Tumor contrast retention immediately following embolization predicts subsequent radiologic tumor necrosis after bland and drug eluting bead embolotherapy of HCC

Abstract

Purpose To determine the factors that are independent predictors of subsequent radiologic necrosis following embolotherapy of HCC. Materials and Methods From Dec 2007 and Mar 2012, 101 pts with Okuda stage I or II HCC not amenable to resection, with adequate liver function were randomized to HAE with Bead Block (BB, n=51) or TACE with LC Bead (n=50) loaded with 150 mg of doxorubicin. 72 patients (BB, n=35; LC, n=37) underwent pre-procedure triphasic CT, immediate post-procedure non-contrast CT 15 min after embolization, and followup triphasic CT 3 weeks post treatment. 135 index tumors were assessed. TCR was determined based on change in Hounsfield units (HU) of the index tumors between pre-procedure and immediate post-procedure scans (Grade 0, 120 HU change). Radiologic tumor necrosis was measured on the 3 week followup CT by calculating the ratio of necrotic and overall tumor volumes using semi-automated volumetric analysis software developed at our institution. Univariate and multivariate regression was performed to determine whether demographic factors, tumor characteristics, embolic agent, and TCR were predictors of the degree of necrosis. Results Demographics and initial tumor characteristics between the BB and LC groups were comparable: median age 68 vs 55 (p Conclusion Tumor contrast retention, but not embolic agent, is an independent predictor of radiologic necrosis following embolotherapy for HCC.