title: Transarterial chemoembolization in soft-tissue sarcoma metastases to the liver - the use of imaging biomarkers as predictors of patient survival.
abstract: BACKGROUND
  The clinical management of patients with metastatic soft-tissue sarcoma of the liver is complicated by the paucity of reliable clinical data. This study evaluated the safety profile, survival outcome as well as the role of imaging biomarkers of tumor response in metastatic soft-tissue sarcoma (mSTS) of the liver treated with conventional transarterial chemoembolization (cTACE).
  
  
  METHODS
  This retrospective analysis included 30 patients with mSTS of the liver treated with cTACE. The safety profile, overall survival (OS) and progression-free survival (PFS) after the procedure were evaluated. Tumor response in each patient was assessed using RECIST, modified (m) RECIST and EASL guidelines. In addition, a 3D quantification of the enhancing tumor volume (quantitative [q] EASL) was performed. For each method, patients were classified as responders (R) and non-responders (NR), and evaluated using Kaplan-Meier and multivariate Cox proportional hazard ratio (HR) analysis.
  
  
  RESULTS
  No Grade III or IV toxicities were reported in a total of 77 procedures (mean, 2.6/patient). Median OS was 21.2 months (95% CI, 13.4-28.9) and PFS was 6.3 months (95% CI, 4.4-8.2). The enhancement-based techniques identified 11 (44%), 12 (48%) and 12 (48%) patients as R according to EASL, mRECIST and qEASL, respectively. No stratification was achieved with RECIST. Multivariate analysis identified tumor response according to mRECIST and qEASL as reliable predictors of improved patient survival (P=0.019; HR 0.3 [0.1-0.8] and P=0.006; HR 0.2 [0.1-0.6], respectively).
  
  
  CONCLUSIONS
  This study confirmed the role of cTACE as a safe salvage therapy option in patients with mSTS of the liver. The demonstrated advantages of enhancement-based tumor response assessment techniques over size-based criteria validate mRECIST and qEASL as preferable methods after intraarterial therapy.
authors.affiliation: Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology, The Johns Hopkins Hospital, Sheikh Zayed Tower, Suite 7203, 1800 Orleans St, Baltimore, MD, USA 21287; Department of Diagnostic and Interventional Radiology, Charite Universitätsmedizin, Berlin, Germany.
authors.forename: Julius
authors.initials: J
authors.lastname: Chapiro
authors.affiliation: Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology, The Johns Hopkins Hospital, Sheikh Zayed Tower, Suite 7203, 1800 Orleans St, Baltimore, MD, USA 21287.
authors.forename: Rafael
authors.initials: R
authors.lastname: Duran
authors.affiliation: U/S Imaging and Interventions (UII), Philips Research North America, Briarcliff Manor, NY, USA.
authors.forename: MingDe
authors.initials: M
authors.lastname: Lin
authors.affiliation: Department of Surgery, The Johns Hopkins Hospital, Baltimore, MD, USA.
authors.forename: Benedetto
authors.initials: B
authors.lastname: Mungo
authors.affiliation: Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology, The Johns Hopkins Hospital, Sheikh Zayed Tower, Suite 7203, 1800 Orleans St, Baltimore, MD, USA 21287.
authors.forename: Todd
authors.initials: T
authors.lastname: Schlachter
authors.affiliation: Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology, The Johns Hopkins Hospital, Sheikh Zayed Tower, Suite 7203, 1800 Orleans St, Baltimore, MD, USA 21287.
authors.forename: Rüdiger
authors.initials: R
authors.lastname: Schernthaner
authors.affiliation: Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology, The Johns Hopkins Hospital, Sheikh Zayed Tower, Suite 7203, 1800 Orleans St, Baltimore, MD, USA 21287; Department of Diagnostic and Interventional Radiology, Charite Universitätsmedizin, Berlin, Germany.
authors.forename: Boris
authors.initials: B
authors.lastname: Gorodetski
authors.affiliation: Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology, The Johns Hopkins Hospital, Sheikh Zayed Tower, Suite 7203, 1800 Orleans St, Baltimore, MD, USA 21287.
authors.forename: Zhijun
authors.initials: Z
authors.lastname: Wang
authors.affiliation: Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology, The Johns Hopkins Hospital, Sheikh Zayed Tower, Suite 7203, 1800 Orleans St, Baltimore, MD, USA 21287. Electronic address: jfg@jhmi.edu.
authors.forename: Jean François
authors.initials: JF
authors.lastname: Geschwind
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers; D016461:Chemoembolization, Therapeutic / Q000379:methods; D003952:Diagnostic Imaging; D018572:Disease-Free Survival; D005260:Female; D006499:Hepatic Artery; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality / Q000556:secondary* / Q000628:therapy*; D008297:Male; D012189:Retrospective Studies; D012509:Sarcoma / Q000401:mortality / Q000556:secondary* / Q000628:therapy*; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers
keywords: EASL; Liver cancer; MRI; RECIST; Sarcoma; Transarterial chemoembolization; Volumetry; mRECIST