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Hepatic abscess after transarterial chemoembolization (TACE): a complication with possible therapeutic effect via serendipitous immunotherapy
S126
’
Tuesday
Scientific Session
4:03 PM
Abstract No. 290
Hepatic abscess after transarterial chemoembolization (TACE): a complication with possible therapeutic effect via serendipitous immunotherapy
TUESDAY: Scientific Sessions
M. AbdelRazek, N. Kothary, J. Louie, D. Sze; Stanford University Medical Center, Stanford, CA Purpose: To study the clinical outcomes of abscess formation after transarterial chemoembolization (TACE). Materials: Of 1514 patients undergoing TACE from 2003 through 2015, 16 patients (1.1%) (11 M/5 F; age range 41-81 years) with hepatocellular carcinoma (n ¼ 12), neuroendocrine metastases (n ¼ 4) or other cell types (n ¼ 1) developed hepatic abscesses after undergoing treatment. Radiographic response (modified Response Evaluation Criteria in Solid Tumors, mRECIST), pre and post-procedural biochemical and hematological profiles, and clinical outcomes including hepatic progression-free survival (HPFS) and overall survival (OS) were evaluated. Results: Liver abscess developed after 17 of 62 TACE treatment sessions (27.4%) in these 16 patients. 11 patients had undergone previous bilio-enteric surgery, and 12 required percutaneous abscess drainage. Mean largest tumor diameter was 6.3 ⫾ 3.0 cm. Radiographic response by mRECIST at 1 month follow-up was CR (n ¼ 6, 35%), PR (n ¼ 7, 41%), SD (n ¼ 1, 6%) and PD (n ¼ 3, 18%), which compares favorably with our previously published overall results (16% CR, NS). A significant relationship was discovered between the degree of elevated leucocytosis and positive tumor response, with the disease control response group (CR þ PR þ SD) showing a mean leucocyte count of 18.9 k/ul compared with the non-response group (PD) showing a count of 11.7 k/ul (p ¼ 0.037). The HPFS and OS were 15 and 28 months, which also compare favorably with our previously published statistics (OS 23 months, NS). Conclusions: Although hepatic abscess formation after TACE is a dreaded complication associated with considerable morbidity, the infection may play a paradoxical role in disease control, either by direct tumor cell destruction or by an immuno-adjuvant mechanism. Future development of TACE technology could incorporate oncolytic pathogens and immune system stimulants.
4:12 PM
Abstract No. 291
Baseline apparent diffusion coefficient as a predictor of response to liver-directed therapies in hepatocellular carcinoma 1
2
2
3
A. Niekamp , R. Abel-Wahab , J. Kuban , B. Odisio , A. Mahvash2, M. Hassan2, A. Kaseb4, R. Sheth2; 1The University of Texas at Houston, Houston, TX; 2MD Anderson Cancer Center, Houston, TX; 3UT MD Anderson Cancer Center, Houston, TX; 4MD Anderson Cancer Center, Houston, TX Purpose: Baseline apparent diffusion coefficient (ADC) has been proposed as a predictor for early treatment response following doxorubicin drug-eluting bead (DEB)
’
JVIR
chemoembolization for hepatocellular carcinoma (HCC) (1). ADC is a non-invasive surrogate for interstitial fluid pressure (2), a barrier to therapy in DEB chemoembolization (3). We hypothesized that baseline ADC would predict response to DEB chemoembolization but not radioembolization or thermal ablation given their differing methods of cell death. Materials: A single-institution , IRB-approved retrospective review of patients with HCC who underwent DEB chemoembolization, radioembolization, or thermal ablation between 2012 to 2014 was performed. Patients with MR imaging with quantitative ADC measurements within 60 days of the procedure were included. Outcomes at 6 months post-procedure were determined using mRECIST criteria. Logistic regression analysis was performed to evaluate ADC as an independent predictor for objective response. Results: A total of 84 patients were included in the study, of whom 42 underwent DEB chemoembolization, 27 underwent radioembolization, and 15 underwent thermal ablation. There was no significant difference in ADC value between patients who underwent DEB chemoembolization and radioembolization (1.2 x 10-3 mm2/s vs 1.0 x 10-3 mm2/s, P ¼ 0.08), though patients undergoing radioembolization had larger tumors (median 6.3cm vs 3.5cm, P o 0.001). ADC was found to correlate with objective response independent of procedure type and tumor size (P ¼ 0.04). For patients undergoing DEB chemoembolization, ADC correlated with objective response (P ¼ 0.04) independent of tumor size; however, there was no significant correlation between ADC and outcomes in patients who underwent radioembolization and thermal ablation. Conclusions: In agreement with previous studies, baseline ADC is an imaging predictor for response to DEB chemoembolization. Moreover, as a marker of interstitial fluid pressure, ADC may help determine which tumors will be better treated with modalities that do not rely on drug diffusion such as radioembolization and thermal ablation.
4:21 PM
Abstract No. 292
High hepatopulmonary shunting improves survival in patients undergoing intrahepatic arterial chemotherapy infusion for treatment of liver metastases D. Hu1, R. Abel-Wahab2, J. Kuban2, B. Odisio3, A. Mahvash2, M. Hassan2, A. Kaseb4, R. Sheth2; 1Baylor College of Medicine, Houston, TX; 2MD Anderson Cancer Center, Houston, TX; 3UT MD Anderson Cancer Center, Houston, TX; 4MD Anderson Cancer Center, houston, TX Purpose: High lung shunt fraction (LSF) 4 10% has been shown to be a prognostic factor for decreased survival in patients undergoing radioembolization (1). The existing data are limited by the fact that high LSFs affect the dose of radioembolic administered, thus confounding the survival results. At our institution, LSFs are measured in patients prior to intrahepatic arterial chemotherapy (IAC) infusions. The purpose of this study was to determine if high LSF predicts survival in patients receiving IAC. Materials: A single-institution , IRB-approved retrospective review of patients between 2010 to 2014 undergoing IAC infusion (n ¼ 45) for a variety of tumor types (colorectal
’
Tuesday
Scientific Session
4:03 PM
Abstract No. 290
Hepatic abscess after transarterial chemoembolization (TACE): a complication with possible therapeutic effect via serendipitous immunotherapy
TUESDAY: Scientific Sessions
M. AbdelRazek, N. Kothary, J. Louie, D. Sze; Stanford University Medical Center, Stanford, CA Purpose: To study the clinical outcomes of abscess formation after transarterial chemoembolization (TACE). Materials: Of 1514 patients undergoing TACE from 2003 through 2015, 16 patients (1.1%) (11 M/5 F; age range 41-81 years) with hepatocellular carcinoma (n ¼ 12), neuroendocrine metastases (n ¼ 4) or other cell types (n ¼ 1) developed hepatic abscesses after undergoing treatment. Radiographic response (modified Response Evaluation Criteria in Solid Tumors, mRECIST), pre and post-procedural biochemical and hematological profiles, and clinical outcomes including hepatic progression-free survival (HPFS) and overall survival (OS) were evaluated. Results: Liver abscess developed after 17 of 62 TACE treatment sessions (27.4%) in these 16 patients. 11 patients had undergone previous bilio-enteric surgery, and 12 required percutaneous abscess drainage. Mean largest tumor diameter was 6.3 ⫾ 3.0 cm. Radiographic response by mRECIST at 1 month follow-up was CR (n ¼ 6, 35%), PR (n ¼ 7, 41%), SD (n ¼ 1, 6%) and PD (n ¼ 3, 18%), which compares favorably with our previously published overall results (16% CR, NS). A significant relationship was discovered between the degree of elevated leucocytosis and positive tumor response, with the disease control response group (CR þ PR þ SD) showing a mean leucocyte count of 18.9 k/ul compared with the non-response group (PD) showing a count of 11.7 k/ul (p ¼ 0.037). The HPFS and OS were 15 and 28 months, which also compare favorably with our previously published statistics (OS 23 months, NS). Conclusions: Although hepatic abscess formation after TACE is a dreaded complication associated with considerable morbidity, the infection may play a paradoxical role in disease control, either by direct tumor cell destruction or by an immuno-adjuvant mechanism. Future development of TACE technology could incorporate oncolytic pathogens and immune system stimulants.
4:12 PM
Abstract No. 291
Baseline apparent diffusion coefficient as a predictor of response to liver-directed therapies in hepatocellular carcinoma 1
2
2
3
A. Niekamp , R. Abel-Wahab , J. Kuban , B. Odisio , A. Mahvash2, M. Hassan2, A. Kaseb4, R. Sheth2; 1The University of Texas at Houston, Houston, TX; 2MD Anderson Cancer Center, Houston, TX; 3UT MD Anderson Cancer Center, Houston, TX; 4MD Anderson Cancer Center, Houston, TX Purpose: Baseline apparent diffusion coefficient (ADC) has been proposed as a predictor for early treatment response following doxorubicin drug-eluting bead (DEB)
’
JVIR
chemoembolization for hepatocellular carcinoma (HCC) (1). ADC is a non-invasive surrogate for interstitial fluid pressure (2), a barrier to therapy in DEB chemoembolization (3). We hypothesized that baseline ADC would predict response to DEB chemoembolization but not radioembolization or thermal ablation given their differing methods of cell death. Materials: A single-institution , IRB-approved retrospective review of patients with HCC who underwent DEB chemoembolization, radioembolization, or thermal ablation between 2012 to 2014 was performed. Patients with MR imaging with quantitative ADC measurements within 60 days of the procedure were included. Outcomes at 6 months post-procedure were determined using mRECIST criteria. Logistic regression analysis was performed to evaluate ADC as an independent predictor for objective response. Results: A total of 84 patients were included in the study, of whom 42 underwent DEB chemoembolization, 27 underwent radioembolization, and 15 underwent thermal ablation. There was no significant difference in ADC value between patients who underwent DEB chemoembolization and radioembolization (1.2 x 10-3 mm2/s vs 1.0 x 10-3 mm2/s, P ¼ 0.08), though patients undergoing radioembolization had larger tumors (median 6.3cm vs 3.5cm, P o 0.001). ADC was found to correlate with objective response independent of procedure type and tumor size (P ¼ 0.04). For patients undergoing DEB chemoembolization, ADC correlated with objective response (P ¼ 0.04) independent of tumor size; however, there was no significant correlation between ADC and outcomes in patients who underwent radioembolization and thermal ablation. Conclusions: In agreement with previous studies, baseline ADC is an imaging predictor for response to DEB chemoembolization. Moreover, as a marker of interstitial fluid pressure, ADC may help determine which tumors will be better treated with modalities that do not rely on drug diffusion such as radioembolization and thermal ablation.
4:21 PM
Abstract No. 292
High hepatopulmonary shunting improves survival in patients undergoing intrahepatic arterial chemotherapy infusion for treatment of liver metastases D. Hu1, R. Abel-Wahab2, J. Kuban2, B. Odisio3, A. Mahvash2, M. Hassan2, A. Kaseb4, R. Sheth2; 1Baylor College of Medicine, Houston, TX; 2MD Anderson Cancer Center, Houston, TX; 3UT MD Anderson Cancer Center, Houston, TX; 4MD Anderson Cancer Center, houston, TX Purpose: High lung shunt fraction (LSF) 4 10% has been shown to be a prognostic factor for decreased survival in patients undergoing radioembolization (1). The existing data are limited by the fact that high LSFs affect the dose of radioembolic administered, thus confounding the survival results. At our institution, LSFs are measured in patients prior to intrahepatic arterial chemotherapy (IAC) infusions. The purpose of this study was to determine if high LSF predicts survival in patients receiving IAC. Materials: A single-institution , IRB-approved retrospective review of patients between 2010 to 2014 undergoing IAC infusion (n ¼ 45) for a variety of tumor types (colorectal