Lipiodol retention pattern after TACE for HCC is a predictor for local progression in lesions with complete response

Marco Dioguardi Burgio,Magaly Zappa,Valérie Vilgrain,Maxime Ronot,Riccardo Sartoris,Annie Sibert,Claudia Libotean

doi:10.1186/s40644-019-0260-2

Abstract

BackgroundTo evaluate the predictive value of the lipiodol retention pattern for local progression of HCC with a complete response (CR) on CT according to mRECIST criteria after a first session of conventional chemoembolization (cTACE).MethodsFrom January 2014 to May 2016 all consecutive patients undergoing a first cTACE session for HCC were identified. Inclusion criteria were the presence of ≤3 HCCs and available pre- and post-cTACE CT. Tumor response was classified according to mRECIST criteria. The analysis focused on tumors with a CR. The lipiodol retention pattern in these tumors was classified as complete (C-Lip, covering the entire tumor volume), or incomplete (I-Lip). Local progression was defined as the reappearance of areas of enhancement on arterial-phase images with washout on portal/delayed phase images within 2 cm from treated tumors on follow-up CT.ResultsThe final population included 50 patients with 82 HCCs. A total of 46 (56%) HCCs were classified with a CR, including 16 (35%) with I-Lip, and 30 (65%) with C-Lip. After a median follow-up of 14 months (3.2–35.9 months), 15/16 (94%) and 10/30 (30%) of I-Lip and C-Lip HCCs showed local progression on CT, respectively (p < 0.001), with no significant difference in the time to progression (mean 11.1 ± 2 vs. 13.4 ± 3 months for I-Lip and C-Lip, respectively p = 0.51).ConclusionsHCCs with incomplete lipiodol retention after a first cTACE session have a high risk of local progression even when there is a CR according to mRECIST, and should be considered to be incompletely treated.

Highlights

To evaluate the predictive value of the lipiodol retention pattern for local progression of hepatocellular carcinoma (HCC) with a complete response (CR) on computed tomography (CT) according to mRECIST criteria after a first session of conventional chemoembolization
After treatment, a tumor with no hypervascular component is Dioguardi Burgio et al Cancer Imaging (2019) 19:75 considered to be necrotic and according to mRECIST criteria, a complete response (CR) is achieved when all hypervascular components have disappeared. mRECIST has been shown to be reproducible for the differentiation of a response and non-response after Transarterial chemoembolization (TACE) [10], and to improve identification of complete or almost complete tumor necrosis [11]
Inclusion criteria were (i) the presence of at least one HCC according to EASL clinical practice guidelines [1], (ii) contrast-enhanced computed tomography (CT) before the conventional chemoembolization (cTACE) procedure, and during follow-up and (iii) the presence of up to three HCCs to better identify local progression of individual tumors

Summary

Introduction

To evaluate the predictive value of the lipiodol retention pattern for local progression of HCC with a complete response (CR) on CT according to mRECIST criteria after a first session of conventional chemoembolization (cTACE). TACE is the most common bridge therapy in patients waiting for liver transplantation, because it has been shown to improve patient drop out [4, 5]. RECIST 1.1 criteria are not accurate in HCC after locoregional therapy such as TACE, as they have been shown to largely underestimate tumor necrosis [8]. For this reason, a modified version (mRECIST) has been proposed by the American Association for the Study of Liver Diseases [9], which takes into account the single axial measurement of the hypervascular portion of the tumor considered to represent viable tissue. After treatment, a tumor with no hypervascular component is Dioguardi Burgio et al Cancer Imaging (2019) 19:75 considered to be necrotic and according to mRECIST criteria, a complete response (CR) is achieved when all hypervascular components have disappeared. mRECIST has been shown to be reproducible for the differentiation of a response and non-response after TACE [10], and to improve identification of complete or almost complete tumor necrosis [11]

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