Radiological–pathological correlation study of hepatocellular carcinoma undergoing local chemoradiotherapy and surgery

Jun Won Kim, Jinsil Seong, Mi Sook Park, Kyung Sik Kim, Young Nyun Park, KwangHyub Han, Ki Chang Keum, Ik Jae Lee

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Abstract

Background and Aims: Optimal response criteria and assessment timing were investigated through radiologic–pathologic correlation in hepatocellular carcinoma (HCC) treated with localized chemoradiotherapy (CRT). Methods: We reviewed 19 consecutive HCC patients who underwent surgical resection after radiotherapy and concurrent hepatic arterial infusion chemotherapy. Patients who received transarterial chemoembolization before RT or surgery were excluded from evaluation. Tumor diameters and total and enhancing tumor volumes were measured from CT images obtained 1, 3, 6, and 9 months after CRT. Percent changes calculated using size (RECIST and WHO) and enhancement criteria (mRECIST and EASL) were correlated with percent changes in total and enhancing tumor volumes, and with percent viable tumor in surgical specimens. Results: Median time between CRT and resection was 4.1 months (range, 1.5–15.4 months). CR and PR rates were 0 and 68% by RECIST, 0 and 63% by WHO, 53% and 37% by mRECIST, and 53% and 42% by EASL. Pathologic CR (pCR) rate was 52.6%. Radiologic criteria showed strong correlation with tumor volumes at 1 and 3 months after CRT; at 6 months, however, size and enhancement criteria showed strong correlation only with total and enhancing tumor volumes, respectively. Enhancement criteria were better predictors of pathologic response at all times including preoperative evaluation (RECIST: R 2 = 0.303, P = 0.015 and WHO: R 2 = 0.366, P = 0.006 vs. mRECIST: R 2 = 0.760, P < 0.0001 and EASL: R 2 = 0.768, P < 0.0001). Time interval >6 months before resection showed significant correlation with pCR (P = 0.013). Conclusions: We recommend using enhancement criteria in assessing tumor viability, especially if the tumor was to be resected <6 months after CRT.

Original languageEnglish
Pages (from-to)1619-1627
Number of pages9
JournalJournal of Gastroenterology and Hepatology (Australia)
Volume31
Issue number9
DOIs
Publication statusPublished - 2016 Sep 1

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Chemoradiotherapy
Hepatocellular Carcinoma
Tumor Burden
Neoplasms
Radiotherapy
Drug Therapy
Liver
Response Evaluation Criteria in Solid Tumors

All Science Journal Classification (ASJC) codes

  • Hepatology
  • Gastroenterology

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Kim, Jun Won ; Seong, Jinsil ; Park, Mi Sook ; Kim, Kyung Sik ; Park, Young Nyun ; Han, KwangHyub ; Keum, Ki Chang ; Lee, Ik Jae. / Radiological–pathological correlation study of hepatocellular carcinoma undergoing local chemoradiotherapy and surgery. In: Journal of Gastroenterology and Hepatology (Australia). 2016 ; Vol. 31, No. 9. pp. 1619-1627.
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title = "Radiological–pathological correlation study of hepatocellular carcinoma undergoing local chemoradiotherapy and surgery",
abstract = "Background and Aims: Optimal response criteria and assessment timing were investigated through radiologic–pathologic correlation in hepatocellular carcinoma (HCC) treated with localized chemoradiotherapy (CRT). Methods: We reviewed 19 consecutive HCC patients who underwent surgical resection after radiotherapy and concurrent hepatic arterial infusion chemotherapy. Patients who received transarterial chemoembolization before RT or surgery were excluded from evaluation. Tumor diameters and total and enhancing tumor volumes were measured from CT images obtained 1, 3, 6, and 9 months after CRT. Percent changes calculated using size (RECIST and WHO) and enhancement criteria (mRECIST and EASL) were correlated with percent changes in total and enhancing tumor volumes, and with percent viable tumor in surgical specimens. Results: Median time between CRT and resection was 4.1 months (range, 1.5–15.4 months). CR and PR rates were 0 and 68{\%} by RECIST, 0 and 63{\%} by WHO, 53{\%} and 37{\%} by mRECIST, and 53{\%} and 42{\%} by EASL. Pathologic CR (pCR) rate was 52.6{\%}. Radiologic criteria showed strong correlation with tumor volumes at 1 and 3 months after CRT; at 6 months, however, size and enhancement criteria showed strong correlation only with total and enhancing tumor volumes, respectively. Enhancement criteria were better predictors of pathologic response at all times including preoperative evaluation (RECIST: R 2 = 0.303, P = 0.015 and WHO: R 2 = 0.366, P = 0.006 vs. mRECIST: R 2 = 0.760, P < 0.0001 and EASL: R 2 = 0.768, P < 0.0001). Time interval >6 months before resection showed significant correlation with pCR (P = 0.013). Conclusions: We recommend using enhancement criteria in assessing tumor viability, especially if the tumor was to be resected <6 months after CRT.",
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Radiological–pathological correlation study of hepatocellular carcinoma undergoing local chemoradiotherapy and surgery. / Kim, Jun Won; Seong, Jinsil; Park, Mi Sook; Kim, Kyung Sik; Park, Young Nyun; Han, KwangHyub; Keum, Ki Chang; Lee, Ik Jae.

In: Journal of Gastroenterology and Hepatology (Australia), Vol. 31, No. 9, 01.09.2016, p. 1619-1627.

Research output: Contribution to journalArticle

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AU - Kim, Jun Won

AU - Seong, Jinsil

AU - Park, Mi Sook

AU - Kim, Kyung Sik

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AU - Han, KwangHyub

AU - Keum, Ki Chang

AU - Lee, Ik Jae

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N2 - Background and Aims: Optimal response criteria and assessment timing were investigated through radiologic–pathologic correlation in hepatocellular carcinoma (HCC) treated with localized chemoradiotherapy (CRT). Methods: We reviewed 19 consecutive HCC patients who underwent surgical resection after radiotherapy and concurrent hepatic arterial infusion chemotherapy. Patients who received transarterial chemoembolization before RT or surgery were excluded from evaluation. Tumor diameters and total and enhancing tumor volumes were measured from CT images obtained 1, 3, 6, and 9 months after CRT. Percent changes calculated using size (RECIST and WHO) and enhancement criteria (mRECIST and EASL) were correlated with percent changes in total and enhancing tumor volumes, and with percent viable tumor in surgical specimens. Results: Median time between CRT and resection was 4.1 months (range, 1.5–15.4 months). CR and PR rates were 0 and 68% by RECIST, 0 and 63% by WHO, 53% and 37% by mRECIST, and 53% and 42% by EASL. Pathologic CR (pCR) rate was 52.6%. Radiologic criteria showed strong correlation with tumor volumes at 1 and 3 months after CRT; at 6 months, however, size and enhancement criteria showed strong correlation only with total and enhancing tumor volumes, respectively. Enhancement criteria were better predictors of pathologic response at all times including preoperative evaluation (RECIST: R 2 = 0.303, P = 0.015 and WHO: R 2 = 0.366, P = 0.006 vs. mRECIST: R 2 = 0.760, P < 0.0001 and EASL: R 2 = 0.768, P < 0.0001). Time interval >6 months before resection showed significant correlation with pCR (P = 0.013). Conclusions: We recommend using enhancement criteria in assessing tumor viability, especially if the tumor was to be resected <6 months after CRT.

AB - Background and Aims: Optimal response criteria and assessment timing were investigated through radiologic–pathologic correlation in hepatocellular carcinoma (HCC) treated with localized chemoradiotherapy (CRT). Methods: We reviewed 19 consecutive HCC patients who underwent surgical resection after radiotherapy and concurrent hepatic arterial infusion chemotherapy. Patients who received transarterial chemoembolization before RT or surgery were excluded from evaluation. Tumor diameters and total and enhancing tumor volumes were measured from CT images obtained 1, 3, 6, and 9 months after CRT. Percent changes calculated using size (RECIST and WHO) and enhancement criteria (mRECIST and EASL) were correlated with percent changes in total and enhancing tumor volumes, and with percent viable tumor in surgical specimens. Results: Median time between CRT and resection was 4.1 months (range, 1.5–15.4 months). CR and PR rates were 0 and 68% by RECIST, 0 and 63% by WHO, 53% and 37% by mRECIST, and 53% and 42% by EASL. Pathologic CR (pCR) rate was 52.6%. Radiologic criteria showed strong correlation with tumor volumes at 1 and 3 months after CRT; at 6 months, however, size and enhancement criteria showed strong correlation only with total and enhancing tumor volumes, respectively. Enhancement criteria were better predictors of pathologic response at all times including preoperative evaluation (RECIST: R 2 = 0.303, P = 0.015 and WHO: R 2 = 0.366, P = 0.006 vs. mRECIST: R 2 = 0.760, P < 0.0001 and EASL: R 2 = 0.768, P < 0.0001). Time interval >6 months before resection showed significant correlation with pCR (P = 0.013). Conclusions: We recommend using enhancement criteria in assessing tumor viability, especially if the tumor was to be resected <6 months after CRT.

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