title: mRECIST and EASL responses at early time point by contrast-enhanced dynamic MRI predict survival in patients with unresectable hepatocellular carcinoma (HCC) treated by doxorubicin drug-eluting beads transarterial chemoembolization (DEB TACE).
abstract: BACKGROUND
  We analyzed the magnetic resonance imaging (MRI) responses by world health organization (WHO), response evaluation criteria in solid tumor (RECIST), European Association for the Study of Liver (EASL), and modified RECIST (mRECIST) guidelines and correlated with survival after doxorubicin (Adriamycin; Pharmacia & Upjohn, Peapac, NJ). drug-eluting beads transarterial chemoembolization (DEB TACE) in patients with unresectable hepatocellular carcinoma (HCC).
  
  
  METHODS
  The early target and overall imaging responses were studied in 120 consecutive patients treated with DEB TACE for unresectable HCC, using RECIST, WHO, EASL, and mRECIST guidelines on contrast-enhanced dynamic liver MRI. The median period between the DEB TACE and assessment scan was 33.50 days. Survival analyses were carried out with the Kaplan-Meier method and the Cox proportional model.
  
  
  RESULTS
  WHO and RECIST1.1 had poor correlation with survival. mRECIST and EASL had significant correlation with survival with target lesion response rates of 63.3% and 48.3% and with overall response rates of 52.5% and 39.2%, respectively. The responders of EASL and mRECIST had significant median survival (P ≤ 0.0001). Moreover, mRECIST was better than EASL in predicting survival, because the survival difference between responders and non-responders of overall response was statistically significant (P = 0.013) for mRECIST, but not for EASL (P = 0.064).
  
  
  CONCLUSIONS
  EASL and mRECIST responses measured on MRI at an early time point after DEB TACE predicted survival. mRECIST response demonstrated higher survival correlation than EASL.
authors.affiliation: Departments of Interventional Radiology and Image Guided Medicine, Winship Cancer Institute, Emory University School of Medicine, 1364 Clifton Road NE, Suite AG-05, Atlanta, GA 30322, USA.
authors.forename: H J
authors.initials: HJ
authors.lastname: Prajapati
authors.forename: J R
authors.initials: JR
authors.lastname: Spivey
authors.forename: S I
authors.initials: SI
authors.lastname: Hanish
authors.forename: B F
authors.initials: BF
authors.lastname: El-Rayes
authors.forename: J S
authors.initials: JS
authors.lastname: Kauh
authors.forename: Z
authors.initials: Z
authors.lastname: Chen
authors.forename: H S
authors.initials: HS
authors.lastname: Kim
mesh_terms: D000368:Aged; D000970:Antineoplastic Agents / Q000008:administration & dosage; D006528:Carcinoma, Hepatocellular / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000473:pathology; D016461:Chemoembolization, Therapeutic; D004317:Doxorubicin / Q000008:administration & dosage*; D005260:Female; D017408:Guidelines as Topic; D006801:Humans; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000000981:diagnostic imaging / Q000188:drug therapy*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D011859:Radiography; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents; D004317:Doxorubicin