title: Assessment of clinical and radiological response to sorafenib in hepatocellular carcinoma patients.
abstract: Sorafenib is an effective anti-angiogenic treatment for hepatocellular carcinoma (HCC). The assessment of tumor progression in patients treated with sorafenib is crucial to help identify potentially-resistant patients, avoiding unnecessary toxicities. Traditional methods to assess tumor progression are based on variations in tumor size and provide unreliable results in patients treated with sorafenib. New methods to assess tumor progression such as the modified Response Evaluation Criteria in Solid Tumors or European Association for the Study of Liver criteria are based on imaging to measure the vascularization and tumor volume (viable or necrotic). These however fail especially when the tumor response results in irregular development of necrotic tissue. Newer assessment techniques focus on the evaluation of tumor volume, density or perfusion. Perfusion computed tomography and Dynamic Contrast-Enhanced-UltraSound can measure the vascularization of HCC lesions and help predict tumor response to anti-angiogenic therapies. Mean Transit Time is a possible predictive biomarker to measure tumor response. Volumetric techniques are reliable, reproducible and time-efficient and can help measure minimal changes in viable tumor or necrotic tissue, allowing the prompt identification of non-responders. Volume ratio may be a reproducible biomarker for tumor response. Larger trials are needed to confirm the use of these techniques in the prediction of response to sorafenib.
authors.affiliation: Rodolfo Sacco, Valeria Mismas, Antonio Romano, Marco Bertini, Michele Bertoni, Graziana Federici, Salvatore Metrangolo, Giuseppe Parisi, Emanuele Tumino, Giampaolo Bresci, Luca Giacomelli, Dipartimento di Gastroenterologia-UO Gastroenterologia e Malattie del Ricambio, Azienda Ospedaliero Universitaria Pisana, 56124 Pisa, Italy.
authors.forename: Rodolfo
authors.initials: R
authors.lastname: Sacco
authors.affiliation: Rodolfo Sacco, Valeria Mismas, Antonio Romano, Marco Bertini, Michele Bertoni, Graziana Federici, Salvatore Metrangolo, Giuseppe Parisi, Emanuele Tumino, Giampaolo Bresci, Luca Giacomelli, Dipartimento di Gastroenterologia-UO Gastroenterologia e Malattie del Ricambio, Azienda Ospedaliero Universitaria Pisana, 56124 Pisa, Italy.
authors.forename: Valeria
authors.initials: V
authors.lastname: Mismas
authors.affiliation: Rodolfo Sacco, Valeria Mismas, Antonio Romano, Marco Bertini, Michele Bertoni, Graziana Federici, Salvatore Metrangolo, Giuseppe Parisi, Emanuele Tumino, Giampaolo Bresci, Luca Giacomelli, Dipartimento di Gastroenterologia-UO Gastroenterologia e Malattie del Ricambio, Azienda Ospedaliero Universitaria Pisana, 56124 Pisa, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Romano
authors.affiliation: Rodolfo Sacco, Valeria Mismas, Antonio Romano, Marco Bertini, Michele Bertoni, Graziana Federici, Salvatore Metrangolo, Giuseppe Parisi, Emanuele Tumino, Giampaolo Bresci, Luca Giacomelli, Dipartimento di Gastroenterologia-UO Gastroenterologia e Malattie del Ricambio, Azienda Ospedaliero Universitaria Pisana, 56124 Pisa, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Bertini
authors.affiliation: Rodolfo Sacco, Valeria Mismas, Antonio Romano, Marco Bertini, Michele Bertoni, Graziana Federici, Salvatore Metrangolo, Giuseppe Parisi, Emanuele Tumino, Giampaolo Bresci, Luca Giacomelli, Dipartimento di Gastroenterologia-UO Gastroenterologia e Malattie del Ricambio, Azienda Ospedaliero Universitaria Pisana, 56124 Pisa, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Bertoni
authors.affiliation: Rodolfo Sacco, Valeria Mismas, Antonio Romano, Marco Bertini, Michele Bertoni, Graziana Federici, Salvatore Metrangolo, Giuseppe Parisi, Emanuele Tumino, Giampaolo Bresci, Luca Giacomelli, Dipartimento di Gastroenterologia-UO Gastroenterologia e Malattie del Ricambio, Azienda Ospedaliero Universitaria Pisana, 56124 Pisa, Italy.
authors.forename: Graziana
authors.initials: G
authors.lastname: Federici
authors.affiliation: Rodolfo Sacco, Valeria Mismas, Antonio Romano, Marco Bertini, Michele Bertoni, Graziana Federici, Salvatore Metrangolo, Giuseppe Parisi, Emanuele Tumino, Giampaolo Bresci, Luca Giacomelli, Dipartimento di Gastroenterologia-UO Gastroenterologia e Malattie del Ricambio, Azienda Ospedaliero Universitaria Pisana, 56124 Pisa, Italy.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Metrangolo
authors.affiliation: Rodolfo Sacco, Valeria Mismas, Antonio Romano, Marco Bertini, Michele Bertoni, Graziana Federici, Salvatore Metrangolo, Giuseppe Parisi, Emanuele Tumino, Giampaolo Bresci, Luca Giacomelli, Dipartimento di Gastroenterologia-UO Gastroenterologia e Malattie del Ricambio, Azienda Ospedaliero Universitaria Pisana, 56124 Pisa, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Parisi
authors.affiliation: Rodolfo Sacco, Valeria Mismas, Antonio Romano, Marco Bertini, Michele Bertoni, Graziana Federici, Salvatore Metrangolo, Giuseppe Parisi, Emanuele Tumino, Giampaolo Bresci, Luca Giacomelli, Dipartimento di Gastroenterologia-UO Gastroenterologia e Malattie del Ricambio, Azienda Ospedaliero Universitaria Pisana, 56124 Pisa, Italy.
authors.forename: Emanuele
authors.initials: E
authors.lastname: Tumino
authors.affiliation: Rodolfo Sacco, Valeria Mismas, Antonio Romano, Marco Bertini, Michele Bertoni, Graziana Federici, Salvatore Metrangolo, Giuseppe Parisi, Emanuele Tumino, Giampaolo Bresci, Luca Giacomelli, Dipartimento di Gastroenterologia-UO Gastroenterologia e Malattie del Ricambio, Azienda Ospedaliero Universitaria Pisana, 56124 Pisa, Italy.
authors.forename: Giampaolo
authors.initials: G
authors.lastname: Bresci
authors.affiliation: Rodolfo Sacco, Valeria Mismas, Antonio Romano, Marco Bertini, Michele Bertoni, Graziana Federici, Salvatore Metrangolo, Giuseppe Parisi, Emanuele Tumino, Giampaolo Bresci, Luca Giacomelli, Dipartimento di Gastroenterologia-UO Gastroenterologia e Malattie del Ricambio, Azienda Ospedaliero Universitaria Pisana, 56124 Pisa, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Giacomelli
authors.affiliation: Rodolfo Sacco, Valeria Mismas, Antonio Romano, Marco Bertini, Michele Bertoni, Graziana Federici, Salvatore Metrangolo, Giuseppe Parisi, Emanuele Tumino, Giampaolo Bresci, Luca Giacomelli, Dipartimento di Gastroenterologia-UO Gastroenterologia e Malattie del Ricambio, Azienda Ospedaliero Universitaria Pisana, 56124 Pisa, Italy.
authors.forename: Sara
authors.initials: S
authors.lastname: Marceglia
authors.affiliation: Rodolfo Sacco, Valeria Mismas, Antonio Romano, Marco Bertini, Michele Bertoni, Graziana Federici, Salvatore Metrangolo, Giuseppe Parisi, Emanuele Tumino, Giampaolo Bresci, Luca Giacomelli, Dipartimento di Gastroenterologia-UO Gastroenterologia e Malattie del Ricambio, Azienda Ospedaliero Universitaria Pisana, 56124 Pisa, Italy.
authors.forename: Irene
authors.initials: I
authors.lastname: Bargellini
keywords: Dynamic Contrast-Enhanced-UltraSound; Hepatocellular carcinoma; Perfusion computed tomography; Response Evaluation Criteria in Solid Tumors; Sorafenib; Volumetric assessment