Introduction: Transarterial chemoembolization (TACE) reduces tumor growth and increases survival in patients with hepatocellular carcinoma (HCC). Drug-eluting beads (DEB) deliver slow-release chemotherapy and reduce s...Introduction: Transarterial chemoembolization (TACE) reduces tumor growth and increases survival in patients with hepatocellular carcinoma (HCC). Drug-eluting beads (DEB) deliver slow-release chemotherapy and reduce systemic toxicity during TACE. This study correlated initial tumor response according to modified RECIST (mRECIST) criteria and 1-year survival in patients with HCC treated with TACE-DEB, and identified predictors of tumor response. Methods: Fifty-two patients with HCC received TACE-DEB loaded with doxorubicin 75 mg during a 6-month period. Tumor response was evaluated 1 month after the procedure according to mRECIST criteria. Results: Most patients were cirrhotic and etiology of liver disease was hepatitis C in 26/52 (50%). Similar numbers of patients had Barcelona Clinic Liver Cancer (BCLC) A and BCLC B disease. Most patients had one nodule (66%). Complete response (CR) was achieved in 12/52 (23%), partial response in 19/52 (37%), stable disease in 4/52 (8%) and progressive disease in 17/52 (32%). Largest HCC ≤58 mm and BCLC stage A were associated with CR. The 1-year survival was 74%, with survival rates of 95% and 56% in the BCLC A and B groups, respectively. Variables reflecting tumor extension were associated with better survival. CR according to mRECIST criteria was a predictor of better 1-year survival (100% vs. 64%, P < 0.05). Conclusion: BCLC A and CR according to mRECIST criteria predict improved 1-year survival in patients with HCC treated with TACE-DEB. Further studies are needed to evaluate other predictors of survival and to determine if tumor response predicts long-term survival.展开更多
We read with great interest the multinational retrospective study by Scheiner and coworkers1 on patients with advanced hepatocellular carcinoma who achieved complete remission after first-line systemic immunotherapy.T...We read with great interest the multinational retrospective study by Scheiner and coworkers1 on patients with advanced hepatocellular carcinoma who achieved complete remission after first-line systemic immunotherapy.Their excellent study provides strong evidence in support of systemic immunotherapy for certain patients with advanced disease,as well as for using modified Response Evaluation Criteria In Solid Tumours(mRECIST)rather than stricter RECIST 1.1 guidelines when deciding how to manage these patients.展开更多
Radiation-based local-regional therapies for hepatocellular carcinoma(HCC)have gained wide acceptance due to promising rates of tumor response,survival,and safety profiles.After treatment,it is important to assess tum...Radiation-based local-regional therapies for hepatocellular carcinoma(HCC)have gained wide acceptance due to promising rates of tumor response,survival,and safety profiles.After treatment,it is important to assess tumor response to determine further management,patient prognosis,and endpoint outcomes for clinical trials.To standardize imaging interpretation and reporting of HCC response to local-regional treatment,a few imaging-based response assessment systems were developed.Two of them have emerged as the most used:the Liver Imaging Reporting and Data System(LI-RADS)Treatment Response Algorithm(LR-TRA)and the modified Response Evaluation Criteria in Solid Tumors(mRECIST).While these systems have been validated for the assessment of response to ablative locoregional therapies,assessment of response to radiation-based therapies can be challenged by persistent or evolving imaging features and is still an area of active research.Following the advances in technology and a better understanding of tumor biology that allowed for the increased application of radiation-based local-regional therapies for the treatment of HCC,research is still needed to address the limitations of current imaging criteria for assessing tumor response to these novel techniques.In this review,we describe radiation-based liver-directed treatment options,examine imaging criteria for assessing treatment response,discuss practical limitations and gaps in knowledge when applying these response criteria,and address future directions that may help to improve accuracy and outcomes when assessing response to radiation-based HCC treatment.展开更多
文摘Introduction: Transarterial chemoembolization (TACE) reduces tumor growth and increases survival in patients with hepatocellular carcinoma (HCC). Drug-eluting beads (DEB) deliver slow-release chemotherapy and reduce systemic toxicity during TACE. This study correlated initial tumor response according to modified RECIST (mRECIST) criteria and 1-year survival in patients with HCC treated with TACE-DEB, and identified predictors of tumor response. Methods: Fifty-two patients with HCC received TACE-DEB loaded with doxorubicin 75 mg during a 6-month period. Tumor response was evaluated 1 month after the procedure according to mRECIST criteria. Results: Most patients were cirrhotic and etiology of liver disease was hepatitis C in 26/52 (50%). Similar numbers of patients had Barcelona Clinic Liver Cancer (BCLC) A and BCLC B disease. Most patients had one nodule (66%). Complete response (CR) was achieved in 12/52 (23%), partial response in 19/52 (37%), stable disease in 4/52 (8%) and progressive disease in 17/52 (32%). Largest HCC ≤58 mm and BCLC stage A were associated with CR. The 1-year survival was 74%, with survival rates of 95% and 56% in the BCLC A and B groups, respectively. Variables reflecting tumor extension were associated with better survival. CR according to mRECIST criteria was a predictor of better 1-year survival (100% vs. 64%, P < 0.05). Conclusion: BCLC A and CR according to mRECIST criteria predict improved 1-year survival in patients with HCC treated with TACE-DEB. Further studies are needed to evaluate other predictors of survival and to determine if tumor response predicts long-term survival.
基金supported by the Guangxi Key Research and Development Plan(GuiKe AB24010082)the First-class Discipline Innovation-driven Talent Program of Guangxi Medical University.
文摘We read with great interest the multinational retrospective study by Scheiner and coworkers1 on patients with advanced hepatocellular carcinoma who achieved complete remission after first-line systemic immunotherapy.Their excellent study provides strong evidence in support of systemic immunotherapy for certain patients with advanced disease,as well as for using modified Response Evaluation Criteria In Solid Tumours(mRECIST)rather than stricter RECIST 1.1 guidelines when deciding how to manage these patients.
文摘Radiation-based local-regional therapies for hepatocellular carcinoma(HCC)have gained wide acceptance due to promising rates of tumor response,survival,and safety profiles.After treatment,it is important to assess tumor response to determine further management,patient prognosis,and endpoint outcomes for clinical trials.To standardize imaging interpretation and reporting of HCC response to local-regional treatment,a few imaging-based response assessment systems were developed.Two of them have emerged as the most used:the Liver Imaging Reporting and Data System(LI-RADS)Treatment Response Algorithm(LR-TRA)and the modified Response Evaluation Criteria in Solid Tumors(mRECIST).While these systems have been validated for the assessment of response to ablative locoregional therapies,assessment of response to radiation-based therapies can be challenged by persistent or evolving imaging features and is still an area of active research.Following the advances in technology and a better understanding of tumor biology that allowed for the increased application of radiation-based local-regional therapies for the treatment of HCC,research is still needed to address the limitations of current imaging criteria for assessing tumor response to these novel techniques.In this review,we describe radiation-based liver-directed treatment options,examine imaging criteria for assessing treatment response,discuss practical limitations and gaps in knowledge when applying these response criteria,and address future directions that may help to improve accuracy and outcomes when assessing response to radiation-based HCC treatment.
