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Transl Oncol. 2016 Oct;9(5):377-383. doi: 10.1016/j.tranon.2016.07.005. Epub 2016 Sep 12.

Renal Cell Carcinoma Metastatic to the Liver: Early Response Assessment after Intraarterial Therapy Using 3D Quantitative Tumor Enhancement Analysis.

Author information

1
Yale University School of Medicine, Yale New Haven Hospital, New Haven, CT, USA; Department of Diagnostic and Interventional Radiology, Charité Universitätsmedizin, Campus Virchow Klinikum, Berlin, Germany.
2
Medical University of Vienna, Department of Biomedical Imaging and Image-Guided Therapy, Vienna, Austria.
3
Centre Hospitalier Universitaire Vaudois and University of Lausanne, Department of Radiology, Lausanne, Switzerland.
4
The Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins Hospital, Baltimore, MD, USA.
5
Vascular and Interventional Radiology, Northwestern University Feinberg School of Medicine.
6
Yale University School of Medicine, Yale New Haven Hospital, New Haven, CT, USA; U/S Imaging and Interventions, Philips Research North America, Cambridge, MA, USA.
7
Department of Diagnostic and Interventional Radiology, Charité Universitätsmedizin, Campus Virchow Klinikum, Berlin, Germany.
8
Yale University School of Medicine, Yale New Haven Hospital, New Haven, CT, USA.
9
Yale University School of Medicine, Yale New Haven Hospital, New Haven, CT, USA. Electronic address: jeff.geschwind@yale.edu.

Abstract

PURPOSE:

Liver metastases from renal cell carcinoma (RCC) are not uncommon in the course of disease. However, data about tumor response to intraarterial therapy (IAT) are scarce. This study assessed whether changes of enhancing tumor volume using quantitative European Association for the Study of the Liver (qEASL) on magnetic resonance imaging (MRI) and computed tomography (CT) can evaluate tumor response and predict overall survival (OS) early after therapy.

METHODS AND MATERIALS:

Fourteen patients with liver metastatic RCC treated with IAT (transarterial chemoembolization: n= 9 and yttrium-90: n= 5) were retrospectively included. All patients underwent contrast-enhanced imaging (MRI: n= 10 and CT: n= 4) 3 to 4 weeks pre- and posttreatment. Response to treatment was evaluated on the arterial phase using Response Evaluation Criteria in Solid Tumors (RECIST), World Health Organization, modified RECIST, EASL, tumor volume, and qEASL. Paired t test was used to compare measurements pre- and post-IAT. Patients were stratified into responders (≥65% decrease in qEASL) and nonresponders (<65% decrease in qEASL). OS was evaluated using Kaplan-Meier curves with log-rank test and the Cox proportional hazard model.

RESULTS:

Mean qEASL (cm3) decreased from 93.5 to 67.2 cm3 (P= .004) and mean qEASL (%) from 63.1% to 35.6% (P= .001). No significant changes were observed using other response criteria. qEASL was the only significant predictor of OS when used to stratify patients into responders and nonresponders with median OS of 31.9 versus 11.1 months (hazard ratio [HR], 0.43; 95% confidence interval [CI], 0.19-0.97; P= .042) for qEASL (cm3) and 29.9 versus 10.2 months (HR, 0.09; 95% CI, 0.01-0.74; P= .025) for qEASL (%).

CONCLUSION:

Three-dimensional (3D) quantitative tumor analysis is a reliable predictor of OS when assessing treatment response after IAT in patients with RCC metastatic to the liver. qEASL outperforms conventional non-3D methods and can be used as a surrogate marker for OS early after therapy.

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