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Prediction of hepatocellular carcinoma response to 90Yttrium radioembolization using volumetric ADC histogram quantification: preliminary results.

ABSTRACT: PURPOSE:To assess the predictive value of volumetric apparent diffusion coefficient (vADC) histogram quantification obtained before and 6?weeks (6w) post-treatment for assessment of hepatocellular carcinoma (HCC) response to 90Yttrium radioembolization (RE). METHODS:In this retrospective study, 22 patients (M/F 15/7, mean age 65y) who underwent lobar RE were included between October 2013 and November 2014. All patients underwent routine liver MRI pre-treatment and 6w after RE. Two readers assessed index tumor response at 6?months after RE in consensus, using mRECIST criteria. vADC histogram parameters of index tumors at baseline and 6w, and changes in vADC (?vADC) histogram parameters were calculated. The predictive value of ADC metrics was assessed by logistic regression with stepwise parameter selection and ROC analyses. RESULTS:Twenty two HCC lesions (mean size 3.9?±?2.9?cm, range 1.2-12.3?cm) were assessed. Response at 6?months was as follows: complete response (CR, n?=?6), partial response (PR, n?=?3), stable disease (SD, n?=?12) and progression (PD, n?=?1). vADC median/mode at 6w (1.81-1.82 vs. 1.29-1.35?×?10-?3?mm2/s) and ?vADC median/max (27-44% vs. 0-10%) were significantly higher in CR/PR vs. SD/PD (p?=?0.011-0.036), while there was no significant difference at baseline. Logistic regression identified vADC median at 6w as an independent predictor of response (CR/PR) with odds ratio (OR) of 3.304 (95% CI: 1.099-9.928, p?=?0.033) and AUC of 0.77. ?vADC mean was identified as an independent predictor of CR with OR of 4.153 (95%CI: 1.229-14.031, p?=?0.022) and AUC of 0.91. CONCLUSION:Diffusion histogram parameters obtained at 6w and early changes in ADC from baseline are predictive of subsequent response of HCCs treated with RE, while pre-treatment vADC histogram parameters are not. These results need confirmation in a larger study. TRIAL REGISTRATION:This retrospective study was IRB-approved and the requirement for informed consent was waived.

SUBMITTER: Gordic S

PROVIDER: S-EPMC6541997 | biostudies-literature | 2019 May

REPOSITORIES: biostudies-literature

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Prediction of hepatocellular carcinoma response to <sup>90</sup>Yttrium radioembolization using volumetric ADC histogram quantification: preliminary results.

Gordic Sonja S Wagner Mathilde M Zanato Riccardo R Hectors Stefanie S Besa Cecilia C Kihira Shingo S Kim Edward E Taouli Bachir B

Cancer imaging : the official publication of the International Cancer Imaging Society 20190529 1

<h4>Purpose</h4>To assess the predictive value of volumetric apparent diffusion coefficient (vADC) histogram quantification obtained before and 6 weeks (6w) post-treatment for assessment of hepatocellular carcinoma (HCC) response to <sup>90</sup>Yttrium radioembolization (RE).<h4>Methods</h4>In this retrospective study, 22 patients (M/F 15/7, mean age 65y) who underwent lobar RE were included between October 2013 and November 2014. All patients underwent routine liver MRI pre-treatment and 6w af ...[more]

PMID: 31142363

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Project description:Background & aimsTransarterial radioembolization (TARE) with Yttrium-90 resin microspheres is an established treatment option for patients with hepatocellular carcinoma (HCC). However, optimising treatment application and patient selection remains challenging. We report here on the effectiveness, safety and prognostic factors, including dosing methods, associated with TARE for HCC in the prospective observational CIRT study.MethodsWe analysed 422 patients with HCC enrolled between Jan 2015 and Dec 2017, with follow-up visits every 3 months for up to 24 months after first TARE. Patient characteristics and treatment-related data were collected at baseline; adverse events and time-to-event data (overall survival [OS], progression-free survival [PFS] and hepatic PFS) were collected at every 3-month follow-up visit. We used the multivariable Cox proportional hazard model and propensity score matching to identify independent prognostic factors for effectiveness outcomes.ResultsThe median OS was 16.5 months, the median PFS was 6.1 months, and the median hepatic PFS was 6.7 months. Partition model dosimetry resulted in improved OS compared to body surface area calculations on multivariable analysis (hazard ratio 0.65; 95% CI 0.46-0.92; p = 0.0144), which was confirmed in the exact matching propensity score analysis (hazard ratio 0.56; 95% CI 0.35-0.89; p = 0.0136). Other independent prognostic factors for OS were ECOG-performance status >0 (p = 0.0018), presence of ascites (p = 0.0152), right-sided tumours (p = 0.0002), the presence of portal vein thrombosis (p = 0.0378) and main portal vein thrombosis (p = 0.0028), ALBI grade 2 (p = 0.0043) and 3 (p = 0.0014). Adverse events were recorded in 36.7% of patients, with 9.7% of patients experiencing grade 3 or higher adverse events.ConclusionsThis large prospective observational dataset shows that TARE is an effective and safe treatment in patients with HCC. Using partition model dosimetry was associated with a significant improvement in survival outcomes.Impact and implicationsTransarterial radioembolization (TARE) is a form of localised radiation therapy and is a potential treatment option for primary liver cancer. We observed how TARE was used in real-life clinical practice in various European countries and if any factors predict how well the treatment performs. We found that when a more complex but personalised method to calculate the applied radiation activity was used, the patient responded better than when a more generic method was used. Furthermore, we identified that general patient health, ascites and liver function can predict outcomes after TARE.Clinical trial numberNCT02305459.

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Dataset Information

Prediction of hepatocellular carcinoma response to 90Yttrium radioembolization using volumetric ADC histogram quantification: preliminary results.

Publications

Prediction of hepatocellular carcinoma response to <sup>90</sup>Yttrium radioembolization using volumetric ADC histogram quantification: preliminary results.

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