Abstract
ObjectivesTo analyse the predictive value of the volume of enhancement of disease (VED), based on the CT arterial enhancement coefficient (ΔArt%), in the evaluation of the sorafenib response in patients with advanced hepatocellular carcinoma (HCC).MethodsPatients with sorafenib-treated advanced HCC, who underwent a multiphase contrast-enhanced CT before (T0) and after 60–70 days of starting therapy (T1), were included. The same target lesions utilised for the response evaluation according to modified Response Evaluation Criteria in Solid Tumors criteria were retrospectively used for the ΔArt% calculation ([(HUarterial phase − HUunenhanced phase) / HUunenhanced phase] × 100). ΔArt% was weighted for the lesion volume to obtain the VED. We compared VEDT0 and VEDT1 values in patients with clinical benefit (CB) or progressive disease (PD). The impact of VED, ancillary imaging findings, and blood chemistries on survival probability was evaluated.ResultsThirty-two patients (25 men, mean age 65.8 years) analysed between 2012 and 2016 were selected. At T1, 8 patients had CB and 24 had PD. VEDT0 was > 70% in 8/8 CB patients compared with 12/24 PD patients (p = 0.011). Patients with VEDT0 > 70% showed a significantly higher median survival than those with lower VEDT0 (451.5 days vs. 209.5 days, p = 0.032). Patients with VEDT0 > 70% and alpha-fetoproteinT0 ≤ 400 ng/ml had significantly longer survival than all other three combinations. In multivariate analysis, VEDT0 > 70% emerged as the only factor independently associated with survival (p = 0.037).ConclusionIn patients with advanced HCC treated with sorafenib, VED is a novel radiologic parameter obtained by contrast-enhanced CT, which could be helpful in selecting patients who are more likely to respond to sorafenib, and with a longer survival.Key Points• To achieve the best results of treatment with sorafenib in advanced HCC, a strict selection of patients is needed.• New radiologic parameters predictive of the response to sorafenib would be essential.• Volume of enhancement of disease (VED) is a novel radiologic parameter obtained by contrast-enhanced CT, which could be helpful in selecting patients who are more likely to respond to therapy, and with a longer survival.
Highlights
Hepatocellular carcinoma (HCC) is the fourth cause of cancer death in the world, with an increasing incidence, in Western countries [1]
Volume of enhancement of disease (VED) is a novel radiologic parameter obtained by contrast-enhanced computed tomography (CT), which could be helpful in selecting patients who are more likely to respond to therapy, and with a longer survival
Relevant side effects limit the use of this drug [5–8], and it would be crucial to identify specific biomarkers for therapy response prediction, currently not available, several studies looked for computed tomography (CT) or magnetic resonance (MR) parameters to anticipate the response to treatment [9–11]
Summary
Hepatocellular carcinoma (HCC) is the fourth cause of cancer death in the world, with an increasing incidence, in Western countries [1]. In the Sorafenib HCC Assessment Randomized Protocol (SHARP) and Asia Pacific trials [5, 6], induced a modest but significant increase in survival (3 months) with respect to the control group, no radiologic evidence of response to therapy was reported [7]. Relevant side effects limit the use of this drug [5–8], and it would be crucial to identify specific biomarkers for therapy response prediction, currently not available, several studies looked for computed tomography (CT) or magnetic resonance (MR) parameters to anticipate the response to treatment [9–11]. Choi et al [10] reported that changes in tumour vascularity were the most specific indicators of treatment response in patients with gastrointestinal stromal tumour on imatinib. There are only few reports in the context of HCC [13]
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