoma
Survival
Neoplasms
Magnetic Resonance Imaging
Kaplan-Meier Estimate
Therapeutics
sorafenib
Proportional Hazards Models
Students
Response Evaluation Criteria in Solid Tumors

Keywords

  • DEB-TACE
  • Diffusion-weighted MRI
  • Sorafenib
  • Treatment response
  • Volumetric functional MRI

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

Cite this

Volumetric assessment of tumour response using functional MR imaging in patients with hepatocellular carcinoma treated with a combination of doxorubicin-eluting beads and sorafenib. / Corona-Villalobos, Celia Pamela; Halappa, Vivek Gowdra; Geschwind, Jean Francois H; Bonekamp, Susanne; Reyes, Diane; Cosgrove, David; Pawlik, Timothy M.; Kamel, Ihab R.

In: European Radiology, Vol. 25, No. 2, 2014, p. 380-390.

Research output: Contribution to journalArticle

Corona-Villalobos, Celia Pamela ; Halappa, Vivek Gowdra ; Geschwind, Jean Francois H ; Bonekamp, Susanne ; Reyes, Diane ; Cosgrove, David ; Pawlik, Timothy M. ; Kamel, Ihab R. / Volumetric assessment of tumour response using functional MR imaging in patients with hepatocellular carcinoma treated with a combination of doxorubicin-eluting beads and sorafenib. In: European Radiology. 2014 ; Vol. 25, No. 2. pp. 380-390.
@article{df689f2a18e54fbd98d94ef3483157d8,
title = "Volumetric assessment of tumour response using functional MR imaging in patients with hepatocellular carcinoma treated with a combination of doxorubicin-eluting beads and sorafenib",
abstract = "Objective: To prospectively assess treatment response using volumetric functional magnetic resonance imaging (MRI) metrics in patients with hepatocellular carcinoma (HCC) treated with the combination of doxorubicin-eluting bead–transarterial chemoembolization (DEB TACE) and sorafenib.Methods: A single center study enrolled 41 patients treated with systemic sorafenib, 400 mg twice a day, combined with DEB TACE. All patients had a pre-treatment and 3–4 week post-treatment MRI. Anatomic response criteria (RECIST, mRECIST and EASL) and volumetric functional response (ADC, enhancement) were assessed. Statistical analyses included paired Student’s t-test, Kaplan-Meier curves, Cohen’s Kappa, and multivariate cox proportional hazard model.Results: Median tumour size by RECIST remained unchanged post-treatment (8.3 ± 4.1 cm vs. 8.1 ± 4.3 cm, p = 0.44). There was no significant survival difference for early response by RECIST (p = 0.93). EASL and mRECIST could not be analyzed in 12 patients. Volumetric ADC increased significantly (1.32 × 10−3 mm2/sec to 1.60 × 10−3 mm2/sec, p <0.001), and volumetric enhancement decreased significantly in HAP (38.2 {\%} to 17.6 {\%}, p <0.001) and PVP (76.6 {\%} to 41.2 {\%}, p <0.005). Patients who demonstrated ≥ 65 {\%} decrease PVP enhancement had significantly improved overall survival compared to non-responders (p <0.005).Conclusion: Volumetric PVP enhancement was demonstrated to be significantly correlated with survival in the combination of DEB TACE and sorafenib for patients with HCC, enabling precise stratification of responders and non-responders.Key Points: • PVP enhancement is significantly correlated with survival in responders (p <0.005).• There was no significant survival difference for early response using RECIST (p = 0.93).• mRECIST or EASL could not assess tumour response in 29 {\%} of patients.",
keywords = "DEB-TACE, Diffusion-weighted MRI, Sorafenib, Treatment response, Volumetric functional MRI",
author = "Corona-Villalobos, {Celia Pamela} and Halappa, {Vivek Gowdra} and Geschwind, {Jean Francois H} and Susanne Bonekamp and Diane Reyes and David Cosgrove and Pawlik, {Timothy M.} and Kamel, {Ihab R}",
year = "2014",
doi = "10.1007/s00330-014-3412-6",
language = "English (US)",
volume = "25",
pages = "380--390",
journal = "European Radiology",
issn = "0938-7994",
publisher = "Springer Verlag",
number = "2",

}

TY - JOUR

T1 - Volumetric assessment of tumour response using functional MR imaging in patients with hepatocellular carcinoma treated with a combination of doxorubicin-eluting beads and sorafenib

AU - Corona-Villalobos, Celia Pamela

AU - Halappa, Vivek Gowdra

AU - Geschwind, Jean Francois H

AU - Bonekamp, Susanne

AU - Reyes, Diane

AU - Cosgrove, David

AU - Pawlik, Timothy M.

AU - Kamel, Ihab R

PY - 2014

Y1 - 2014

N2 - Objective: To prospectively assess treatment response using volumetric functional magnetic resonance imaging (MRI) metrics in patients with hepatocellular carcinoma (HCC) treated with the combination of doxorubicin-eluting bead–transarterial chemoembolization (DEB TACE) and sorafenib.Methods: A single center study enrolled 41 patients treated with systemic sorafenib, 400 mg twice a day, combined with DEB TACE. All patients had a pre-treatment and 3–4 week post-treatment MRI. Anatomic response criteria (RECIST, mRECIST and EASL) and volumetric functional response (ADC, enhancement) were assessed. Statistical analyses included paired Student’s t-test, Kaplan-Meier curves, Cohen’s Kappa, and multivariate cox proportional hazard model.Results: Median tumour size by RECIST remained unchanged post-treatment (8.3 ± 4.1 cm vs. 8.1 ± 4.3 cm, p = 0.44). There was no significant survival difference for early response by RECIST (p = 0.93). EASL and mRECIST could not be analyzed in 12 patients. Volumetric ADC increased significantly (1.32 × 10−3 mm2/sec to 1.60 × 10−3 mm2/sec, p <0.001), and volumetric enhancement decreased significantly in HAP (38.2 % to 17.6 %, p <0.001) and PVP (76.6 % to 41.2 %, p <0.005). Patients who demonstrated ≥ 65 % decrease PVP enhancement had significantly improved overall survival compared to non-responders (p <0.005).Conclusion: Volumetric PVP enhancement was demonstrated to be significantly correlated with survival in the combination of DEB TACE and sorafenib for patients with HCC, enabling precise stratification of responders and non-responders.Key Points: • PVP enhancement is significantly correlated with survival in responders (p <0.005).• There was no significant survival difference for early response using RECIST (p = 0.93).• mRECIST or EASL could not assess tumour response in 29 % of patients.

AB - Objective: To prospectively assess treatment response using volumetric functional magnetic resonance imaging (MRI) metrics in patients with hepatocellular carcinoma (HCC) treated with the combination of doxorubicin-eluting bead–transarterial chemoembolization (DEB TACE) and sorafenib.Methods: A single center study enrolled 41 patients treated with systemic sorafenib, 400 mg twice a day, combined with DEB TACE. All patients had a pre-treatment and 3–4 week post-treatment MRI. Anatomic response criteria (RECIST, mRECIST and EASL) and volumetric functional response (ADC, enhancement) were assessed. Statistical analyses included paired Student’s t-test, Kaplan-Meier curves, Cohen’s Kappa, and multivariate cox proportional hazard model.Results: Median tumour size by RECIST remained unchanged post-treatment (8.3 ± 4.1 cm vs. 8.1 ± 4.3 cm, p = 0.44). There was no significant survival difference for early response by RECIST (p = 0.93). EASL and mRECIST could not be analyzed in 12 patients. Volumetric ADC increased significantly (1.32 × 10−3 mm2/sec to 1.60 × 10−3 mm2/sec, p <0.001), and volumetric enhancement decreased significantly in HAP (38.2 % to 17.6 %, p <0.001) and PVP (76.6 % to 41.2 %, p <0.005). Patients who demonstrated ≥ 65 % decrease PVP enhancement had significantly improved overall survival compared to non-responders (p <0.005).Conclusion: Volumetric PVP enhancement was demonstrated to be significantly correlated with survival in the combination of DEB TACE and sorafenib for patients with HCC, enabling precise stratification of responders and non-responders.Key Points: • PVP enhancement is significantly correlated with survival in responders (p <0.005).• There was no significant survival difference for early response using RECIST (p = 0.93).• mRECIST or EASL could not assess tumour response in 29 % of patients.

KW - DEB-TACE

KW - Diffusion-weighted MRI

KW - Sorafenib

KW - Treatment response

KW - Volumetric functional MRI

UR - http://www.scopus.com/inward/record.url?scp=84920846904&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84920846904&partnerID=8YFLogxK

U2 - 10.1007/s00330-014-3412-6

DO - 10.1007/s00330-014-3412-6

M3 - Article

VL - 25

SP - 380

EP - 390

JO - European Radiology

JF - European Radiology

SN - 0938-7994

IS - 2

ER -