Regional chemotherapy for unresectable primary liver cancer: Results of a phase II clinical trial and assessment of DCE-MRI as a biomarker of survival Journal Article

   

Authors:	Jarnagin, W. R.; Schwartz, L. H.; Gultekin, D. H.; Gonen, M.; Haviland, D.; Shia, J.; D'Angelica, M.; Fong, Y.; DeMatteo, R.; Tse, A.; Blumgart, L. H.; Kemeny, N.
Article Title:	Regional chemotherapy for unresectable primary liver cancer: Results of a phase II clinical trial and assessment of DCE-MRI as a biomarker of survival
Abstract:	Background: This study reports the results of hepatic arterial infusion (HAI) with floxuridine (FUDR) and dexamethasone (dex) in patients with unresectable intrahepatic cholangiocarcinoma (ICC) or hepatocellular carcinoma (HCC) and investigates dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) assessment of tumor vascularity as a biomarker of outcome. Patients and methods: Thirty-four unresectable patients (26 ICC and eight HCC) were treated with HAI FUDR/dex. Radiologic dynamic and pharmacokinetic parameters related to tumor perfusion were analyzed and correlated with response and survival. Results: Partial responses were seen in 16 patients (47.1%); time to progression and response duration were 7.4 and 11.9 months, respectively. Median follow-up and median survival were 35 and 29.5 months, respectively; 2-year survival was 67%. DCE-MRI data showed that patients with pretreatment integrated area under the concentration curve of gadolinium contrast over 180 s (AUC 180) &gt;34.2 mM·s had a longer median survival than those with AUC 180 &lt;34 mM·s (35.1 versus 19.1 months, P = 0.002). Decreased volume transfer exchange between the vascular space and extracellular extravascular space (-ΔK<sup>trans</sup>) and the corresponding rate constant (-Δk<sub>ep</sub>) on the first post-treatment scan both predicted survival. Conclusions: In patients with unresectable primary liver cancer, HAI therapy can be effective and safe. Pretreatment and early post-treatment changes in tumor perfusion characteristics may predict treatment outcome. © The Author 2009. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved.
Keywords:	adult; cancer survival; clinical article; treatment outcome; aged; aged, 80 and over; disease-free survival; middle aged; survival analysis; survival rate; clinical trial; hepatocellular carcinoma; advanced cancer; cancer combination chemotherapy; cancer growth; drug dose reduction; drug safety; liver cell carcinoma; side effect; treatment duration; carcinoma, hepatocellular; liver neoplasms; nuclear magnetic resonance imaging; follow up; magnetic resonance imaging; multiple cycle treatment; phase 2 clinical trial; tumor volume; antineoplastic combined chemotherapy protocols; clinical assessment; dexamethasone; antineoplastic activity; abdominal pain; survival time; contrast enhancement; drug response; chemotherapy, cancer, regional perfusion; liver cancer; area under curve; intrahepatic cholangiocarcinoma; bile duct carcinoma; bile duct neoplasms; bile ducts, intrahepatic; cholangiocarcinoma; inoperable cancer; floxuridine; microvasculature; dce-mri; hai fudr; extracellular space; extravascular space; intravascular space
Journal Title:	Annals of Oncology
Volume:	20
Issue:	9
ISSN:	0923-7534
Publisher:	Oxford University Press
Date Published:	2009-09-01
Start Page:	1589
End Page:	1595
Language:	English
DOI:	10.1093/annonc/mdp029
PUBMED:	19491285
PROVIDER:	scopus
PMCID:	PMC2731015
DOI/URL:	http://www.scopus.com/inward/record.url?eid=2-s2.0-69849103783&partnerID=40&md5=17516973043338d6cc63bd7199fa029f
Notes:	--- - "Cited By (since 1996): 5" - "Export Date: 30 November 2010" - "CODEN: ANONE" - "Source: Scopus"

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