Hepatocellular carcinoma with macrovascular invasion: multimodality imaging features for the diagnosis

Cannella, Roberto; Taibbi, Adele; Porrello, Giorgia; Burgio, Marco Dioguardi; Cabibbo, Giuseppe; Bartolotta, Tommaso Vincenzo

doi:10.5152/dir.2020.19569

Cited by 13 publications

(11 citation statements)

References 44 publications

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“…Tumor response was determined using the modified response evaluation criteria in solid tumors (mRECIST), and adverse events were defined using the National Cancer Institute-Common Terminology Criteria for Adverse Events (NCI-CTCAE) version 5.0. Successful downstaging was defined as the disappearance of any intratumoral arterial enhancement of PVTT according to the mRECIST and EASL criteria (15,16).…”

Section: Clinical Data Collection and Definition Of The Outcomesmentioning

confidence: 99%

Combination of Sorafenib, Camrelizumab, Transcatheter Arterial Chemoembolization, and Stereotactic Body Radiation Therapy as a Novel Downstaging Strategy in Advanced Hepatocellular Carcinoma With Portal Vein Tumor Thrombus: A Case Series Study

et al. 2021

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Background and AimAlthough the treatment effect and availability of therapeutic options for advanced hepatocellular carcinoma (HCC) are limited, the downstaging strategy may improve patient prognosis. This study aimed to investigate the potential of combination therapy as a downstaging strategy for treating advanced HCC with portal vein tumor thrombus (PVTT).MethodsThis retrospective case series included patients having advanced HCC with PVTT, who received the combination therapy of sorafenib, camrelizumab, transcatheter arterial chemoembolization (TACE), and stereotactic body radiation therapy (SBRT) from January 2019 to December 2019 in Xiangya Hospital, Central South University. The downstaging rate, treatment responses, progression-free survival (PFS), overall survival (OS), disease control rate, and toxicities were evaluated.ResultsOf the 13 patients, HCC downstaging was achieved in 4 (33.3%) patients who later received hepatectomy. The overall response rate was 41.7%, and the disease control rate was 50.0%. The median PFS time was 15.7 months, with a 1-year PFS rate of 58.3%, whereas the median OS was not reached after 1 year (1-year OS, 83.3%). No severe adverse events or grade 3–4 adverse effect was observed in 12 of the 13 enrolled patients; therapy had to be discontinued in only one patient due to adverse events, who was excluded from the study. The most common adverse effect was fever (n = 4, 33.3%), followed by skin reaction (n = 3, 25%).ConclusionA combination therapy comprising sorafenib, camrelizumab, TACE, and SBRT is an effective downstaging strategy for advanced HCC with PVTT and is associated with few adverse events.

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Section: Clinical Data Collection and Definition Of The Outcomesmentioning

confidence: 99%

Combination of Sorafenib, Camrelizumab, Transcatheter Arterial Chemoembolization, and Stereotactic Body Radiation Therapy as a Novel Downstaging Strategy in Advanced Hepatocellular Carcinoma With Portal Vein Tumor Thrombus: A Case Series Study

et al. 2021

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“…Even though there were several factors associated with HCC both clinical and radiographic factors ( Tables 1 & 2 ), only portal vein invasion and the largest mass size were independently associated with HCC after being adjusted with other factors ( Table 3 ). Portal vein invasion, a sign for HCC staging, is an indicator for stage IIIB in TNM staging system and prognostic factor [ 13 , 14 ]. Additionally, portal vein thrombosis was associated with survival and treatment [ 15 ].…”

Section: Discussionmentioning

confidence: 99%

Clinical Versus Radiographical Factors Associated With Hepatocellular Carcinoma Diagnosis in high-risk Patients: Sizes Matter

et al. 2022

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Aim: This study aimed to evaluate if clinical or radiographic findings can be used for hepatocellular carcinoma (HCC) diagnosis particularly in high-risk patients. Methods: This was a prospective study and evaluated factors associated with HCC. Results: There were 260 patients met the study criteria: 219 patients (84.23%) were HCC. Two factors significantly associated with HCC: portal vein invasion and the largest mass size. The cutoff point for the largest mass size of 2 cm or over gave sensitivity and specificity for HCC of 83.56 and 87.80%, respectively. Conclusion: Portal vein invasion and the largest liver mass of 2 cm or over may be diagnostic factors for HCC in high-risk patients, while clinical factors were not suggestive for HCC.

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“…The National Cancer Institute’s Common Terminology Criteria for Adverse Events (NCI-CTCAE) v5.0 were used to define AEs. Successful downstaging was reflected by absent tumoral arterial enhancement of PVTT based on the mRECIST and EASL criteria [ 9 , 10 ]. The secondary surgery was conducted once the successful downstaging was observed, and the sorafenib and ICI administrations were still performed after the secondary surgery.…”

Section: Methodsmentioning

confidence: 99%

A Combination of Sorafenib, an Immune Checkpoint Inhibitor, TACE and Stereotactic Body Radiation Therapy versus Sorafenib and TACE in Advanced Hepatocellular Carcinoma Accompanied by Portal Vein Tumor Thrombus

Zhang

Liao

et al. 2022

Cancers

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Background: This study compared the effectiveness of the combined administration of sorafenib, an immune checkpoint inhibitor, transcatheter arterial chemoembolization (TACE), and stereotactic body radiation therapy (SBRT) (SITS group) vs. sorafenib combined with TACE (ST group) in treating and downstaging advanced hepatocellular carcinoma (HCC) with portal vein tumor thrombus (PVTT). Methods: The present study included patients with advanced HCC and PVTT treated with one of the above combination therapies. The downstaging rate, objective response rate (ORR), progression-free survival (PFS), overall survival (OS), disease control rate (DCR), and adverse events (AEs) were assessed. Results: Sixty-two patients were analyzed. The ORR was elevated in the SITS group compared with the ST group (p = 0.036), but no differences were found in DCR (p = 0.067). The survival analysis revealed higher PFS (p = 0.015) and OS (p = 0.013) in the SITS group, with median PFS and OS times of 10.4 and 13.8 months, respectively. Ten patients displayed successful downstaging and underwent surgery in the SITS group, vs. none in the ST group. The prognosis was better in surgically treated patients compared with the non-surgery subgroup, based on PFS (p < 0.001) and OS (p = 0.003). Despite a markedly higher rate of AEs in the SITS group (p = 0.020), including two severe AEs, the SITS combination therapy had an acceptable safety profile. Conclusion: The SITS combination therapy yields higher PFS and OS than the combined administration of sorafenib and TACE in patients with advanced HCC and PVTT, especially as a downstaging strategy before surgery.

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Hepatocellular carcinoma with macrovascular invasion: multimodality imaging features for the diagnosis

Cited by 13 publications

References 44 publications

Combination of Sorafenib, Camrelizumab, Transcatheter Arterial Chemoembolization, and Stereotactic Body Radiation Therapy as a Novel Downstaging Strategy in Advanced Hepatocellular Carcinoma With Portal Vein Tumor Thrombus: A Case Series Study

Combination of Sorafenib, Camrelizumab, Transcatheter Arterial Chemoembolization, and Stereotactic Body Radiation Therapy as a Novel Downstaging Strategy in Advanced Hepatocellular Carcinoma With Portal Vein Tumor Thrombus: A Case Series Study

Clinical Versus Radiographical Factors Associated With Hepatocellular Carcinoma Diagnosis in high-risk Patients: Sizes Matter

A Combination of Sorafenib, an Immune Checkpoint Inhibitor, TACE and Stereotactic Body Radiation Therapy versus Sorafenib and TACE in Advanced Hepatocellular Carcinoma Accompanied by Portal Vein Tumor Thrombus

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