Transarterial chemoembolization in soft-tissue sarcoma metastases to the liver – The use of imaging biomarkers as predictors of patient survival

Abstract

Background The clinical management of patients with metastatic soft-tissue sarcoma of the liver is complicated by the paucity of reliable clinical data. This study evaluated the safety profile, survival outcome as well as the role of imaging biomarkers of tumor response in metastatic soft-tissue sarcoma (mSTS) of the liver treated with conventional transarterial chemoembolization (cTACE). Materials/methods This retrospective analysis included 30 patients with mSTS of the liver treated with cTACE. The safety profile, overall survival (OS) and progression-free survival (PFS) after the procedure were evaluated. Tumor response in each patient was assessed using RECIST, modified (m) RECIST and EASL guidelines. In addition, a 3D quantification of the enhancing tumor volume (quantitative [q] EASL) was performed. For each method, patients were classified as responders (R) and non-responders (NR), and evaluated using Kaplan-Meier and multivariate Cox proportional hazard ratio (HR) analysis. Results No Grade III or IV toxicities were reported in a total of 77 procedures (mean, 2.6/patient). Median OS was 21.2 months (95% CI, 13.4–28.9) and PFS was 6.3 months (95% CI, 4.4–8.2). The enhancement-based techniques identified 11 (44%), 12 (48%) and 12 (48%) patients as R according to EASL, mRECIST and qEASL, respectively. No stratification was achieved with RECIST. Multivariate analysis identified tumor response according to mRECIST and qEASL as reliable predictors of improved patient survival (P = 0.019; HR 0.3 [0.1–0.8] and P = 0.006; HR 0.2 [0.1–0.6], respectively). Conclusion This study confirmed the role of cTACE as a safe salvage therapy option in patients with mSTS of the liver. The demonstrated advantages of enhancement-based tumor response assessment techniques over size-based criteria validate mRECIST and qEASL as preferable methods after intraarterial therapy.

Comparison of Existing Response Criteria in Patients with Hepatocellular Carcinoma Treated with Transarterial Chemoembolization Using a 3D Quantitative Approach

“…Indeed, several works have shown the predictive value of tumor segmentation–based quantitative analysis in patients with HCC (24,25). This was also done for metastatic disease in the liver, where it was shown that the same 3D methods used in our work had improved survival prediction when compared with the one- and two-dimensional methods (32,33,39). …”

Imaging Biomarkers of Tumor Response in Neuroendocrine Liver Metastases Treated with Transarterial Chemoembolization: Can Enhancing Tumor Burden of the Whole Liver Help Predict Patient Survival?

“…Second, a volumetric assessment addresses the discordance between lesion diameter or area and volume of tumor tissue—a limitation associated with one-and two-dimensional enhancement-based criteria (mRECIST and EASL, respectively) (14,15,39). Both criteria examine one axial section, which often is not representative of the entire tumor and could explain why mRECIST and EASL were poor biomarkers for survival in our study and other studies (11,14,17,18). Volumetric enhancement–based criteria, however, measure the entire tumor and can account for the heterogeneous, nonspherical necrosis that embolotherapy induces (15,39).…”

“…Volumetric measurements of tumor enhancement are more representative of tumor necrosis and have been shown to help predict survival (11,14,17,18). In general, volumetric analysis has been applied on a lesion-by-lesion basis.…”

Hypo-Vascular Liver Metastases Treated with Transarterial chemoembolization: Assessment of Early Response by Volumetric Contrast-Enhanced and Diffusion-Weighted Magnetic Resonance Imaging

“…Quantitative and functional evaluation of hepatic lesions provide a more comprehensive assessment of tumor response, as these metrics consider changes in the whole tumor as opposed to conventional criteria which assess the tumor in a single axial plane. In addition, former studies have shown a higher correlation between these volumetric metrics with overall survival and histopathological evaluation compared with anatomic metrics [13], [14], [16], [22], [28], [29]. Yet, to date, only a few studies have assessed similar application of both volumetric and anatomic metrics for hypo-vascular liver metastases.…”