Validation of dynamic contrast-enhanced ultrasound in predicting outcomes of antiangiogenic therapy for solid tumors: the French multicenter support for innovative and expensive techniques study.

OBJECTIVES: Dynamic contrast-enhanced ultrasound (DCE-US) has been used in single-center studies to evaluate tumor response to antiangiogenic treatments: the change of area under the perfusion curve (AUC), a criterion linked to blood volume, was consistently correlated with the Response Evaluation Criteria in Solid Tumors response. The main objective here was to do a multicentric validation of the use of DCE-US to evaluate tumor response in different solid tumor types treated by several antiangiogenic agents. A secondary objective was to evaluate the costs of the procedure. MATERIALS AND METHODS: This prospective study included patients from 2007 to 2010 in 19 centers (8 teaching hospitals and 11 comprehensive cancer centers). All patients treated with antiangiogenic therapy were eligible. Dynamic contrast-enhanced ultrasound examinations were performed at baseline as well as on days 7, 15, 30, and 60. For each examination, a perfusion curve was recorded during 3 minutes after injection of a contrast agent. Change from baseline at each time point was estimated for each of 7 fitted criteria. The main end point was freedom from progression (FFP). Criterion/time-point combinations with the strongest correlation with FFP were analyzed further to estimate an optimal cutoff point. RESULTS: A total of 1968 DCE-US examinations in 539 patients were analyzed. The median follow-up was 1.65 years. Variations from baseline were significant at day 30 for several criteria, with AUC having the most significant association with FFP (P = 0.00002). Patients with a greater than 40% decrease in AUC at day 30 had better FFP (P = 0.005) and overall survival (P = 0.05). The mean cost of each DCE-US was 180&OV0556;, which corresponds to $250 using the current exchange rate. CONCLUSIONS: Dynamic contrast-enhanced ultrasound is a new functional imaging technique that provides a validated criterion, namely, the change of AUC from baseline to day 30, which is predictive of tumor progression in a large multicenter cohort. Because of its low cost, it should be considered in the routine evaluation of solid tumors treated with antiangiogenic therapy.

Direct intratumoral chemotherapy with carboplatin and epinephrine in a recurrent cervical chordoma: case report.

OBJECTIVE: Chordomas are rare primary bone tumors for which surgery is classically the first-line treatment. However, safe margins are often difficult to obtain, so that patients are at risk of local recurrence. Because radiation therapy and systemic chemotherapy show limited effectiveness, we report the use of direct intratumoral chemotherapy (IC) to treat recurrent chordoma. CLINICAL PRESENTATION: A 46-year-old man presented with a recurrent cervical chordoma after surgery and radiation therapy. This recurrence manifested as C4-C5 spinal cord compression. TECHNIQUE: Three 22-gauge needles were inserted at the upper, middle, and lower parts of the tumor and advanced under computed tomographic guidance while injecting local anesthetic. A 5-mg/mL carboplatin solution was combined with epinephrine (to increase the concentration and antitumor effect of carboplatin) at a final concentration of 0.01 mg/mL and an iodinated contrast agent. We injected 3 to 5 mL of this solution over 5 minutes through each needle under computed tomographic guidance. Eleven intratumoral treatments were performed during an 18-month period. CONCLUSION: A marked clinical response with regression of the spinal cord compression was observed, without specific toxicity. A good partial response was obtained with a 42% decrease in tumor volume (from 69 to 40 cm3). Moreover, the central part of the tumor showed tumor necrosis, as confirmed by histological examination. Thus, in patients with this rare tumor, intratumoral chemotherapy may be a valid treatment option when surgery and radiation therapy fail. Furthermore, intratumoral chemotherapy in combination with surgical treatment should be considered to improve the local control rate.