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Imaging for assessment of treatment response in hepatocellular carcinoma: Current update.

Hayano K, Lee SH, Sahani DV - Indian J Radiol Imaging (2015 Apr-Jun)

Bottom Line: Morphologic methods such as the Response Evaluation Criteria in Solid Tumors (RECIST) are considered as the gold standard for response assessment in the management of cancer.However, with the increasing clinical use of antineoplastic cytostatic agents and locoregional interventional therapies in hepatocellular carcinoma (HCC), conventional morphologic methods are confronting limitations in response assessment.In this review, we discuss various novel imaging methods for response assessment and compare them with the conventional ones in HCC.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA.

ABSTRACT
Morphologic methods such as the Response Evaluation Criteria in Solid Tumors (RECIST) are considered as the gold standard for response assessment in the management of cancer. However, with the increasing clinical use of antineoplastic cytostatic agents and locoregional interventional therapies in hepatocellular carcinoma (HCC), conventional morphologic methods are confronting limitations in response assessment. Thus, there is an increasing interest in new imaging methods for response assessment, which can evaluate tumor biology such as vascular physiology, fibrosis, necrosis, and metabolism. In this review, we discuss various novel imaging methods for response assessment and compare them with the conventional ones in HCC.

No MeSH data available.


Related in: MedlinePlus

Arterial phase CECT of a 72-year-old man with HCC. The area of central necrosis increased after a tyrosine kinase inhibitor therapy (dashed line), while the change in tumor size was not obvious (solid line)
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Figure 2: Arterial phase CECT of a 72-year-old man with HCC. The area of central necrosis increased after a tyrosine kinase inhibitor therapy (dashed line), while the change in tumor size was not obvious (solid line)

Mentions: Generally, targeted therapy agents induce reduction in tumor vascularization, provocation of necrotic area and sometimes cavitation in solid tumors, and these features have been reported in various targeted therapies of HCC.[324252627] Furthermore, all LRTs attempt to induce necrosis of the tumor, which may delay tumor shrinkage during the early post-treatment period. Given these limitations of morphologic response criteria, the European Association for the Study of Liver (EASL) proposed new response criteria in 2000 to take into account tumor necrosis induced by treatment.[28] Accordingly, necrosis is defined as non-enhanced areas on contrast-enhanced (CE) CT/MR within the treated tumor. In 2008, the American Association for the Study of Liver Disease (AASLD) proposed the modified RECIST (mRECIST) criteria, which conceptualized viable tumor measurements. The major change is the definition of the target lesion, which is no longer the whole lesion but only the contrast-enhanced portion of the hepatic lesion on the arterial phase image [Figure 2].[2930] Previous reports demonstrated that EASL or mRECIST had better overall response rate than conventional morphologic criteria such as RECIST and WHO.[213132] In addition, these criteria have shown a better correlation with survival. Gillmore et al.[20] reported that responses measured by EASL and mRECIST after 2-3 months of TACE were independently associated with survival, whereas RECIST 1.1 had no significant association with survival. In a recent retrospective study of HCC patients treated with sorafenib, patients categorized as responders according to mRECIST had a longer overall survival (OS) than the non-responders.[33] Similarly, Shim et al.[34] reported that responses measured by mRECIST and EASL were independent predictors for OS following TACE. Prajapati et al.[32] reported significant associations of mRECIST and EASL with survival, and also suggested that the response based on mRECIST showed a better correlation with survival than that based on EASL. Therefore, response evaluation based on the enhancement may enable more accurate response assessment in terms of survival.


Imaging for assessment of treatment response in hepatocellular carcinoma: Current update.

Hayano K, Lee SH, Sahani DV - Indian J Radiol Imaging (2015 Apr-Jun)

Arterial phase CECT of a 72-year-old man with HCC. The area of central necrosis increased after a tyrosine kinase inhibitor therapy (dashed line), while the change in tumor size was not obvious (solid line)
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4419421&req=5

Figure 2: Arterial phase CECT of a 72-year-old man with HCC. The area of central necrosis increased after a tyrosine kinase inhibitor therapy (dashed line), while the change in tumor size was not obvious (solid line)
Mentions: Generally, targeted therapy agents induce reduction in tumor vascularization, provocation of necrotic area and sometimes cavitation in solid tumors, and these features have been reported in various targeted therapies of HCC.[324252627] Furthermore, all LRTs attempt to induce necrosis of the tumor, which may delay tumor shrinkage during the early post-treatment period. Given these limitations of morphologic response criteria, the European Association for the Study of Liver (EASL) proposed new response criteria in 2000 to take into account tumor necrosis induced by treatment.[28] Accordingly, necrosis is defined as non-enhanced areas on contrast-enhanced (CE) CT/MR within the treated tumor. In 2008, the American Association for the Study of Liver Disease (AASLD) proposed the modified RECIST (mRECIST) criteria, which conceptualized viable tumor measurements. The major change is the definition of the target lesion, which is no longer the whole lesion but only the contrast-enhanced portion of the hepatic lesion on the arterial phase image [Figure 2].[2930] Previous reports demonstrated that EASL or mRECIST had better overall response rate than conventional morphologic criteria such as RECIST and WHO.[213132] In addition, these criteria have shown a better correlation with survival. Gillmore et al.[20] reported that responses measured by EASL and mRECIST after 2-3 months of TACE were independently associated with survival, whereas RECIST 1.1 had no significant association with survival. In a recent retrospective study of HCC patients treated with sorafenib, patients categorized as responders according to mRECIST had a longer overall survival (OS) than the non-responders.[33] Similarly, Shim et al.[34] reported that responses measured by mRECIST and EASL were independent predictors for OS following TACE. Prajapati et al.[32] reported significant associations of mRECIST and EASL with survival, and also suggested that the response based on mRECIST showed a better correlation with survival than that based on EASL. Therefore, response evaluation based on the enhancement may enable more accurate response assessment in terms of survival.

Bottom Line: Morphologic methods such as the Response Evaluation Criteria in Solid Tumors (RECIST) are considered as the gold standard for response assessment in the management of cancer.However, with the increasing clinical use of antineoplastic cytostatic agents and locoregional interventional therapies in hepatocellular carcinoma (HCC), conventional morphologic methods are confronting limitations in response assessment.In this review, we discuss various novel imaging methods for response assessment and compare them with the conventional ones in HCC.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA.

ABSTRACT
Morphologic methods such as the Response Evaluation Criteria in Solid Tumors (RECIST) are considered as the gold standard for response assessment in the management of cancer. However, with the increasing clinical use of antineoplastic cytostatic agents and locoregional interventional therapies in hepatocellular carcinoma (HCC), conventional morphologic methods are confronting limitations in response assessment. Thus, there is an increasing interest in new imaging methods for response assessment, which can evaluate tumor biology such as vascular physiology, fibrosis, necrosis, and metabolism. In this review, we discuss various novel imaging methods for response assessment and compare them with the conventional ones in HCC.

No MeSH data available.


Related in: MedlinePlus