Modified response evaluation criteria in solid tumors and european association for the study of the liver criteria using delayed-phase imaging at an early time point predict survival in patients with unresectable intrahepatic cholangiocarcinoma following yttrium-90 radioembolization

Juan C. Camacho, Nima Kokabi, Minzhi Xing, Hasmukh Prajapati, Bassel El-Rayes, Hyun S. Kim

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Abstract

Purpose To investigate early imaging prognostic factors in unresectable intrahepatic cholangiocarcinoma (ICC) refractory to standard chemotherapy after yttrium-90 (90Y) radioembolization therapy. Materials and Methods In an institutional review board-approved prospective correlative study, 21 consecutive patients with ICC refractory to standard chemotherapy underwent 90Y radioembolization therapy. Target and overall Response Evaluation Criteria In Solid Tumors (RECIST), modified RECIST (mRECIST), and European Association for the Study of the Liver (EASL) treatment responses were assessed. The mRECIST and EASL criteria were modified for application on delayed phases of dynamic contrast-enhanced cross-sectional imaging studies. Conventional definitions for complete and partial response were applied; these responses comprised objective response. Restaging imaging was obtained at 1- and 3-month intervals until patient death. Survival analyses by Kaplan-Meier and log-rank proportional models including application of the landmark method to avoid lead-time bias were performed from the day of treatment. Significance was set at P <.05. Results Median overall survival (OS) from the time of 90Y therapy was 16.3 months (95% confidence interval, 7.2-25.4 mo). Significant differences between mRECIST and EASL versus RECIST were found when categorizing patients into responders and nonresponders (P <.001). Significantly prolonged OS was observed for patients with targeted objective response based on modified mRECIST and EASL criteria (P =.005 and P =.001, respectively) at 3 months. RECIST was not found to correlate with survival at 1- or 3-month follow-up. Conclusions Modified target mRECIST and EASL criteria that employ delayed-phase contrast enhancement at 3 months after 90Y radioembolization therapy for ICC predicted OS. RECIST did not correlate with survival.

Original languageEnglish (US)
Pages (from-to)256-265
Number of pages10
JournalJournal of Vascular and Interventional Radiology
Volume25
Issue number2
DOIs
StatePublished - Feb 1 2014

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Yttrium
Cholangiocarcinoma
Survival
Liver
Therapeutics
Response Evaluation Criteria in Solid Tumors
Drug Therapy
Research Ethics Committees
Survival Analysis
Cross-Sectional Studies
Prospective Studies
Confidence Intervals

All Science Journal Classification (ASJC) codes

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

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title = "Modified response evaluation criteria in solid tumors and european association for the study of the liver criteria using delayed-phase imaging at an early time point predict survival in patients with unresectable intrahepatic cholangiocarcinoma following yttrium-90 radioembolization",
abstract = "Purpose To investigate early imaging prognostic factors in unresectable intrahepatic cholangiocarcinoma (ICC) refractory to standard chemotherapy after yttrium-90 (90Y) radioembolization therapy. Materials and Methods In an institutional review board-approved prospective correlative study, 21 consecutive patients with ICC refractory to standard chemotherapy underwent 90Y radioembolization therapy. Target and overall Response Evaluation Criteria In Solid Tumors (RECIST), modified RECIST (mRECIST), and European Association for the Study of the Liver (EASL) treatment responses were assessed. The mRECIST and EASL criteria were modified for application on delayed phases of dynamic contrast-enhanced cross-sectional imaging studies. Conventional definitions for complete and partial response were applied; these responses comprised objective response. Restaging imaging was obtained at 1- and 3-month intervals until patient death. Survival analyses by Kaplan-Meier and log-rank proportional models including application of the landmark method to avoid lead-time bias were performed from the day of treatment. Significance was set at P <.05. Results Median overall survival (OS) from the time of 90Y therapy was 16.3 months (95{\%} confidence interval, 7.2-25.4 mo). Significant differences between mRECIST and EASL versus RECIST were found when categorizing patients into responders and nonresponders (P <.001). Significantly prolonged OS was observed for patients with targeted objective response based on modified mRECIST and EASL criteria (P =.005 and P =.001, respectively) at 3 months. RECIST was not found to correlate with survival at 1- or 3-month follow-up. Conclusions Modified target mRECIST and EASL criteria that employ delayed-phase contrast enhancement at 3 months after 90Y radioembolization therapy for ICC predicted OS. RECIST did not correlate with survival.",
author = "Camacho, {Juan C.} and Nima Kokabi and Minzhi Xing and Hasmukh Prajapati and Bassel El-Rayes and Kim, {Hyun S.}",
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T1 - Modified response evaluation criteria in solid tumors and european association for the study of the liver criteria using delayed-phase imaging at an early time point predict survival in patients with unresectable intrahepatic cholangiocarcinoma following yttrium-90 radioembolization

AU - Camacho, Juan C.

AU - Kokabi, Nima

AU - Xing, Minzhi

AU - Prajapati, Hasmukh

AU - El-Rayes, Bassel

AU - Kim, Hyun S.

PY - 2014/2/1

Y1 - 2014/2/1

N2 - Purpose To investigate early imaging prognostic factors in unresectable intrahepatic cholangiocarcinoma (ICC) refractory to standard chemotherapy after yttrium-90 (90Y) radioembolization therapy. Materials and Methods In an institutional review board-approved prospective correlative study, 21 consecutive patients with ICC refractory to standard chemotherapy underwent 90Y radioembolization therapy. Target and overall Response Evaluation Criteria In Solid Tumors (RECIST), modified RECIST (mRECIST), and European Association for the Study of the Liver (EASL) treatment responses were assessed. The mRECIST and EASL criteria were modified for application on delayed phases of dynamic contrast-enhanced cross-sectional imaging studies. Conventional definitions for complete and partial response were applied; these responses comprised objective response. Restaging imaging was obtained at 1- and 3-month intervals until patient death. Survival analyses by Kaplan-Meier and log-rank proportional models including application of the landmark method to avoid lead-time bias were performed from the day of treatment. Significance was set at P <.05. Results Median overall survival (OS) from the time of 90Y therapy was 16.3 months (95% confidence interval, 7.2-25.4 mo). Significant differences between mRECIST and EASL versus RECIST were found when categorizing patients into responders and nonresponders (P <.001). Significantly prolonged OS was observed for patients with targeted objective response based on modified mRECIST and EASL criteria (P =.005 and P =.001, respectively) at 3 months. RECIST was not found to correlate with survival at 1- or 3-month follow-up. Conclusions Modified target mRECIST and EASL criteria that employ delayed-phase contrast enhancement at 3 months after 90Y radioembolization therapy for ICC predicted OS. RECIST did not correlate with survival.

AB - Purpose To investigate early imaging prognostic factors in unresectable intrahepatic cholangiocarcinoma (ICC) refractory to standard chemotherapy after yttrium-90 (90Y) radioembolization therapy. Materials and Methods In an institutional review board-approved prospective correlative study, 21 consecutive patients with ICC refractory to standard chemotherapy underwent 90Y radioembolization therapy. Target and overall Response Evaluation Criteria In Solid Tumors (RECIST), modified RECIST (mRECIST), and European Association for the Study of the Liver (EASL) treatment responses were assessed. The mRECIST and EASL criteria were modified for application on delayed phases of dynamic contrast-enhanced cross-sectional imaging studies. Conventional definitions for complete and partial response were applied; these responses comprised objective response. Restaging imaging was obtained at 1- and 3-month intervals until patient death. Survival analyses by Kaplan-Meier and log-rank proportional models including application of the landmark method to avoid lead-time bias were performed from the day of treatment. Significance was set at P <.05. Results Median overall survival (OS) from the time of 90Y therapy was 16.3 months (95% confidence interval, 7.2-25.4 mo). Significant differences between mRECIST and EASL versus RECIST were found when categorizing patients into responders and nonresponders (P <.001). Significantly prolonged OS was observed for patients with targeted objective response based on modified mRECIST and EASL criteria (P =.005 and P =.001, respectively) at 3 months. RECIST was not found to correlate with survival at 1- or 3-month follow-up. Conclusions Modified target mRECIST and EASL criteria that employ delayed-phase contrast enhancement at 3 months after 90Y radioembolization therapy for ICC predicted OS. RECIST did not correlate with survival.

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U2 - 10.1016/j.jvir.2013.10.056

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EP - 265

JO - Journal of Vascular and Interventional Radiology

JF - Journal of Vascular and Interventional Radiology

SN - 1051-0443

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