Promising biomarker predicts survival during chemoembolization of hepatocellular carcinoma

An association between intraprocedural tumor perfusion reduction during chemoembolization and transplant-free survival (TFS) implicates the utility of transcatheter intraarterial perfusion (TRIP) MRI-measured tumor perfusion reduction as an intraprocedural imaging biomarker during chemoembolization, according to a study published March 28 in Radiology.

Although curative treatments are available for hepatocellular carcinoma (HCC), only a small percentage of patients are deemed eligible for definitive therapy. Local-regional therapies such as chemoembolization, however, offer promise for managing the disease.

“Potential functional imaging biomarkers enable assessment of vascular and cellular changes suggestive of early tumor response after transarterial local-regional therapies,” wrote lead author Dingxin Wang, PhD, of Northwestern University in Chicago at the time of the study, and colleagues. “Intraprocedural imaging biomarkers predictive of survival during transarterial local-regional therapies could potentially further enhance the benefits of these interventions in patients with unresectable HCC, as intraprocedural prognostic factors could be used to guide the selection of optimal therapeutic end points at the time of treatment.”

The researchers conducted their study to investigate the predictive value of TRIP MRI-measured tumor perfusion changes during transarterial chemoembolization on TFS in patients with unresectable HCC. The study included 50 adult patients with surgically unresectable single or multifocal measurable HCC and adequate laboratory parameters who underwent chemoembolization in a combined MRI-interventional radiology suite between 2006 and 2010.

After measuring tumor perfusion changes during chemoembolization and assessing the correlation between the percentage perfusion reduction in the tumor during chemoembolization and TFS, the authors found that patients with 35 to 85 percent intraprocedural tumor area under the time-signal intensity curve reduction demonstrated significantly improved median TFS in comparison with patients who had an area under the time-signal intensity curve reduction outside of that range.

The cumulative TFS rates in the 35 and 85 percent range and less than 35 percent or more than 85 percent perfusion reduction groups at one, two and five years after chemoembolization were 66.4 percent, 42.2 percent, and 28.2 percent versus 33.8 percent, 16.9 percent, and zero percent, respectively.

“Our results advocate the use of TRIP MR imaging–measured tumor perfusion reduction as an intraprocedural imaging biomarker for survival,” wrote Wang and colleagues. “This may facilitate further standardization of the chemoembolization technique on the basis of measurable intraprocedural functional end points. As our data suggest, the variation in perfusion reduction during chemoembolization can greatly impact its efficacy. Optimization of intraprocedural perfusion reduction end points of chemoembolization may be necessary,” they concluded.