Korean Journal of Radiology

The Korean Society of Radiology (대한영상의학회)
권호 표지
DOI QR코드

DOI QR Code

Evaluation of Early Response to Treatment of Hepatocellular Carcinoma with Yttrium-90 Radioembolization Using Quantitative Computed Tomography Analysis

  • Kim, Sungwon (Department of Radiology, Severance Hospital, Research Institute of Radiological Science and Center for Clinical Imaging Data Science, Yonsei University College of Medicine) ;
  • Kim, Do-Young (Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine) ;
  • An, Chansik (Department of Radiology, Severance Hospital, Research Institute of Radiological Science and Center for Clinical Imaging Data Science, Yonsei University College of Medicine) ;
  • Han, Kyunghwa (Department of Radiology, Severance Hospital, Research Institute of Radiological Science and Center for Clinical Imaging Data Science, Yonsei University College of Medicine) ;
  • Won, Jong Yun (Department of Radiology, Severance Hospital, Research Institute of Radiological Science and Center for Clinical Imaging Data Science, Yonsei University College of Medicine) ;
  • Kim, Gyoung Min (Department of Radiology, Severance Hospital, Research Institute of Radiological Science and Center for Clinical Imaging Data Science, Yonsei University College of Medicine) ;
  • Kim, Myeong-Jin (Department of Radiology, Severance Hospital, Research Institute of Radiological Science and Center for Clinical Imaging Data Science, Yonsei University College of Medicine) ;
  • Choi, Jin-Young (Department of Radiology, Severance Hospital, Research Institute of Radiological Science and Center for Clinical Imaging Data Science, Yonsei University College of Medicine)
  • Received : 2018.07.19
  • Accepted : 2018.12.10
  • Published : 2019.03.01
⟨ Previous Next ⟩

Abstract

Objective: To identify an imaging predictor for the assessment of early treatment response to yttrium-90 transarterial radioembolization (TARE) in patients with hepatocellular carcinoma (HCC), using a quantitative assessment of dynamic computed tomography (CT) images. Materials and Methods: Dynamic contrast-enhanced CT was obtained pre- and 4 weeks post-TARE in 44 patients (34 men, 10 women; mean age, 60 years) with HCC. Computer software was developed for measuring the percentage increase in the combined delayed-enhancing area and necrotic area (pD + N) and the percentage increase in the necrotic area (pNI) in the tumor-containing segments pre- and post-TARE. Local progression-free survival (PFS) was compared between patient groups using Cox regression and Kaplan-Meier analyses. Results: Post-TARE HCC with pD + N ≥ 35.5% showed significantly longer PFS than those with pD + N < 35.5% (p = 0.001). The local tumor progression hazard ratio was 17.3 (p = 0.009) for pD + N < 35.5% versus pD + N ≥ 35.5% groups. HCCs with a high pNI tended to have longer PFS, although this difference did not reach statistical significance. Conclusion: HCCs with a larger pD + N are less likely to develop local progression after TARE.

Keywords

Acknowledgement

This study was supported by a faculty research grant of Yonsei University College of Medicine for 6-2011-0219.

References

  1. Kennedy A, Coldwell D, Sangro B, Wasan H, Salem R. Integrating radioembolization ((90)Y microspheres) into current treatment options for liver tumors: introduction to the international working group report. Am J Clin Oncol 2012;35:81-90 https://doi.org/10.1097/COC.0b013e3181ec60b8
  2. Kennedy A, Nag S, Salem R, Murthy R, McEwan AJ, Nutting C, et al. Recommendations for radioembolization of hepatic malignancies using yttrium-90 microsphere brachytherapy: a consensus panel report from the radioembolization brachytherapy oncology consortium. Int J Radiat Oncol Biol Phys 2007;68:13-23 https://doi.org/10.1016/j.ijrobp.2006.11.060
  3. Sangro B, Inarrairaegui M, Bilbao JI. Radioembolization for hepatocellular carcinoma. J Hepatol 2012;56:464-473
  4. Therasse P, Arbuck SG, Eisenhauer EA, Wanders J, Kaplan RS, Rubinstein L, et al. New guidelines to evaluate the response to treatment in solid tumors. European Organization for Research and Treatment of Cancer, National Cancer Institute of the United States, National Cancer Institute of Canada. J Natl Cancer Inst 2000;92:205-216 https://doi.org/10.1093/jnci/92.3.205
  5. Lencioni R, Llovet JM. Modified RECIST (mRECIST) assessment for hepatocellular carcinoma. Semin Liver Dis 2010;30:52-60 https://doi.org/10.1055/s-0030-1247132
  6. Keppke AL, Salem R, Reddy D, Huang J, Jin J, Larson AC, et al. Imaging of hepatocellular carcinoma after treatment with yttrium-90 microspheres. AJR Am J Roentgenol 2007;188:768-775 https://doi.org/10.2214/AJR.06.0706
  7. Riaz A, Kulik L, Lewandowski RJ, Ryu RK, Giakoumis Spear G, Mulcahy MF, et al. Radiologic-pathologic correlation of hepatocellular carcinoma treated with internal radiation using yttrium-90 microspheres. Hepatology 2009;49:1185-1193 https://doi.org/10.1002/hep.22747
  8. Herfarth KK, Hof H, Bahner ML, Lohr F, Hoss A, van Kaick G, et al. Assessment of focal liver reaction by multiphasic CT after stereotactic single-dose radiotherapy of liver tumors. Int J Radiat Oncol Biol Phys 2003;57:444-451 https://doi.org/10.1016/S0360-3016(03)00586-8
  9. Maturen KE, Feng MU, Wasnik AP, Azar SF, Appelman HD, Francis IR, et al. Imaging effects of radiation therapy in the abdomen and pelvis: evaluating "innocent bystander" tissues. Radiographics 2013;33:599-619 https://doi.org/10.1148/rg.332125119
  10. Gulec SA, Mesoloras G, Stabin M. Dosimetric techniques in 90Y-microsphere therapy of liver cancer: the MIRD equations for dose calculations. J Nucl Med 2006;47:1209-1211
  11. Tsuji Y, Takahashi N, Fletcher JG, Hough DM, McMenomy BP, Lewis DM, et al. Subtraction color map of contrast-enhanced and unenhanced CT for the prediction of pancreatic necrosis in early stage of acute pancreatitis. AJR Am J Roentgenol 2014;202:W349-W356 https://doi.org/10.2214/AJR.13.10957
  12. Prionas ND, Lindfors KK, Ray S, Huang SY, Beckett LA, Monsky WL, et al. Contrast-enhanced dedicated breast CT: initial clinical experience. Radiology 2010;256:714-723 https://doi.org/10.1148/radiol.10092311
  13. Contal C, O'Quigley J. An application of changepoint methods in studying the effect of age on survival in breast cancer. Computational Statistics & Data Analysis 1999;30:253-270 https://doi.org/10.1016/S0167-9473(98)00096-6
  14. Chen BB, Hsu CY, Yu CW, Hou HA, Liu CY, Wei SY, et al. Dynamic contrast-enhanced MR imaging measurement of vertebral bone marrow perfusion may be indicator of outcome of acute myeloid leukemia patients in remission. Radiology 2011;258:821-831 https://doi.org/10.1148/radiol.10100995
  15. Shrout PE, Fleiss JL. Intraclass correlations: uses in assessing rater reliability. Psychol Bull 1979;86:420-428 https://doi.org/10.1037/0033-2909.86.2.420
  16. Busing KA, Kilian AK, Schaible T, Debus A, Weiss C, Neff KW. Reliability and validity of MR image lung volume measurement in fetuses with congenital diaphragmatic hernia and in vitro lung models. Radiology 2008;246:553-561 https://doi.org/10.1148/radiol.2462062166
  17. Wong CY, Salem R, Raman S, Gates VL, Dworkin HJ. Evaluating 90Y-glass microsphere treatment response of unresectable colorectal liver metastases by [18F]FDG PET: a comparison with CT or MRI. Eur J Nucl Med Mol Imaging 2002;29:815-820 https://doi.org/10.1007/s00259-002-0787-4
  18. Eisenhauer EA, Therasse P, Bogaerts J, Schwartz LH, Sargent D, Ford R, et al. New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1). Eur J Cancer 2009;45:228-247 https://doi.org/10.1016/j.ejca.2008.10.026
  19. Miller AB, Hoogstraten B, Staquet M, Winkler A. Reporting results of cancer treatment. Cancer 1981;47:207-214 https://doi.org/10.1002/1097-0142(19810101)47:1<207::AID-CNCR2820470134>3.0.CO;2-6
  20. Reiner CS, Morsbach F, Sah BR, Puippe G, Schaefer N, Pfammatter T, et al. Early treatment response evaluation after yttrium-90 radioembolization of liver malignancy with CT perfusion. J Vasc Interv Radiol 2014;25:747-759 https://doi.org/10.1016/j.jvir.2014.01.025
  21. Shim JH, Lee HC, Kim SO, Shin YM, Kim KM, Lim YS, et al. Which response criteria best help predict survival of patients with hepatocellular carcinoma following chemoembolization? A validation study of old and new models. Radiology 2012;262:708-718 https://doi.org/10.1148/radiol.11110282
  22. Li Z, Bonekamp S, Halappa VG, Corona-Villalobos CP, Pawlik T, Bhagat N, et al. Islet cell liver metastases: assessment of volumetric early response with functional MR imaging after transarterial chemoembolization. Radiology 2012;264:97-109 https://doi.org/10.1148/radiol.12112161
  23. Gowdra Halappa V, Corona-Villalobos CP, Bonekamp S, Li Z, Reyes D, Cosgrove D, et al. Neuroendocrine liver metastasis treated by using intraarterial therapy: volumetric functional imaging biomarkers of early tumor response and survival. Radiology 2013;266:502-513 https://doi.org/10.1148/radiol.12120495
  24. Miller FH, Keppke AL, Reddy D, Huang J, Jin J, Mulcahy MF, et al. Response of liver metastases after treatment with yttrium-90 microspheres: role of size, necrosis, and PET. AJR Am J Roentgenol 2007;188:776-783 https://doi.org/10.2214/AJR.06.0707
  25. Arslanoglu A, Chalian H, Sodagari F, Seyal AR, Tore HG, Salem R, et al. Threshold for enhancement in treated hepatocellular carcinoma on MDCT: effect on necrosis quantification. AJR Am J Roentgenol 2016;206:536-543 https://doi.org/10.2214/AJR.15.15339
  26. Blazic IM, Lilic GB, Gajic MM. Quantitative assessment of rectal cancer response to neoadjuvant combined chemotherapy and radiation therapy: comparison of three methods of positioning region of interest for ADC measurements at diffusion-weighted MR imaging. Radiology 2017;282:418-428 https://doi.org/10.1148/radiol.2016151908

Cited by

  1. Characteristics of Recent Articles Published in the Korean Journal of Radiology Based on the Citation Frequency vol.21, pp.12, 2020, https://doi.org/10.3348/kjr.2020.1322
  2. CT-based quantitative evaluation of the efficacy after radiofrequency ablation in patients with benign thyroid nodules vol.37, pp.1, 2020, https://doi.org/10.1080/02656736.2020.1779358
  3. Locoregional Therapies in the Treatment of 3- to 5-cm Hepatocellular Carcinoma: Critical Review of the Literature vol.215, pp.1, 2019, https://doi.org/10.2214/ajr.19.22098
  4. HCC advances in diagnosis and prognosis: Digital and Imaging vol.41, pp.suppl, 2019, https://doi.org/10.1111/liv.14865