Chemoembolization for hepatocellular carcinoma

Comprehensive imaging and survival analysis in a 172-patient cohort

Robert J. Lewandowski, Mary F. Mulcahy, Laura M. Kulik, Ahsun Riaz, Robert K. Ryu, Talia B. Baker, Saad M. Ibrahim, Michael I. Abecassis, Frank H. Miller, Kent T. Sato, Seanthan Senthilnathan, Scott A. Resnick, Edward Wang, Ramona Gupta, Richard Chen, Steven B. Newman, Howard B. Chrisman, Albert A. Nemcek, Robert L. Vogelzang, Reed A. Omary & 2 others Al B. Benson, Riad Salem

Research output: Contribution to journalArticle

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Abstract

Purpose: To determine comprehensive imaging and long-term survival outcome following chemoembolization for hepatocellular carcinoma (HCC). Materials and Methods: One hundred seventy-two patients with HCC treated with chemoembolization were studied retrospectively in an institutional review board approved protocol; this study was HIPAA compliant. Baseline laboratory and imaging characteristics were obtained. Clinical and laboratory toxicities following treatment were assessed. Imaging characteristics following chemoembolization were evaluated to determine response rates (size and necrosis) and time to progression (TTP). Survival from the time of first chemoembolization treatment was calculated. Subanalyses were performed by stratifying the population according to Child-Pugh, United Network for Organ Sharing, and Barcelona Clinic for Liver Cancer (BCLC) staging systems. Results: Cirrhosis was present in 157 patients (91%); portal hypertension was present in 139 patients (81%). Eleven patients (6%) had metastases at baseline. Portal vein thrombosis was present in 11 patients (6%). Fifty-five percent of patients experienced some form of toxicity following treatment; 21% developed grade 3 or 4 bilirubin toxicity. Post-chemoembolization response was seen in 31% and 64% of patients according to size and necrosis criteria, respectively. Median TTP was 7.9 months (95% confidence interval: 7.1, 9.4) but varied widely by stage. Median survival was significantly different between patients with BCLC stages A, B, and C disease (stage A, 40.0 months; B, 17.4 months; C, 6.3 months; P < .0001). Conclusion: The determination of TTP and survival in patients with HCC is confounded by tumor biology and background cirrhosis; chemoembolization was shown to be a safe and effective therapy in patients with HCC.

Original languageEnglish
Pages (from-to)955-965
Number of pages11
JournalRadiology
Volume255
Issue number3
DOIs
StatePublished - Jun 1 2010
Externally publishedYes

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Survival Analysis
Hepatocellular Carcinoma
Survival
Liver Neoplasms
Fibrosis
Necrosis
Health Insurance Portability and Accountability Act
Neoplasm Staging
Research Ethics Committees
Portal Hypertension
Therapeutics
Portal Vein
Bilirubin
Thrombosis
Confidence Intervals
Neoplasm Metastasis

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

Cite this

Lewandowski, R. J., Mulcahy, M. F., Kulik, L. M., Riaz, A., Ryu, R. K., Baker, T. B., ... Salem, R. (2010). Chemoembolization for hepatocellular carcinoma: Comprehensive imaging and survival analysis in a 172-patient cohort. Radiology, 255(3), 955-965. https://doi.org/10.1148/radiol.10091473

Chemoembolization for hepatocellular carcinoma : Comprehensive imaging and survival analysis in a 172-patient cohort. / Lewandowski, Robert J.; Mulcahy, Mary F.; Kulik, Laura M.; Riaz, Ahsun; Ryu, Robert K.; Baker, Talia B.; Ibrahim, Saad M.; Abecassis, Michael I.; Miller, Frank H.; Sato, Kent T.; Senthilnathan, Seanthan; Resnick, Scott A.; Wang, Edward; Gupta, Ramona; Chen, Richard; Newman, Steven B.; Chrisman, Howard B.; Nemcek, Albert A.; Vogelzang, Robert L.; Omary, Reed A.; Benson, Al B.; Salem, Riad.

In: Radiology, Vol. 255, No. 3, 01.06.2010, p. 955-965.

Research output: Contribution to journalArticle

Lewandowski, RJ, Mulcahy, MF, Kulik, LM, Riaz, A, Ryu, RK, Baker, TB, Ibrahim, SM, Abecassis, MI, Miller, FH, Sato, KT, Senthilnathan, S, Resnick, SA, Wang, E, Gupta, R, Chen, R, Newman, SB, Chrisman, HB, Nemcek, AA, Vogelzang, RL, Omary, RA, Benson, AB & Salem, R 2010, 'Chemoembolization for hepatocellular carcinoma: Comprehensive imaging and survival analysis in a 172-patient cohort', Radiology, vol. 255, no. 3, pp. 955-965. https://doi.org/10.1148/radiol.10091473
Lewandowski, Robert J. ; Mulcahy, Mary F. ; Kulik, Laura M. ; Riaz, Ahsun ; Ryu, Robert K. ; Baker, Talia B. ; Ibrahim, Saad M. ; Abecassis, Michael I. ; Miller, Frank H. ; Sato, Kent T. ; Senthilnathan, Seanthan ; Resnick, Scott A. ; Wang, Edward ; Gupta, Ramona ; Chen, Richard ; Newman, Steven B. ; Chrisman, Howard B. ; Nemcek, Albert A. ; Vogelzang, Robert L. ; Omary, Reed A. ; Benson, Al B. ; Salem, Riad. / Chemoembolization for hepatocellular carcinoma : Comprehensive imaging and survival analysis in a 172-patient cohort. In: Radiology. 2010 ; Vol. 255, No. 3. pp. 955-965.
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T2 - Comprehensive imaging and survival analysis in a 172-patient cohort

AU - Lewandowski, Robert J.

AU - Mulcahy, Mary F.

AU - Kulik, Laura M.

AU - Riaz, Ahsun

AU - Ryu, Robert K.

AU - Baker, Talia B.

AU - Ibrahim, Saad M.

AU - Abecassis, Michael I.

AU - Miller, Frank H.

AU - Sato, Kent T.

AU - Senthilnathan, Seanthan

AU - Resnick, Scott A.

AU - Wang, Edward

AU - Gupta, Ramona

AU - Chen, Richard

AU - Newman, Steven B.

AU - Chrisman, Howard B.

AU - Nemcek, Albert A.

AU - Vogelzang, Robert L.

AU - Omary, Reed A.

AU - Benson, Al B.

AU - Salem, Riad

PY - 2010/6/1

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N2 - Purpose: To determine comprehensive imaging and long-term survival outcome following chemoembolization for hepatocellular carcinoma (HCC). Materials and Methods: One hundred seventy-two patients with HCC treated with chemoembolization were studied retrospectively in an institutional review board approved protocol; this study was HIPAA compliant. Baseline laboratory and imaging characteristics were obtained. Clinical and laboratory toxicities following treatment were assessed. Imaging characteristics following chemoembolization were evaluated to determine response rates (size and necrosis) and time to progression (TTP). Survival from the time of first chemoembolization treatment was calculated. Subanalyses were performed by stratifying the population according to Child-Pugh, United Network for Organ Sharing, and Barcelona Clinic for Liver Cancer (BCLC) staging systems. Results: Cirrhosis was present in 157 patients (91%); portal hypertension was present in 139 patients (81%). Eleven patients (6%) had metastases at baseline. Portal vein thrombosis was present in 11 patients (6%). Fifty-five percent of patients experienced some form of toxicity following treatment; 21% developed grade 3 or 4 bilirubin toxicity. Post-chemoembolization response was seen in 31% and 64% of patients according to size and necrosis criteria, respectively. Median TTP was 7.9 months (95% confidence interval: 7.1, 9.4) but varied widely by stage. Median survival was significantly different between patients with BCLC stages A, B, and C disease (stage A, 40.0 months; B, 17.4 months; C, 6.3 months; P < .0001). Conclusion: The determination of TTP and survival in patients with HCC is confounded by tumor biology and background cirrhosis; chemoembolization was shown to be a safe and effective therapy in patients with HCC.

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