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Early survival prediction after intra-arterial therapies: a 3D quantitative MRI assessment of tumour response after TACE or radioembolization of colorectal cancer metastases to the liver

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Abstract

Objectives

This study evaluated the predictive role of 1D, 2D and 3D quantitative, enhancement-based MRI regarding overall survival (OS) in patients with colorectal liver metastases (CLM) following intra-arterial therapies (IAT).

Methods

This retrospective analysis included 29 patients who underwent transarterial chemoembolization (TACE) or radioembolization and received MRI within 6 weeks after therapy. Tumour response was assessed using 1D and 2D criteria (such as European Association for the Study of the Liver guidelines [EASL] and modified Response Evaluation Criteria in Solid Tumors [mRECIST]). In addition, a segmentation-based 3D quantification of overall (volumetric [v] RECIST) and enhancing lesion volume (quantitative [q] EASL) was performed on portal venous phase MRI. Accordingly, patients were classified as responders (R) and non-responders (NR). Survival was evaluated using Kaplan–Meier analysis and compared using Cox proportional hazard ratios (HR).

Results

Only enhancement-based criteria identified patients as responders. EASL and mRECIST did not predict patient survival (P = 0.27 and P = 0.44, respectively). Using uni- and multivariate analysis, qEASL was identified as the sole predictor of patient survival (9.9 months for R, 6.9 months for NR; P = 0.038; HR 0.4).

Conclusion

The ability of qEASL to predict survival early after IAT provides evidence for potential advantages of 3D quantitative tumour analysis.

Key Points

Volumetric assessment of colorectal liver metastases after intra-arterial therapy is feasible.

Early 3D quantitative tumour analysis after intra-arterial therapy may predict patient survival.

Volumetric tumour response assessment shows advantages over 1D and 2D techniques.

Enhancement-based MR response assessment is preferable to size-based measurements.

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Acknowledgments

The scientific guarantor of this publication is Jean-François Geschwind. The authors of this manuscript declare relationships with the following companies: JC, grant support: Rolf W. Günther Foundation for Radiological Sciences; RD, none; ML, Philips employee; RS, none; DL, Philips employee; ZW, none; LJS, grant support: Rolf W. Günther Foundation for Radiological Sciences; JFG, consultant: Miocompatibles/BTG, Bayer HealthCare, Guerbet, Nordion/BTG, Philips HealthCare and Jennerex. Grant support: Biocompatibles/BTG, Bayer HealthCare, Philips Medical, Nodion/BTG, Threshold, Guerbet, DOD, NCI-ECOG and NIH-RO1. This study has received funding by NIH/NCI R01 CA160771, P30 CA006973, NCRR UL1 RR 025005, Philips Research North America, Briarcliff Manor, New York and the Rolf W. Günther Foundation for Radiological Sciences. Vivek Charu, Johns Hopkins Bloomberg School of Public Health kindly provided statistical advice for this manuscript.

Institutional review board approval was obtained. Written informed consent was waived by the institutional review board. Methodology: retrospective, diagnostic, prognostic study, performed at one institution.

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Correspondence to Jean-François Geschwind.

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Chapiro, J., Duran, R., Lin, M. et al. Early survival prediction after intra-arterial therapies: a 3D quantitative MRI assessment of tumour response after TACE or radioembolization of colorectal cancer metastases to the liver. Eur Radiol 25, 1993–2003 (2015). https://doi.org/10.1007/s00330-015-3595-5

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