Does the Degree of Hepatocellular Carcinoma Tumor Necrosis following Transarterial Chemoembolization Impact Patient Survival?

Purpose. The association between transarterial chemoembolization- (TACE-) induced HCC tumor necrosis measured by the modified Response Evaluation Criteria In Solid Tumors (mRECIST) and patient survival is poorly defined. We hypothesize that survival will be superior in HCC patients with increased TACE-induced tumor necrosis.Materials and Methods. TACE interventions were retrospectively reviewed. Tumor response was quantified via dichotomized (responders and nonresponders) and the four defined mRECIST categories.Results. Median survival following TACE was significantly greater in responders compared to nonresponders (20.8 months versus 14.9 months,p=0.011). Survival outcomes also significantly varied among the four mRECIST categories (p=0.0003): complete, 21.4 months; partial, 20.8; stable, 16.8; and progressive, 7.73. Only progressive disease demonstrated significantly worse survival when compared to complete response. Multivariable analysis showed that progressive disease, increasing total tumor diameter, and non-Child-Pugh class A were independent predictors of post-TACE mortality.Conclusions. Both dichotomized (responders and nonresponders) and the four defined mRECIST responses to TACE in patients with HCC were predictive of survival. The main driver of the survival analysis was poor survival in the progressive disease group. Surprisingly, there was small nonsignificant survival benefit between complete, partial, and stable disease groups. These findings may inform HCC treatment decisions following first TACE.

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Initial Transarterial Chemoembolization (TACE) Using HepaSpheres 20–40 µm and Subsequent Lipiodol TACE in Patients with Hepatocellular Carcinoma > 5 cm

Life ◽

10.3390/life11040358 ◽

2021 ◽

Vol 11 (4) ◽

pp. 358

Author(s):

Su Min Cho ◽

Hee Ho Chu ◽

Jong Woo Kim ◽

Jin Hyung Kim ◽

Dong Il Gwon

Keyword(s):

Hepatocellular Carcinoma ◽

Median Time ◽

Transarterial Chemoembolization ◽

Median Overall Survival ◽

Progressive Disease ◽

Complete Response ◽

Treatment Method ◽

Local Tumor Recurrence ◽

Drug Eluting

Purpose: To investigate clinical outcomes of drug-eluting bead transarterial chemoembolization (DEB-TACE) using HepaSpheres 20–40 µm in diameter and subsequent cisplatin-based lipiodol TACE (Cis-TACE) in patients with hepatocellular carcinoma (HCC) > 5 cm. Materials and Methods: This study included 39 consecutive patients (34 men, 5 women; mean age, 63.5 years; range, 39–80 years) who underwent DEB-TACE using HepaSpheres 20–40 µm as first-line treatment for HCC > 5 cm (mean diameter, 8.2 cm; range, 5.1–13 cm) between September 2018 and August 2019. Patients with new tumors, residual tumors, or tumor growth after initial DEB-TACE underwent subsequent Cis-TACE. Results: All 39 patients underwent initial DEB-TACE successfully, with 35 (89.7%) and three (7.7%) patients experiencing minor and major complications, respectively. After initial DEB-TACE, one patient (2.6%) achieved complete response (CR), 35 (89.7%) achieved partial response (PR), and three (7.7%) experienced progressive disease (PD). During a median follow-up period of 14.4 months (range, 0.6–23 months), 23 patients underwent Cis-TACE, with 11, three, and nine achieving CR, PR, and PD, respectively. The median overall survival time was 20.9 months (95% confidence interval (CI), 18.6–23.2 months), the median time to progression was 8.8 months (95% CI, 6.5–11.1 months), and the median time to local tumor recurrence was 16 months (95% CI, 7.4–24.6 months). Conclusions: DEB-TACE using HepaSpheres 20–40 µm in diameter can be a safe and effective initial treatment method in patients with HCC > 5 cm. Subsequent Cis-TACE constitutes a good adjuvant method to enhance tumor response after initial DEB-TACE.

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Callispheres® Drug-Eluting Beads Transarterial Chemoembolization Might be an Efficient and Safety Down-Staging Therapy in Unresectable Liver Cancer Patients

10.21203/rs.3.rs-1012045/v1 ◽

2021 ◽

Author(s):

Ning Peng ◽

Linfeng Mao ◽

Yiwen Tao ◽

Kaiyin Xiao ◽

Guandou Yuan ◽

...

Keyword(s):

Liver Cancer ◽

Cancer Patients ◽

Transarterial Chemoembolization ◽

Objective Response ◽

Liver Volume ◽

Complete Response ◽

Tumor Diameter ◽

Kaplan Meier ◽

Drug Eluting Beads ◽

Drug Eluting

Abstract Purpose: The purpose was to explore the effect of drug-eluting beads transarterial chemoembolization (DEB-TACE) on down-staging in unresectable liver cancer patients.Methods: 15 unresectable liver cancer patients received DEB-TACE as a down-staging treatment before hepatectomy were enrolled. Data (including demographics, histories, clinical features at diagnosis and cycles of DEB-TACE before hepatectomy) were collected. Treatment response was evaluated at one month after DEB-TACE. Tumor diameter was evaluated by abdominal computed tomography scan. The residual liver volume was evaluated by IQQA liver system, Relapse-free survival (RFS) and overall survival (OS) were calculated by Kaplan-Meier curves.Results: After DEB-TACE, 3 (20.0%) patients achieved complete response (CR) and 10 (66.7%) patients achieved objective response rate (ORR), meanwhile, 5 (27.8%) tumors achieved CR and 12 (66.7%) tumors achieved ORR. Tumor diameter was decreased after DEB-TACE compared to before DEB-TACE (9.4±3.3 vs. 5.4±3.5 cm) (P<0.01). As to residual liver volume, it was increased after DEB-TACE compared to before DEB-TACE (1066.2 cm3 vs. 1172.5 cm3) (P=0.007). More importantly, 15 (100%) patients could receive resection after DEB-TACE, (including 14 (93.3%) patients with curative resection and 1 (6.7%) patient with palliative resection). For survival, the median RFS was 26.0 months, and the percentage of 5-year accumulating RFS was 20%. As to OS, the median OS was 54.5 months, and the percentage of 5-year accumulating OS was 40%. For safety profiles, 5 patients had postoperative pain, 7 patients had fever, and 1 had nausea and vomiting.Conclusion: DEB-TACE might be an efficient and safety down-staging treatment in unresectable liver cancer patients.

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Palliative treatment with electrochemotherapy in recurrent or metastatic vaginal cancer

International Journal of Gynecological Cancer ◽

10.1136/ijgc-2020-001471 ◽

2020 ◽

Vol 30 (7) ◽

pp. 939-946 ◽

Cited By ~ 1

Author(s):

Anna Myriam Perrone ◽

Martina Ferioli ◽

Andrea Galuppi ◽

Manuela Coe ◽

Francesca De Terlizzi ◽

...

Keyword(s):

Overall Survival ◽

Partial Response ◽

Stable Disease ◽

Palliative Treatment ◽

Progressive Disease ◽

Evaluation Criteria ◽

Complete Response ◽

Vaginal Cancer ◽

Response Evaluation ◽

Response Evaluation Criteria

ObjectiveVaginal metastases are very rare events with a poor prognosis. To improve the quality of life, local treatments should be considered. The aim of this study was to evaluate the role of electrochemotherapy as palliative treatment in vaginal cancer not amenable to standard treatments due to poor performance status, previous treatments, or advanced disease.MethodsThis is a prospective observational study on patients diagnosed with vaginal cancer and treated from January 2017 to December 2018 with palliative electrochemotherapy. We collected data on patients with vaginal cancer treated by electrochemotherapy with the aim of local control. Data regarding electrochemotherapy, hospital stay, adverse events, and patient outcomes were analyzed. Intravenous bleomycin was injected as a bolus in 2–3 min at a dose of 15 000 UI/m2 and electrical pulses started 8 min after chemotherapy. Electrochemotherapy response was defined according to the Response Evaluation Criteria in Solid Tumors.ResultsFive patients with vaginal recurrence (two squamous, two melanomas, and one leiomyosarcoma) and one with vaginal metastasis from intestinal adenocarcinoma received one treatment and two patients were re-treated. Imaging reported nodal metastasis (inguinal or pelvic) in two patients, distant metastases in two, and both node and distant metastasis in two patients, respectively. Response Evaluation Criteria in Solid Tumors showed a complete response in one patient, partial response in three patients, stable disease in one patient, and progressive disease in one patient, with an overall response rate of 67% and a clinical benefit rate (complete response, partial response, stable disease) of 83%. Two patients were re-treated and had a new response (partial response and stable disease, respectively). At last follow-up, two patients had died of the disease, two were alive with stable disease, one was alive with progressive disease, and one was alive without disease. Median post-electrochemotherapy overall survival was 12.9 months (range 1.6–26.9) and 1-year overall survival was 66.7%.ConclusionsThis preliminary experience showed a tumor response or stabilization in 83% of patients requiring palliative management for vaginal cancer. Further studies are needed to evaluate treatment outcome in larger and prospective series.

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Predictors of Complete Response in Patients with Hepatocellular Carcinoma Treated with Trans-Arterial Radioembolization

Current Oncology ◽

10.3390/curroncol28010095 ◽

2021 ◽

Vol 28 (1) ◽

pp. 965-977

Author(s):

Yuna Kim ◽

Jae Seung Lee ◽

Hye Won Lee ◽

Beom Kyung Kim ◽

Jun Yong Park ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Regression Analysis ◽

Tumor Size ◽

Cox Regression ◽

Evaluation Criteria ◽

Total Bilirubin Level ◽

Complete Response ◽

Meld Score ◽

Tumor Diameter ◽

Cox Regression Analysis

Background: Trans-arterial radioembolization (TARE) has shown promising results in treating hepatocellular carcinoma (HCC). We identified independent predictors of radiological complete response (CR) in patients with intrahepatic HCC who were treated with TARE. Methods: Patients with intrahepatic HCC treated with TARE between 2011 and 2017 were recruited. CR was defined according to the modified Response Evaluation Criteria in Solid Tumors. Cox regression analysis was used to determine independent predictors of CR. Results: The median age of study participants (83 men and 19 women) was 64.3 years. The mean survival after TARE was 55.5 months, and 21 (20.6%) patients died during the study period. Patients who achieved CR (14 patients, 13.7%) had significantly higher serum albumin level (median 4.1 vs. 3.9 g/dL), lower total bilirubin level (median 0.6 vs. 0.7 mg/dL), lower aspartate aminotransferase level (median 30.0 vs. 43.0 IU/L), lower alkaline phosphatase level (median 79.0 vs. 103.0 IU/L), lower alpha-fetoprotein level (median 12.7 vs. 39.9 ng/mL), lower des-gamma-carboxyprothrombin level (median 575.5 vs. 2772.0 mAU/mL), lower model for end-stage liver disease (MELD) score (median 6.0 vs. 7.0), and smaller maximal tumor diameter (median 6.3 vs. 9.0 cm) compared to those who did not achieve CR (all p < 0.005). Multivariate Cox regression analysis showed that lower MELD score (hazard ratio (HR) = 0.436, p = 0.015) and maximal tumor size < 9 cm (HR = 11.180, p = 0.020) were independent predictors of an increased probability of radiological CR after TARE. Conclusions: Low MELD score and small maximal tumor size were independently associated with an increased probability of CR after TARE in patients with intrahepatic HCC.

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Assessing solid tumor response with and without RECIST.

Journal of Clinical Oncology ◽

10.1200/jco.2016.34.4_suppl.504 ◽

2016 ◽

Vol 34 (4_suppl) ◽

pp. 504-504

Author(s):

Aileen Deng ◽

Benjamin E Leiby ◽

Russell J. Schilder ◽

William Kevin Kelly ◽

Sandeep Deshmukh ◽

...

Keyword(s):

Solid Tumors ◽

Progressive Disease ◽

Tumor Response ◽

Evaluation Criteria ◽

Kappa Statistic ◽

Response Assessment ◽

Complete Response ◽

Response Evaluation ◽

Academic Center ◽

Standard Report

504 Background: Response Evaluation Criteria in Solid Tumors (RECIST) has become widely accepted as gold standard for response evaluation in clinical trials. It remains underutilized in routine clinical practice. We compared tumor response assessment made with and without RECIST. Methods: This study included patients with solid tumors who underwent imaging from January 2013 to December 2014 at a single academic center. Tumor response was assessed by a radiologist using RECIST and by an oncologist (Onc) and resident (Res) without using RECIST (standard report). Tumor response was classified as progressive disease (PD), stable disease (SD), partial response (PR) and complete response (CR). Agreement in assessment between RECIST and standard report was determined by percent agreement and Kappa statistic. Results: 292 imaging studies were included. Concordance between RECIST and Onc-interpreted standard report is presented in Table 1. Overall agreement between RECIST and Onc-interpreted standard report was 56% (95% CI: 46-65%) and Kappa was 0.31 (95% CI: 0.19-0.44). Similar results were seen between RECIST and Res-interpreted standard report (Table 1). Overall agreement between RECIST and Res-interpreted report was 54% (95% CI: 44%-63%) and Kappa was 0.26 (95% CI: 0.13-0.40). Conclusions: Our study found variability in tumor response assessment between clinicians and radiologists. RECIST-classified PD was often interpreted as SD and vice versa, a distinction that affect treatment decisions. Our study highlights the need to standardize tumor response assessment. [Table: see text]

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DSM-TACE of HCC: Evaluation of Tumor Response in Patients Ineligible for Other Systemic or Loco-Regional Therapies

RöFo - Fortschritte auf dem Gebiet der Röntgenstrahlen und der bildgebenden Verfahren ◽

10.1055/a-1111-9955 ◽

2020 ◽

Vol 192 (09) ◽

pp. 862-869

Author(s):

Johannes Haubold ◽

Markus P. Reinboldt ◽

Axel Wetter ◽

Yan Li ◽

Johannes Maximilian Ludwig ◽

...

Keyword(s):

Progressive Disease ◽

Tumor Response ◽

Serum Bilirubin ◽

Evaluation Criteria ◽

Complete Response ◽

Meld Score ◽

Treatment Alternative ◽

Degradable Starch Microspheres ◽

Key Points ◽

Promising Treatment

Purpose To analyze tumor response, survival and safety in patients with non-resectable hepatocellular carcinoma (HCC) treated with transarterial hepatic chemoembolization using degradable starch microspheres (DSM-TACE) combined with doxorubicin who had no local interventional or systemic therapy alternative according to an interdisciplinary conference. Materials and Methods In this retrospective study, 28 patients (23 male, 5 female, median age 67 years) with unresectable HCC, serum bilirubin levels < 3 mg/dl and contraindications to Sorafenib, RFA, SIRT or cTACE were included. DSM-TACE was performed using Embocept® S (15 ml) and doxorubicin (50 mg/25 ml) three times every 4–6 weeks. Patients were initially staged using the Barcelona Clinic Liver Cancer System (BCLC). Basic liver function was evaluated with the MELD-score. Tumor response was assessed using the modified Response Evaluation Criteria in Solid Tumors (mRECIST). Results DSM-TACE could be technically successfully performed in all 28 patients. At control imaging after three treatments, the overall rates of complete response (CR), partial response (PR), stable disease (SD), and progressive disease (PD) were 14.3 %, 25 %, 39.3 % and 21.4 %, respectively, according to mRECIST. With regard to BCLC stages, the results were as follows (CR, PR, PD): BCLC A (n = 8): 7.1 %, 7.1 %, 10.7 %, 1.2 %; BCLC B (n = 12): 0 %, 10.7 %, 17.9 %, 14.3 %; BCLC C (n = 5): 0 %, 3.6 %, 10.7 %, 3.6 %; BCLC D (n = 3): 3.6 %, 3.6 %, 0 %, 3.6 %. According to this, DSM-TACE showed an overall good median survival of 682 days, although the patients’ survival was strictly dependent on BCLC stage. Conclusion DSM-TACE is a safe and promising treatment alternative for patients with unresectable HCC who are ineligible for other loco-regional therapies. Key Points: Citation Format

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Random Survival Forests to Predict Disease Control for Hepatocellular Carcinoma Treated With Transarterial Chemoembolization Combined With Sorafenib

Frontiers in Molecular Biosciences ◽

10.3389/fmolb.2021.618050 ◽

2021 ◽

Vol 8 ◽

Author(s):

Bin-Yan Zhong ◽

Zhi-Ping Yan ◽

Jun-Hui Sun ◽

Lei Zhang ◽

Zhong-Heng Hou ◽

...

Keyword(s):

Risk Factors ◽

Hepatocellular Carcinoma ◽

Disease Control ◽

Transarterial Chemoembolization ◽

Gini Index ◽

Evaluation Criteria ◽

Complete Response ◽

Important Variable ◽

Independent Risk Factors ◽

One Year

Objectives: To use baseline variables to predict one-year disease control for patients with hepatocellular carcinoma (HCC) treated with transarterial chemoembolization (TACE) combined with sorafenib as initial treatment by applying a machine learning approach based on the random survival forest (RF) model.Materials and Methods: The multicenter retrospective study included 496 patients with HCC treated with TACE combined with sorafenib between January 2014 and December 2018. The independent risk factors associated with one-year disease control (complete response, partial response, stable disease) were identified using the RF model, and their predictive importance was determined using the Gini index. Tumor response was assessed according to modified Response Evaluation Criteria in Solid Tumors.Results: The median overall survival was 15.5 months. A total of 186 (37.5%) patients achieved positive one-year disease control. The Barcelona Clinic Liver Cancer (BCLC) stage (Gini index: 20.0), tumor size (≤7 cm, >7 cm; Gini index: 9.0), number of lobes involved (unilobar, bilobar; Gini index: 6.4), alpha-fetoprotein level (≤200 ng/dl, >200 ng/dl; Gini index: 6.1), albumin–bilirubin grade (Gini index: 5.7), and number of lesions (1, >1; Gini index: 5.3) were identified as independent risk factors, with the BCLC stage as the most important variable. The RF model achieved a higher concordance index of 0.724 compared to that for the logistic regression model (0.709).Conclusions: The RF model is a simple and accurate approach for prediction of one-year disease control for patients with HCC treated with TACE combined with sorafenib.

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Hepatic Clostridium Perfringens Abscess Formation after Radiofrequency Ablation Therapy for Hepatocellular Carcinoma: Report of a Rare Case

Case Reports in Oncology ◽

10.1159/000517024 ◽

2021 ◽

pp. 906-911

Author(s):

Ming-Hung Wang ◽

Yuan-Hung Kuo ◽

Yi-Hao Yen ◽

Sheng-Nan Lu ◽

Jing-Houng Wang ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Radiofrequency Ablation ◽

Liver Abscess ◽

Clostridium Perfringens ◽

Transarterial Chemoembolization ◽

Complete Response ◽

Abscess Formation ◽

Ablation Therapy ◽

Pugh Class ◽

Radiofrequency Ablation Therapy

Liver abscess formation is one of the major complications following radiofrequency ablation (RFA) in patients with hepatocellular carcinoma (HCC). Clostridium perfringens is a rare but fatal (mortality rate: 70–100%) organism that could lead to severe sepsis. We presented a case where a 63-year-old woman with diabetes mellitus, hypertension, chronic hepatitis B-related cirrhosis in Child-Pugh class A and HCC with initial TNM stage II who had undergone 2 sessions of transarterial chemoembolization. RFA was performed for 4 small HCC due to poor effect of previous transarterial chemoembolization. However, all 4 treated tumors developed liver abscesses presenting with septic shock within 1 day. Aspirated abscesses and blood culture both yielded C. perfringens infection. After intensive care, optimal intravenous antibiotic, and abscesses aspiration, the patient recovered successfully. All tumors achieved complete response during the follow-up period without local recurrence. The clinical presentations and risk factors of C. perfringens-related liver abscess after RFA will be discussed in this manuscript.

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Real-life use of talimogene laherparepvec (T-VEC) in melanoma patients in centers in Austria, Switzerland and Germany

Journal for ImmunoTherapy of Cancer ◽

10.1136/jitc-2020-001701 ◽

2021 ◽

Vol 9 (2) ◽

pp. e001701

Author(s):

Julia Maria Ressler ◽

Matthias Karasek ◽

Lukas Koch ◽

Rita Silmbrod ◽

Joanna Mangana ◽

...

Keyword(s):

Chart Review ◽

Progressive Disease ◽

Overall Response Rate ◽

Real Life ◽

Retrospective Chart Review ◽

Distant Metastases ◽

Complete Response ◽

Talimogene Laherparepvec ◽

Metastatic Lesions ◽

Melanoma Patients

BackgroundTalimogene laherparepvec (T-VEC) is a licensed therapy for use in melanoma patients of stage IIIB-IVM1a with injectable, unresectable metastatic lesions in Europe. Approval was based on the Oncovex Pivotal Trial in Melanoma study, which also included patients with distant metastases and demonstrated an overall response rate (ORR) of 40.5% and a complete response (CR) rate of 16.6%.ObjectivesThe aim of this study was to assess the outcome of melanoma patients treated with T-VEC in a real-life clinical setting.MethodsBased on data from 10 melanoma centers in Austria, Switzerland and southern Germany, we conducted a retrospective chart review, which included 88 patients (44 male, 44 female) with a median age of 72 years (range 36–95 years) treated with T-VEC during the period from May 2016 to January 2020.Results88 patients fulfilled the inclusion criteria for analysis. The ORR was 63.7%. 38 patients (43.2%) showed a CR, 18 (20.5%) had a partial response, 8 (9.1%) had stable disease and 24 (27.3%) patients had a progressive disease. The median treatment period was 19 weeks (range: 1–65), an average of 11 doses (range: 1–36) were applied. 39 (45.3%) patients developed adverse events, mostly mild, grade I (64.1%).ConclusionThis real-life cohort treatment with T-VEC showed a high ORR and a large number of durable CRs.

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Imaging Assessment of Tumor Response in the Era of Immunotherapy

Diagnostics ◽

10.3390/diagnostics11061041 ◽

2021 ◽

Vol 11 (6) ◽

pp. 1041

Author(s):

Jun Nakata ◽

Kayako Isohashi ◽

Yoshihiro Oka ◽

Hiroko Nakajima ◽

Soyoko Morimoto ◽

...

Keyword(s):

Positron Emission Tomography ◽

Solid Tumors ◽

False Positive ◽

Progressive Disease ◽

Tumor Response ◽

Metabolic Response ◽

Evaluation Criteria ◽

Emission Tomography ◽

Response Criteria ◽

Positron Emission

Assessment of tumor response during treatment is one of the most important purposes of imaging. Before the appearance of immunotherapy, response evaluation criteria in solid tumors (RECIST) and positron emission tomography response criteria in solid tumors (PERCIST) were, respectively, the established morphologic and metabolic response criteria, and cessation of treatment was recommended when progressive disease was detected according to these criteria. However, various types of immunotherapy have been developed over the past 20 years, which show novel false positive findings on images, as well as distinct response patterns from conventional therapies. Antitumor immune response itself causes 18F-fluorodeoxyglucose (FDG) uptake in tumor sites, known as “flare phenomenon”, so that positron emission tomography using FDG can no longer accurately identify remaining tumors. Furthermore, tumors often initially increase, followed by stability or decrease resulting from immunotherapy, which is called “pseudoprogression”, so that progressive disease cannot be confirmed by computed tomography or magnetic resonance imaging at a single time point. As a result, neither RECIST nor PERCIST can accurately predict the response to immunotherapy, and therefore several new response criteria fixed for immunotherapy have been proposed. However, these criteria are still controversial, and also require months for response confirmation. The establishment of optimal response criteria and the development of new imaging technologies other than FDG are therefore urgently needed. In this review, we summarize the false positive images and the revision of response criteria for each immunotherapy, in order to avoid discontinuation of a truly effective immunotherapy.

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