ABSTRACT
Aim: This study aims to assess the outcome of transarterial chemoembolization (TACE) and sorafenib in the treatment ofadvanced stage of hepatocellular carcinoma (HCC).Materials and Methods: The longitudinal analysis of the data was approved by the institutional ethical committee and properinformed consent was taken from the study population. Advanced-stage HCC was defined according to Barcelona clinic livercancer staging classification (Child-Pugh Class A or B, Eastern Cooperative Oncology Group performance status of 1–2, and/or macrovascular invasion or extrahepatic metastasis). A total number of 22 patients of advanced-stage HCC were treatedwith TACE (n = 11) and sorafenib (n = 11) between the period of July 2017 and September 2018. Modified response evaluationcriteria in solid tumors (mRECIST) were used to evaluate the outcome in all patients.Results: There was no significant difference between the tumor characteristics (size and number of the lesion, portal veininvasion, and metastases) in the study groups. Both sorafenib and TACE would result in stable response in majority of thepatients using mRECIST with no significant difference in the overall survival period between these two treatment modalities.Conclusion: TACE is similar to sorafenib in terms of outcome in advanced-stage HCC using mRECIST. Thus, TACE can be consideredas an effective treatment modality in advanced-stage HCC; however, further studies are required to firmly establish this clause.
ABSTRACT
Objective To investigate the consistency of mRECIST criterion and RECIST criterion in evaluating the curative effect of transcatheter arterial chemoembolization (TACE) combined with radiofrequency ablation (RFA) for primary hepatocellular carcinoma (PHC) which condition exceeds Milan liver transplantation standard in order to determine which criterion can evaluate the curative effect better.Methods A total of 78 PHC patients,whose lesion's extent exceeded Milan standard and who had received TACE combined with RFA therapy,were included in this study.The curative effect was separately evaluated by mRECIST criterion and RECIST criterion.KAPPA coefficient was calculated to determine the consistency of the evaluation results by the two criteria.By using Kaplan-Mier method,the median survival time (MST) of patients achieving different remission degree was calculated.Log-rank test was used to draw survival curve.The MST and the survival curve of patients with different remission degree were statistically compared between the two criteria.Results By using SPSS19.0 software,the KAPPA coefficient of the evaluation results of the two criteria was 0.243 (x2=5.250,P＜0.01).The MST of patients,which was calculated by Kaplan-Mier method,had multiple overlapping parts with SD and PR curves that were drawn by log-rank test based on RECIST criterion,the difference between the two was not statistically significant (P＞0.05).When mRECIST criterion was based on,the survival curve of patients with different remission degree was relatively balanced and showed no overlapping parts,the difference between the two was statistically significant (P＜0.01).Conclusion (1) The mRECIST criterion is not suitable for the evaluation of the curative effect of PHC patients whose lesion's extent exceeds Milan standard,and mRECIST criterion can not apply to make evaluation of the curative effect for PHC when the lesion's border is unclear and its enhancement is not obvious.(2) mRECIST criterion can more accurately evaluate the curative effect of TACE combined with PRA in treating PHC which extent exceeds Milan liver transplantation standard.
ABSTRACT
Hepatocellular carcinomas are highly vascular tumors, showing progressive hypervascularity by the process of neoangiogenesis. Tumor angiogenesis is critical for tumor growth as well as metastatic spread therefore, imaging and quantification of tumor neo-angiogenesis is essential for monitoring response to targeted therapies and predicting disease progression. Sorafenib is a molecular targeting agent used for treating hypervascular tumors. This drug is now the standard of care in treatment of patients with advanced hepatocellular carcinoma. Due to its anti-angiogenic and anti-proliferative actions, imaging findings following treatment with Sorafenib are quite distinct when compared to conventional chemotherapeutic agents. Liver MRI is a widely adopted imaging modality for assessing treatment response in hepatocellular carcinoma and imaging features may reflect pathophysiological changes within the tumor. In this mini-review, we will discuss MRI findings after Sorafenib treatment in hepatocellular carcinoma and review the feasibility of MRI as an early biomarker in differentiating responders from non-responders after treatment with molecular targeting agents.