title: Identification of responders to sorafenib in hepatocellular carcinoma: is tumor volume measurement the way forward?
abstract: OBJECTIVE
  Early assessment of hepatocellular carcinoma (HCC) response during sorafenib (SO) treatment is challenging, since tumor necrosis, extension and radiological appearance can be inhomogeneous. We evaluated the predictive value of different imaging criteria - such as Response Evaluation Criteria in Solid Tumors (RECIST) 1.1, European Association for the Study of the Liver (EASL), modified RECIST (mRECIST), tumor density and volume variations - in the early follow-up of SO treatment.
  
  
  METHODS
  The study included 22 patients. CT images from baseline and 2 months were reviewed to assess response according to RECIST 1.1, mRECIST, EASL, Choi's criteria (decreased tumor density by ≥15%) and arterial-enhancing tumor volume ratio; α-fetoprotein (AFP) variations were expressed as AFP ratio.
  
  
  RESULTS
  The response criteria and volume measurements were reproducible (k > 0.80). The overall disease control rate was 40.9% by EASL and mRECIST, and 27.3% by RECIST 1.1; a ≥15% decrease in tumor density was observed in 9 patients (40.9%). The mean volume ratio was 1.73 ± 2.12, the mean AFP ratio 14 ± 37. The 1-year survival rate was 65.9%. Volume ratio was the only predictive factor for survival, with 1-year cumulative survival rates of 90% for volume ratios ≤1.1 and of 45.4% for volume ratios >1.1 (p = 0.04).
  
  
  CONCLUSIONS
  Tumor volume measurements are reproducible and might provide an early predictive marker of response in HCC patients treated with SO.
authors.affiliation: Department of Diagnostic and Interventional Radiology, Pisa University Hospital, Pisa, Italy.
authors.forename: Irene
authors.initials: I
authors.lastname: Bargellini
authors.forename: Alessandra
authors.initials: A
authors.lastname: Scionti
authors.forename: Valeria
authors.initials: V
authors.lastname: Mismas
authors.forename: Gianluca
authors.initials: G
authors.lastname: Masi
authors.forename: Caterina
authors.initials: C
authors.lastname: Vivaldi
authors.forename: Carlo
authors.initials: C
authors.lastname: Bartolozzi
authors.forename: Rodolfo
authors.initials: R
authors.lastname: Sacco
mesh_terms: D000368:Aged; D014408:Biomarkers, Tumor / Q000378:metabolism; D006528:Carcinoma, Hepatocellular / Q000188:drug therapy* / Q000378:metabolism / Q000473:pathology*; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000188:drug therapy* / Q000378:metabolism / Q000473:pathology*; D008297:Male; D009536:Niacinamide / Q000031:analogs & derivatives* / Q000627:therapeutic use; D010671:Phenylurea Compounds / Q000627:therapeutic use*; D011446:Prospective Studies; D012189:Retrospective Studies; D000077157:Sorafenib; D015996:Survival Rate; D014057:Tomography, X-Ray Computed
chemical_list: D014408:Biomarkers, Tumor; D010671:Phenylurea Compounds; D009536:Niacinamide; D000077157:Sorafenib