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Neoadjuvant locoregional therapy and long-term outcomes of patients with hepatocellular carcinoma listed for orthotopic liver transplantation
JVIR
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Scientific Session
Sunday
Huazhong University of Science and Technology, Durham, NC
3:09 PM
Abstract No. 33
Neoadjuvant locoregional therapy and long-term outcomes of patients with hepatocellular carcinoma listed for orthotopic liver transplantation P. Habibollahi, S. Hunt, T. Gade, B. Shin, M. Dagli, J. Mondschein, D. Sudheendra, S. Stavropoulos, M. Soulen, G. Nadolski; Hospital of the University of Pennsylvania, Philadelphia, PA Purpose: Locoregional therapy (LRT) is recommended for patients with hepatocellular carcinoma (HCC) listed for orthotopic liver transplantation (OLT) with expected wait times greater than 6 months. A retrospective single center study was performed to evaluate the effect of LRT on the outcomes of patients with HCC listed for OLT.
S17
Material: Institutional transplant database was reviewed to identify the patients listed for OLT with HCC (Mar1998-Dec2010). Patient and tumor characteristics including number and size of tumors, severity of liver disease, type of LRT, and waitlist time were recorded with a follow up period of 6.5 years from diagnosis. Kaplan-Meier technique and Cox proportional hazard ratios were used for survival analysis and identification of survival predictors. Results: 359 patients were initially included. 72 patients were delisted (delisted group) and 287 underwent orthotopic liver transplantation (OLT) (OLT group). 155 and 45 patients from the OLT and delisted groups underwent locoregional therapy (LRT), respectively. Patients who went on to OLT received the following types of LRT: transcatheter arterial chemoembolization (TACE) 150, radiofrequency ablation (RFA) 27, TACE and RFA 18, radioembolization 3, cryoablation 1, and percutaneous acetic acid injection 1. Patients who were delisted received the following types of LRT: TACE 36, TACE and RFA 8 and RFA 1. Median wait time and sum of largest tumor diameter was markedly higher for LRT patients (132 days vs. 54 days and 37.4 ± 16.5 mm vs 32.1 ± 16.0 mm, po0.05). LRT was associated with significantly better survival among delisted patients at the end of follow up (1249.6 ± 137.4 vs. 742.1 ± 155.4 days, p ¼ 0.028). In the OLT group, survival was similar between LRT and no LRT group but survival was significantly better in patients with largest tumor diameter ≥30 mm (1949.4 ± 95.1 vs. 1694.8 ± 135.5, p ¼ 0.02). Conclusions: Despite longer OLT wait list times and larger tumors, patients with HCC treated with LRT prior to transplant had similar overall survival compared to patients not treated with LRT. Further subgroup analysis suggests patients with tumor diameter greater than 3 cm would have improved survival with pre-transplant LRT.
3:18 PM
Abstract No. 34
Identifying enhancement-based staging markers on baseline MR imaging in patients with colorectal cancer liver metastases undergoing loco-regional tumor therapy M. Ghani1, J. Chapiro1, B. Letzen1, V. Thakur1, M. Lin1, X. Papademetris1, R. Schernthaner2, S. Huber1, J. Geschwind1; 1Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA; 2Department of Radiology, Medical University of Vienna, Vienna, Austria Purpose: To determine the predictive value of tumor enhancement on baseline imaging in patients with liver-dominant colorectal cancer metastases undergoing loco-regional tumor therapies. Materials: This retrospective study included 86 patients with colorectal cancer (CRC) liver metastases, treated with TACE (n ¼ 42) or Y90 radioembolization (n ¼ 46) between 2001 and 2014. All patients received contrast-enhanced MRI prior to therapy. Semiautomated whole-liver and tumor segmentations of three dominant lesions were performed on baseline MRI to calculate total tumor and liver volumes (TTV and TLV). Quantitative 3D analysis was performed to calculate enhancing tumor volume (ETV), enhancing tumor burden (ETB, calculated as ETV/TLV), and enhancing liver volume (ELV). 1 A 65 cm3 cutoff was chosen for TTV and ETV, and 4% was chosen as the cutoff for ETB.2 For ELV, absolute and
SUNDAY: Scientific Sessions
Purpose: Recent studies of liver imaging reporting and data system (LI-RADS) category 4 “probably HCC” lesions are conflicting. While more than 90% of LI-RADS 4 lesions may be HCCs, only 1/3 progress and 1/3 downgrade without treatment. It is unclear whether LI-RADS 4 lesions should be treated with locoregional therapy, particularly in the setting of coexisting LI-RADS 5 lesions. This study compared the outcomes of treated versus untreated LI-RADS 4 lesions in patients undergoing transcatheter arterial embolization (TAE). Materials: From 2005 to 2014, 193 patients underwent bland TAE for presumed HCC. Preprocedure multiphase contrast enhanced CT and MR scans were retrospectively reviewed, and the dominant lesion(s) prompting TAE and any other lesions were classified according to the latest LI-RADS criteria (v2014). TAE procedures were reviewed to determine whether LI-RADS 4 lesions were within or outside the embolized liver volume during treatment of the dominant lesion(s). Time to progression to LI-RADS 5 on follow up imaging was estimated for treated versus untreated lesions using the Kaplan-Meier method and compared using the log rank test. Results: There were 72 LI-RADS 4 lesions in 58 patients undergoing TAE. Follow up imaging was available for 56 lesions in 45 patients (34 male, mean age 61). The dominant lesion(s) prompting TAE met LI-RADS 5 criteria in 84% of patients. LI-RADS 4 lesions were a mean of 1.5 cm in size, and 84%, 73%, 20%, and 9% demonstrated arterial hyperenhancement, washout, a capsule, and growth, respectively. Forty LI-RADS 4 lesions were within the embolized liver volume for treatment of the dominant lesion(s) and were considered treated, and 16 lesions were outside and considered untreated. The 6 and 12 month rates of progression from LI-RADS 4 to LI-RADS 5 were 3% and 19% for treated lesions versus 42% and 73% for untreated lesions (po0.001). Conclusions: Following TAE for a dominant lesion elsewhere in the liver, untreated LI-RADS 4 lesions showed a significantly higher rate of progression compared with treated LI-RADS 4 lesions. These results suggest that in the context of a coexisting LI-RADS 5 lesion, consideration should be given to LI-RADS 4 directed locoregional therapy.
’
’
Scientific Session
Sunday
Huazhong University of Science and Technology, Durham, NC
3:09 PM
Abstract No. 33
Neoadjuvant locoregional therapy and long-term outcomes of patients with hepatocellular carcinoma listed for orthotopic liver transplantation P. Habibollahi, S. Hunt, T. Gade, B. Shin, M. Dagli, J. Mondschein, D. Sudheendra, S. Stavropoulos, M. Soulen, G. Nadolski; Hospital of the University of Pennsylvania, Philadelphia, PA Purpose: Locoregional therapy (LRT) is recommended for patients with hepatocellular carcinoma (HCC) listed for orthotopic liver transplantation (OLT) with expected wait times greater than 6 months. A retrospective single center study was performed to evaluate the effect of LRT on the outcomes of patients with HCC listed for OLT.
S17
Material: Institutional transplant database was reviewed to identify the patients listed for OLT with HCC (Mar1998-Dec2010). Patient and tumor characteristics including number and size of tumors, severity of liver disease, type of LRT, and waitlist time were recorded with a follow up period of 6.5 years from diagnosis. Kaplan-Meier technique and Cox proportional hazard ratios were used for survival analysis and identification of survival predictors. Results: 359 patients were initially included. 72 patients were delisted (delisted group) and 287 underwent orthotopic liver transplantation (OLT) (OLT group). 155 and 45 patients from the OLT and delisted groups underwent locoregional therapy (LRT), respectively. Patients who went on to OLT received the following types of LRT: transcatheter arterial chemoembolization (TACE) 150, radiofrequency ablation (RFA) 27, TACE and RFA 18, radioembolization 3, cryoablation 1, and percutaneous acetic acid injection 1. Patients who were delisted received the following types of LRT: TACE 36, TACE and RFA 8 and RFA 1. Median wait time and sum of largest tumor diameter was markedly higher for LRT patients (132 days vs. 54 days and 37.4 ± 16.5 mm vs 32.1 ± 16.0 mm, po0.05). LRT was associated with significantly better survival among delisted patients at the end of follow up (1249.6 ± 137.4 vs. 742.1 ± 155.4 days, p ¼ 0.028). In the OLT group, survival was similar between LRT and no LRT group but survival was significantly better in patients with largest tumor diameter ≥30 mm (1949.4 ± 95.1 vs. 1694.8 ± 135.5, p ¼ 0.02). Conclusions: Despite longer OLT wait list times and larger tumors, patients with HCC treated with LRT prior to transplant had similar overall survival compared to patients not treated with LRT. Further subgroup analysis suggests patients with tumor diameter greater than 3 cm would have improved survival with pre-transplant LRT.
3:18 PM
Abstract No. 34
Identifying enhancement-based staging markers on baseline MR imaging in patients with colorectal cancer liver metastases undergoing loco-regional tumor therapy M. Ghani1, J. Chapiro1, B. Letzen1, V. Thakur1, M. Lin1, X. Papademetris1, R. Schernthaner2, S. Huber1, J. Geschwind1; 1Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA; 2Department of Radiology, Medical University of Vienna, Vienna, Austria Purpose: To determine the predictive value of tumor enhancement on baseline imaging in patients with liver-dominant colorectal cancer metastases undergoing loco-regional tumor therapies. Materials: This retrospective study included 86 patients with colorectal cancer (CRC) liver metastases, treated with TACE (n ¼ 42) or Y90 radioembolization (n ¼ 46) between 2001 and 2014. All patients received contrast-enhanced MRI prior to therapy. Semiautomated whole-liver and tumor segmentations of three dominant lesions were performed on baseline MRI to calculate total tumor and liver volumes (TTV and TLV). Quantitative 3D analysis was performed to calculate enhancing tumor volume (ETV), enhancing tumor burden (ETB, calculated as ETV/TLV), and enhancing liver volume (ELV). 1 A 65 cm3 cutoff was chosen for TTV and ETV, and 4% was chosen as the cutoff for ETB.2 For ELV, absolute and
SUNDAY: Scientific Sessions
Purpose: Recent studies of liver imaging reporting and data system (LI-RADS) category 4 “probably HCC” lesions are conflicting. While more than 90% of LI-RADS 4 lesions may be HCCs, only 1/3 progress and 1/3 downgrade without treatment. It is unclear whether LI-RADS 4 lesions should be treated with locoregional therapy, particularly in the setting of coexisting LI-RADS 5 lesions. This study compared the outcomes of treated versus untreated LI-RADS 4 lesions in patients undergoing transcatheter arterial embolization (TAE). Materials: From 2005 to 2014, 193 patients underwent bland TAE for presumed HCC. Preprocedure multiphase contrast enhanced CT and MR scans were retrospectively reviewed, and the dominant lesion(s) prompting TAE and any other lesions were classified according to the latest LI-RADS criteria (v2014). TAE procedures were reviewed to determine whether LI-RADS 4 lesions were within or outside the embolized liver volume during treatment of the dominant lesion(s). Time to progression to LI-RADS 5 on follow up imaging was estimated for treated versus untreated lesions using the Kaplan-Meier method and compared using the log rank test. Results: There were 72 LI-RADS 4 lesions in 58 patients undergoing TAE. Follow up imaging was available for 56 lesions in 45 patients (34 male, mean age 61). The dominant lesion(s) prompting TAE met LI-RADS 5 criteria in 84% of patients. LI-RADS 4 lesions were a mean of 1.5 cm in size, and 84%, 73%, 20%, and 9% demonstrated arterial hyperenhancement, washout, a capsule, and growth, respectively. Forty LI-RADS 4 lesions were within the embolized liver volume for treatment of the dominant lesion(s) and were considered treated, and 16 lesions were outside and considered untreated. The 6 and 12 month rates of progression from LI-RADS 4 to LI-RADS 5 were 3% and 19% for treated lesions versus 42% and 73% for untreated lesions (po0.001). Conclusions: Following TAE for a dominant lesion elsewhere in the liver, untreated LI-RADS 4 lesions showed a significantly higher rate of progression compared with treated LI-RADS 4 lesions. These results suggest that in the context of a coexisting LI-RADS 5 lesion, consideration should be given to LI-RADS 4 directed locoregional therapy.
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