Treatment response to transcatheter arterial embolization and chemoembolization in primary and metastatic tumors of the liver (original) (raw)
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2014
Liver metastases from neuroendocrine tumor (NET) can be treated by transarterial embolization (TAE) or transarterial chemoembolization (TACE).The goal of TAE and TACE is to reduce blood flow to the tumor resulting in tumor ischemia and necrosis. In this retrospective study, the effectiveness and safety of TAE-TACE in the treatment of liver metastases in patients with NET was compared. Thirty patients with a histologically confirmed gastro-entero-pancreatic NET with liver metastases were retrospectively investigated. Seventeen patients underwent TAE, while 13 patients underwent TACE. Tumor response, degree of devascularization in treated lesions, and progression free survival (PFS) were evaluated in the whole population and then separately in TAE and TACE subgroups. In all patients treated with TAE and TACE, there was a significant size reduction of lesions as compared to baseline. Per lesion reduction was 2.2 ± 1.4 versus 3.3 ± 1.5 cm for TAE (p \ 0.001) and 2.2 ± 1.5 versus 3.4 ± 1.7 cm for TACE (p \ 0.001). In the whole population, the median PFS for all patients was 36 months (16.2-55.7 CI), without significant difference between TAE and TACE. In no patient did adverse events grade 3 and 4 as well as TAE/TACErelated death occurred, while the post-embolization syndrome occurred in 41 % of patients treated with TAE and 61 % of those treated with TACE. TAE and TACE are both effective in NET patients with liver metastases. TAE should be preferred to TACE in light of its similar anti-tumor effects and slightly better toxicity profile.
Journal of thee Medical Sciences (Berkala Ilmu Kedokteran), 2020
Hepatocellular carcinoma (HCC) is a major problem of global health.Transarterial chemoembolization (TACE) is the treatment of choice for unresectable HCC. The TACE is routinely conducted in major hospitals in Indonesia, however it rarely published. The use of modified response in evaluation criteria in solid tumors (mRECIST) was introduced as an accurate method of measuring tumor response in HCC. This study aimedto investigate the factorsaffecting tumor response to TACE therapy in HCC patients by using mRECIST. It was a retrospective cohort study conducted on 30 patients who successfully underwent the first TACE procedure in the Department of Radiology, Dr. Wahidin Sudirohusodo General Hospital, Makassar, Indonesia from January 2016 to August 2019. The multiphase abdominal computed tomography before and after as well as laboratory examination results before TACE were collected and analyzed. Chi-Square and Spearman-tests were used for the statistical analysis. A significant relationship between tumor location (p=0.016), number of tumor (p=0.001) and Child-Pugh score with tumor response to TACE therapy (p = 0.016) was observed. Solitary tumors tend to have a better therapeutic response, meanwhile, tumors located in the left lobe of patients with Child-Pugh B scores showed a decreased tumor response. Furthermore, no a significant relationship between age (p=0.920), sex (p=0.303), tumor size> 5 cm (p=0.082) and alpha-fetoprotein (AFP) levels (p=0.414) with tumor response was observed. In conclusion, TACE is preferably therapy for multinodular and unresectable HCC. Tumor response after TACE can be well assessed using mRECIST. The factorsaffecting tumor response to TACE therapy arenumber of tumor, location, and Child-Pugh score.
Evaluation of transarterial chemoembolization in treating hepatocellular carcinoma
Egyptian Liver Journal, 2013
Background & aim In clinical practice, transarterial chemoembolization (TACE) has been widely used for the treatment of hepatocellular carcinoma (HCC) beyond as well as within guideline recommendations. Here we aimed to verify whether two consecutive non-responses could be an optimal criterion for creating a rule to stop TACE being performed on these patients. Methods This study evaluated 200 patients with HCC beyond the Milan criteria, initially treated with TACE. TACE response was determined using the mRECIST criteria via dynamic CT or MRI. Median follow-up duration was 23.9 months. Results Within the 200 patients analyzed, 183 (91.5%) were male, with a total median age of 59.8 years. The mean size of the largest tumor was 6.8 cm, with 80 (40.0%) patients with �4 tumors. After the first TACE procedure, complete response, partial response, stable disease, or progressive disease were observed in 48 (24.0%), 87 (43.5%), 59 (29.5%) and 6 (3.0%) of patients, respectively. 45 (22.5%) patients showed no objective response (OR) following two consecutive TACE sessions. Of these, 28 received a subsequent TACE, with a 10.7% OR rate. Patients without OR showed poorer survival when compared to patients who achieved OR after repeated TACE. Multivariable analysis showed that size of the largest tumor >5cm and high alpha-fetoprotein of >200 ng/mL were significant factors associated with failure of OR to two consecutive TACE sessions. Conclusion Patients showing no OR to two consecutive TACE sessions will present a poor OR to subsequent TACE procedures. Early transition to systemic therapy may be advocated in such cases.
Journal of Hepatology, 2014
We assessed the clinical implications of the best response compared with the initial response during repeated transarterial chemoembolization (TACE) for hepatocellular carcinoma (HCC). Methods: We evaluated 332 patients with intermediate-stage HCC and preserved liver function initially treated with repeated TACE. All had P1 lesion measuring P1 cm, and the response measured after each session was based on EASL and mRECIST criteria. We performed survival analyses according to response kinetics, and identified clinical factors associated with the need for repeated TACE to achieve the best response. Results: An objective response, either a complete response (CR) or a partial response (PR), after the first TACE was seen in about 50% of patients by both EASL and mRECIST. In terms of the best response during serial TACE, 250 patients (75.3%) by EASL and 278 (83.7%) by mRECIST were overall responders. The sizes of the largest and second largest tumors were the only parameters positively correlated with the number of TACE sessions required to achieve the best response (p <0.05). Multivariate Cox analysis showed that achieving a CR or PR as the best response was the best predictor of survival following TACE with a hazard ratio of 0.45 by EASL and 0.24 by mRECIST, and more than 0.69 and 0.71, respectively for initial responders (p <0.05). Conclusions: The best response observed during serial TACE, rather than the initial response, most strongly predicts the survival of patients with intermediate-stage HCC. The number of TACE sessions needed to achieve a best response is a function of tumor size. Ó
World Journal of Surgery
Background Radioembolization (RE) with intra-arterial administration of 90 Y microspheres is a promising technique for the treatment of liver metastases from small intestinal neuroendocrine tumors (SI-NET) not amenable to surgery or local ablation. However, studies comparing RE to other loco-regional therapies are lacking. The aim of this randomized study was to compare the therapeutic response and safety after RE and bland hepatic arterial embolization (HAE), and to investigate early therapy-induced changes with diffusion-weighted MRI (DWI-MRI). Methods Eleven patients were included in a prospective randomized controlled pilot study, six assigned to RE and five to HAE. Response according to RECIST 1.1 using MRI or CT at 3 and 6 months post-treatment was recorded as well as changes in DWI-MRI parameters after 1 month. Data on biochemical tumor response, toxicity, and side effects were also collected. Results Three months after treatment, all patients in the HAE group showed partial response according to RECIST while none in the RE group did (p = 0.0022). After 6 months, the response rates were 4/5 (80%) and 2/6 (33%) in the HAE and RE groups, respectively (NS). DWI-MRI metrics could not predict RECIST response, but lower pretreatment ADC (120-800) and larger ADC (0-800) increase at 1 month were related to larger decrease in tumor diameter when all tumors were counted. Conclusion HAE resulted in significantly higher RECIST response after 3 months, but no difference compared to RE remained after 6 months. These preliminary findings indicate that HAE remains a safe option for the treatment of liver metastases from SI-NET, and further studies are needed to establish the role of RE and the predictive value of MR-DWI.
2007
Transcatheter arterial chemoembolisation (TACE) has been reported to be an efficient treatment of liver metastases of endocrine tumours in short series of patients. However, several factors seem to affect its results. The aim of this work is to identify predictors of response to TACE for liver metastases of endocrine tumours. A total of 163 TACE procedures were performed in 67 patients between 1994 and 2004. Forty-four patients were treated with streptozotocin and 23 with doxorubicin. Primary tumour was located in the pancreas for 19 patients, and had been removed in 43. Thirty-eight tumours were functioning. Response rate was 37% (confidence interval [CI] 95%: 28 -49%). Median time to progression (TTP) was 14.5 months (CI 95%: 9 -41). In multivariate analysis (n ¼ 43), predictors of tumour response were body mass index (BMI) (odds ratio [OR]: 1.3; CI 95%: 1.04 -1.63; P ¼ 0.022), functioning type of tumour (OR: 7.31; CI 95%: 1.26 -42.5; P ¼ 0.027), arterial phase enhancement on abdominal computed tomography (CT) (OR: 8.11; CI 95%:1.06 -62; P ¼ 0.044) and use of streptozotocin for cytotoxic agent (OR: 21.3; CI 95%: 1.48 -306; P ¼ 0.025). Analysis of TTP predictors showed that BMI (hazard ratio [HR]: 0.85; CI 95%: 0.76 -0.86; P ¼ 0.01) and arterial phase enhancement (HR: 0.3; CI 95%: 0.12 -0.73; P ¼ 0.008) were associated with delayed progression. This large study confirms the previously reported results of TACE regarding its efficacy for the treatment of liver metastases of endocrine tumours. Arterial phase enhancement on abdominal CT and BMI are predictors of treatment's efficacy. Streptozotocin should be the preferred cytotoxic agent in order to save anthracycline for systemic chemotherapy.
Pancreas, 2014
Objectives-We compared the clinical outcomes of patients with metastatic neuroendocrine tumors (mNET) treated with hepatic artery embolization (HAE), chemoembolization (HACE) and selective internal radiation therapy (SIRT) at our institution over the last ten years. Methods-Medical records of 42 mNET patients with hepatic metastases treated with HAE, HACE or SIRT at the University of Iowa from 2001 to 2011 were analyzed. Results-13 patients had HAE, 17 had HACE and 12 had SIRT as their initial procedure. TTP was similar between SIRT (15.1 months) and HACE/HAE groups (19.6 months) (p= 0.968). There was a trend towards increased TTP in patients receiving HACE (33.4 months), compared to HAE (12.1 months) or SIRT (15.1 months), although not statistically significant (p = 0.512). The overall survival for all patients from the first intervention was 41.9 months. There was no difference between HACE/HAE and SIRT in post-therapy change of CgA (p=0.233) and PcSt (p=0.158) levels. TTP did not correlate with the change in the post-therapy CgA (p=0.299) or PcSt (p=0.208) levels.
European Journal of Radiology, 2013
To retrospectively evaluate agreement between modified RECIST (mRECIST) assessed at Computed Tomography (CT) and pathology in a large series of patients with hepatocellular carcinoma (HCC) who were transplanted after transarterial chemoembolization (TACE). Materials and methods: IRB approval was obtained. The study included 178 patients (M/F = 155/23; mean age 55.8 ± 6.3 years) with HCC who were transplanted after TACE from January 1996 to December 2010 and with at least one CT examination before liver transplantation (LT). Two blinded independent readers retrospectively reviewed CT examinations, to assess tumor response to TACE according to mRECIST. Patients were classified in responders (complete and partial response) and non-responders (stable and progressive disease). On the explanted livers, percentage of tumor necrosis was classified as 100, >50 and <50%. Results: The mean interval between latest CT and LT was 57.4 ± 39.8 days. At latest CT examination, the objective response rate was 78.1% (139/178), with 86 cases (48.3%) of complete response (CR). A good intra-(k = 0.75 and 0.86) and inter-observer (k = 0.81) agreement was obtained. On a per-patient basis, agreement between mRECIST and pathology was obtained in 120 patients (67.4%), with 19 cases (10.7%) of underestimation and 39 cases (21.9%) of overestimation of tumor response at CT. CT sensitivity and specificity in differentiating between responders and non-responders were 93 and 82.9%, respectively. Out of 302 nodules, sensitivity and specificity of CT in detecting complete necrosis were 87.5 and 68.9%, respectively. Conclusions: CT can overestimate tumor response after TACE. Nonetheless, mRECIST assessed at CT after TACE are reproducible and reliable in differentiating responders and non-responders.
Journal of Clinical Medicine Research, 2018
Background: To determine whether response to transarterial chemoembolization (TACE) predicts survival and to identify pretreatment factors associated with TACE response and prognosis. Methods: Between April and September 2010, 50 patients underwent TACE for hepatocellular carcinoma. Response to TACE was assessed using post-treatment computed tomography (CT) and magnetic resonance imaging (MRI) scans and tumor marker levels and classified as Response Poor (P) and Non-poor (NP). Time zero was set to September 30, 2010, and survival rates were analyzed by landmarking. Cumulative survival rates were calculated using the Kaplan-Meier method and compared according to grades using the log-rank test; contributing factors to survival were analyzed using a Cox proportional hazards model. Pretreatment factors were analyzed for 109 TACE sessions performed until October 2017, using a multiple logistic regression model. Receiver operating characteristic (ROC) curves were generated to determine the best tumor number for predicting response P. Results: Response P patients showed significantly lower cumulative survival rates than Response NP patients (P < 0.001). On multivariate analysis, tumor number (hazard ratio (HR), 1.475), protein-induced vitamin-K absence-II (HR, 4.539), and the number of previous TACE sessions (HR, 1.472) were identified as pretreatment factors contributing to Response P. Further, pre-treatment platelet count (HR, 0.876) and tumor number (HR, 1.330) were factors contributing to survival in multivariate analysis. ROC curve analysis revealed that the optimal cutoff value to discriminate Response P was 7.5. Conclusions: Response to TACE can predict survival. Pretreatment tumor number is a useful factor for predicting both TACE response and prognosis.