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) mm(2)/sec to 1.60 × 10(-3) mm(2)/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).
  
  
  CONCLUSIONS
  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.
  
  
  CONCLUSIONS
  • 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.
authors.affiliation: The Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University, School of Medicine, 600 N. Wolfe St., MRI 110B, Baltimore, MD, 21287, USA, ccorona1@jhmi.edu.
authors.forename: Celia Pamela
authors.initials: CP
authors.lastname: Corona-Villalobos
authors.forename: Vivek Gowdra
authors.initials: VG
authors.lastname: Halappa
authors.forename: Jean-Francois H
authors.initials: JF
authors.lastname: Geschwind
authors.forename: Susanne
authors.initials: S
authors.lastname: Bonekamp
authors.forename: Diane
authors.initials: D
authors.lastname: Reyes
authors.forename: David
authors.initials: D
authors.lastname: Cosgrove
authors.forename: Timothy M
authors.initials: TM
authors.lastname: Pawlik
authors.forename: Ihab R
authors.initials: IR
authors.lastname: Kamel
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000008:administration & dosage; D006528:Carcinoma, Hepatocellular / Q000188:drug therapy / Q000401:mortality / Q000473:pathology*; D003692:Delayed-Action Preparations; D004305:Dose-Response Relationship, Drug; D004317:Doxorubicin / Q000008:administration & dosage*; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008113:Liver Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000473:pathology*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008396:Maryland / Q000453:epidemiology; D008875:Middle Aged; D009536:Niacinamide / Q000008:administration & dosage / Q000031:analogs & derivatives*; D010671:Phenylurea Compounds / Q000008:administration & dosage*; D011446:Prospective Studies; D040262:Receptors, Vascular Endothelial Growth Factor / Q000037:antagonists & inhibitors; D000077157:Sorafenib; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D047368:Tumor Burden
chemical_list: D000970:Antineoplastic Agents; D003692:Delayed-Action Preparations; D010671:Phenylurea Compounds; D009536:Niacinamide; D004317:Doxorubicin; D000077157:Sorafenib; D040262:Receptors, Vascular Endothelial Growth Factor