Uveal Melanoma Metastatic to the Liver: The Role of Quantitative Volumetric Contrast-Enhanced MR Imaging in the Assessment of Early Tumor Response after Transarterial Chemoembolization

Rafael Duran; Julius Chapiro; Constantine Frangakis; MingDe Lin; Todd R Schlachter; Rüdiger E Schernthaner; Zhijun Wang; Lynn J Savic; Vania Tacher; Ihab R Kamel; Jean-François Geschwind

doi:10.1016/j.tranon.2014.05.004

Uveal Melanoma Metastatic to the Liver: The Role of Quantitative Volumetric Contrast-Enhanced MR Imaging in the Assessment of Early Tumor Response after Transarterial Chemoembolization

Transl Oncol. 2014 Aug;7(4):447-55. doi: 10.1016/j.tranon.2014.05.004. Epub 2014 Jun 20.

Authors

Affiliations

¹ Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology, The Johns Hopkins Hospital, Baltimore, MD, 21287, USA. Electronic address: jfg@jhmi.edu.
² Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology, The Johns Hopkins Hospital, Baltimore, MD, 21287, USA. Electronic address: j.chapiro@googlemail.com.
³ Ultrasound and Interventions, Philips Research North America, Briarcliff Manor, NY, USA. Electronic address: cfranga1@jhu.edu.
⁴ Department of Biostatistics, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. Electronic address: ming.lin@philips.com.
⁵ Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology, The Johns Hopkins Hospital, Baltimore, MD, 21287, USA. Electronic address: tschlac1@jhmi.edu.
⁶ Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology, The Johns Hopkins Hospital, Baltimore, MD, 21287, USA. Electronic address: rschern1@jhmi.edu.
⁷ Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology, The Johns Hopkins Hospital, Baltimore, MD, 21287, USA. Electronic address: zwang58@jhmi.edu.
⁸ Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology, The Johns Hopkins Hospital, Baltimore, MD, 21287, USA. Electronic address: lsavic1@jhmi.edu.
⁹ Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology, The Johns Hopkins Hospital, Baltimore, MD, 21287, USA. Electronic address: vaniatacher@gmail.com.
¹⁰ Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology, The Johns Hopkins Hospital, Baltimore, MD, 21287, USA. Electronic address: ikamel@jhmi.edu.

Abstract

Purpose: To determine whether volumetric changes of enhancement as seen on contrast-enhanced magnetic resonance (MR) imaging can help assess early tumor response and predict survival in patients with metastatic uveal melanoma after one session of transarterial chemoembolization (TACE).

Materials and methods: Fifteen patients with 59 lesions who underwent MR imaging before and 3 to 4 weeks after the first TACE were retrospectively included. MR analysis evaluated signal intensities, World Health Organization (WHO), Response Evaluation Criteria in Solid Tumors (RECIST), European Association for the Study of the Liver (EASL), modified RECIST (mRECIST), tumor volume [volumetric RECIST (vRECIST)], and volumetric tumor enhancement [quantitative EASL (qEASL)]. qEASL was expressed in cubic centimeters [qEASL (cm(3))] and as a percentage of the tumor volume [qEASL (%)]. Paired t test with its exact permutation distribution was used to compare measurements before and after TACE. The Kaplan-Meier method with the log-rank test was used to calculate overall survival for responders and non-responders.

Results: In target lesions, mean qEASL (%) decreased from 63.9% to 42.6% (P = .016). No significant changes were observed using the other response criteria. In non-target lesions, mean WHO, RECIST, EASL, mRECIST, vRECIST, and qEASL (cm(3)) were significantly increased compared to baseline. qEASL (%) remained stable (P = .214). Median overall survival was 5.6 months. qEASL (cm(3)) was the only parameter that could predict survival based on target lesions (3.6 vs 40.5 months, P < .001) or overall (target and non-target lesions) response (4.4 vs 40.9 months, P = .001).

Conclusion: Volumetric tumor enhancement may be used as a surrogate biomarker for survival prediction in patients with uveal melanoma after the first TACE.

Abstract

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