Response assessment methods for patients with hepatic metastasis from rare tumor primaries undergoing transarterial chemoembolization

• Published in: Clinical imaging Vol. 89; pp. 112 - 119
• Main Authors: Adam, Lucas C., Savic, Lynn J., Chapiro, Julius, Letzen, Brian, Lin, MingDe, Georgiades, Christos, Hong, Kelvin K., Nezami, Nariman
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.09.2022; Elsevier Limited
• Subjects: Biopsy; Cancer therapies; Carcinoma, Hepatocellular - pathology; Chemoembolization; Chemoembolization, Therapeutic - methods; Complications; Computed tomography; Deposition; Diameters; Endometrial cancer; Ethiodized Oil; Humans; Lipiodol deposition; Liver; Liver Neoplasms - diagnostic imaging; Liver Neoplasms - pathology; Liver Neoplasms - therapy; Magnetic resonance imaging; Medical imaging; Metastases; Metastasis; Metastatic hepatic lesions; Ovaries; Patients; Prostate; qEASL; Response criteria; Retrospective Studies; Software; Solid tumors; Transarterial chemoembolization; Treatment Outcome; Tumors; Volumetric analysis; France; Germany; Metastatic hepatic lesions; Lipiodol deposition; Transarterial chemoembolization; qEASL; Response criteria
• ISSN: 0899-7071; 1873-4499
• DOI: 10.1016/j.clinimag.2022.06.013

This study assessed the response to conventional transarterial chemoembolization (cTACE) in patients with liver metastases from rare tumor primaries using one-dimensional (1D) and three-dimensional (3D) quantitative response assessment methods, and investigate the relationship of lipiodol deposition in predicting response. This retrospective bicentric study included 16 patients with hepatic metastases from rare tumors treated with cTACE between 2002 and 2017. Multi-phasic MR imaging obtained before and after cTACE was used for assessment of response. Response evaluation criteria in solid tumors (RECIST) and modified-RECIST (mRECIST) were utilized for 1D response assessment, and volumetric RECIST (vRECIST) and enhancement-based quantitative European Association for Study of the Liver EASL (qEASL) were used for 3D response assessment. The same day post-cTACE CT scan was analyzed to quantify intratumoral lipiodol deposition (%). The mean and standard deviation (SD) of diameter of treated lesions per targeted area was 7.5 ± 5.4 cm, and the mean and SD of number of metastases in each targeted area was 4.2 ± 4.6. cTACE was technically successful in all patients, without major complications. While RECIST and vRECIST methods did not allocate patients with partial response, mRECIST and qEASL identified patients with partial response. Intratumoral lipiodol deposition significantly predicted treatment response according qEASL (R2 = 0.470, p < 0.01), while no association was shown between lipiodol deposition within treated tumor area and RECIST or mRECIST (p > 0.212). 3D quantitative volumetric response analysis can be used for stratification of response to cTACE in patients with hepatic metastases originating from rare primary tumors. Lipiodol deposition could potentially be used as an early surrogate to predict response to cTACE. [Display omitted] •cTACE was technically successful in all patients with liver metastases from rare tumor origins, without major complications.•Intratumoral lipiodol deposition on post-cTACE CT predicted treatment response according to qEASL (R2 = 0.470, p < 0.01)•There was no association between intratumoral lipiodol deposition and RECIST or mRECIST in patients (p > 0.212).