Radiological‐pathological analysis of WHO, RECIST, EASL, mRECIST and DWI: Imaging analysis from a prospective randomized trial of Y90 ± sorafenib. Issue 5 (1st October 2013)

• Record Type: Journal Article
• Authors: Vouche, Michael; Kulik, Laura; Atassi, Rohi; Memon, Khairuddin; Hickey, Ryan; Ganger, Daniel; Miller, Frank H.; Yaghmai, Vahid; Abecassis, Michael; Baker, Talia; Mulcahy, Mary; Nayar, Ritu; Lewandowski, Robert J.; Salem, Riad
• Is Part Of: Hepatology. Volume 58:Issue 5(2013:Nov.)
• Page Start: 1655
• Page End: 1666
• Publication Date: 2013-10-01
• Subjects: Heart -- Diseases -- Nursing -- Periodicals; Lungs -- Diseases -- Nursing -- Periodicals; Intensive care nursing -- Periodicals; Foie -- Maladies -- Périodiques; 616.362
• DOI: 10.1002/hep.26487
• Languages: English
• ISSNs: 0270-9139

Abstract

Abstract : The aim of this study was to compare radiological and pathological changes and test the adjunct efficacy of Sorafenib to Y90 as a bridge to transplantation in hepatocellular carcinoma (HCC). 15 patients with 16 HCC lesions were randomized to Y90 without (Group A, n = 9) or with Sorafenib (Group B, n = 7). Size (WHO, RECIST), enhancement (EASL, mRECIST) and diffusion‐weighted imaging criteria (apparent diffusion coefficient, ADC) measurements were obtained at baseline, then at 1 and every 3 months after treatment until transplantation. Percentage necrosis in explanted tumors was correlated with imaging findings. 100%, 50%‐99% and <50% pathological necrosis was observed in 6 (67%), 1 (11%), and 2 (22%) tumors in Group A and 3 (42%), 2 (28%), and 2 (28%) in Group B, respectively ( P = 0.81). While ADC ( P = 0.46) did not change after treatment, WHO ( P = 0.06) and RECIST ( P = 0.08) response at 1 month failed to reach significance, but significant responses by EASL ( P < 0.01/0.03) and mRECIST ( P < 0.01/0.03) at 1 and 3 months were observed. Response was equivalent by EASL or mRECIST. No difference in response rates was observed between groups A and B at 1 and 3 months by WHO, RECIST, EASL, mRECIST or ADC measurements. Despite failing to reach significance, smaller baseline size was associated with complete pathological necrosis (CPN) (RECIST: P = 0.07; WHO: P = 0.05). However, a cut‐off size of 35 mm was predictive of CPN ( P = 0.005). CPN could not be predicted by WHO ( P = 0.25 and 0.62), RECIST (P = 0.35 and 0.54), EASL ( P = 0.49 and 0.46), mRECIST ( P = 0.49 and 0.60) or ADC ( P = 0.86 and 0.93). Conclusion : The adjunct of Sorafenib did not augment radiological or pathological response to Y90 therapy for HCC. Equivalent significant reduction in enhancement at 1 and 3 months by EASL/mRECIST was noted. Neither EASL nor mRECIST could reliably predict CPN. (HEPATOLOGY 2013;58:1655–1666)