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期刊名称: Hepatology
Volume:58    Issue:5        Page:1655-1666

Radiological‐pathological analysis of WHO, RECIST, EASL, mRECIST and DWI: Imaging analysis from a prospective randomized trial of Y90 ± sorafenib期刊论文

作者: Vouche Michael Kulik Laura Atassi Rohi Memon Khairuddin Hickey Ryan

页码: 1655-1666
被引频次: 46
期刊名称: Hepatology
ISSN: 0270-9139
卷期: Volume:58    Issue:5
语言: English
摘要: The aim of this study was to compare radiological and pathological changes and test the adjunct efficacy of Sorafenib to Y90 as a bridge to transplantation in hepatocellular carcinoma (HCC). 15 patients with 16 HCC lesions were randomized to Y90 without (Group A, n = 9) or with Sorafenib (Group B, n = 7). Size (WHO, RECIST), enhancement (EASL, mRECIST) and diffusion‐weighted imaging criteria (apparent diffusion coefficient, ADC) measurements were obtained at baseline, then at 1 and every 3 months after treatment until transplantation. Percentage necrosis in explanted tumors was correlated with imaging findings. 100%, 50%‐99% and <50% pathological necrosis was observed in 6 (67%), 1 (11%), and 2 (22%) tumors in Group A and 3 (42%), 2 (28%), and 2 (28%) in Group B, respectively ( P = 0.81). While ADC ( P = 0.46) did not change after treatment, WHO ( P = 0.06) and RECIST ( P = 0.08) response at 1 month failed to reach significance, but significant responses by EASL ( P < 0.01/0.03) and mRECIST ( P < 0.01/0.03) at 1 and 3 months were observed. Response was equivalent by EASL or mRECIST. No difference in response rates was observed between groups A and B at 1 and 3 months by WHO, RECIST, EASL, mRECIST or ADC measurements. Despite failing to reach significance, smaller baseline size was associated with complete pathological necrosis (CPN) (RECIST: P = 0.07; WHO: P = 0.05). However, a cut‐off size of 35 mm was predictive of CPN ( P = 0.005). CPN could not be predicted by WHO ( P = 0.25 and 0.62), RECIST (P = 0.35 and 0.54), EASL ( P = 0.49 and 0.46), mRECIST ( P = 0.49 and 0.60) or ADC ( P = 0.86 and 0.93). Conclusion : The adjunct of Sorafenib did not augment radiological or pathological response to Y90 therapy for HCC. Equivalent significant reduction in enhancement at 1 and 3 months by EASL/mRECIST was noted. Neither EASL nor mRECIST could reliably predict CPN. (H EPATOLOGY 2013;58:1655–1666)
相关主题: ADVANCED HEPATOCELLULAR-CARCINOMA, CRITERIA, CHEMOEMBOLIZATION, PROGNOSTIC-FACTORS, MICROSPHERES, RADIOEMBOLIZATION, MALIGNANCIES, RECURRENCE, DIFFUSION, GASTROENTEROLOGY & HEPATOLOGY, RADIOFREQUENCY ABLATION, Niacinamide - analogs & derivatives, Prospective Studies, World Health Organization, Humans, Middle Aged, Niacinamide - therapeutic use, Phenylurea Compounds - therapeutic use, Male, Liver Neoplasms - therapy, Microspheres, Carcinoma, Hepatocellular - pathology, Technetium Tc 99m Aggregated Albumin - administration & dosage, Female, Liver Neoplasms - pathology, Aged, Carcinoma, Hepatocellular - therapy, Diffusion Magnetic Resonance Imaging - methods, Yttrium Radioisotopes - therapeutic use, Index Medicus, pathology analysis, RECIST, imaging, hepatocellular carcinoma, mRECIST,






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