Response evaluation of chemotherapy in metastatic colorectal cancer by contrast enhanced ultrasound.

AIM: To evaluate whether contrast enhanced ultrasound (CEUS) might also be used for response prediction and early response evaluation in patients receiving bevacizumab based chemotherapy for metastasized colorectal cancer. METHODS: Thirty consecutive patients with non primary resectable liver metastases from colorectal cancer underwent CEUS before treatment (CEUS date 1) and before the second (CEUS date 2) and fourth (CEUS date 3) cycle of bevacizumab based chemotherapy. Three parameters [PEAK, Time to peak (TTP) and RISE RATE]were correlated with radiological response. RESULTS: For neoadjuvant purpose a reduction of tumour mass was required to assume clinical response. Based on these response criteria there was a significant (P < 0.001) correlation in TTP between metastases of responders (9.08 s) and non-responders (14.76 s) archived on CEUS date 1. By calculating a standardized quotient (metastases divided by normal liver tissue) we were able to define a cut off, predicting response with a sensitivity of 92.3 % and a specificity of 100 %. To reflect a palliative intention only those patients with progressive disease were classified as non-responders. In this stetting TTP was also significantly (P < 0.01) different between responders and non-responders. In contrast, Peak and Rise rate did not show any significant difference between responder and non-responder. CONCLUSION: CEUS might serve as a surrogate marker to predict treatment response in patients with metastasized colorectal cancer who receive antiangiogenic therapy.

Safe use of FOLFOX in two patients with metastatic colorectal carcinoma and severe hepatic dysfunction.

BACKGROUND: Chemotherapeutic options for patients with metastasised colorectal cancer and impaired liver function are limited. Although oxaliplatin and 5-FU are well tolerated as single therapeutic agents, data supporting their use as combination chemotherapy in the setting of severe hepatic dysfunction are insufficient. PATIENTS AND METHODS: Here, we report on 2 patients with colorectal cancer and severe liver dysfunction secondary to hepatic metastases. On admission both patients displayed a bilirubin of > 22 mg/dL and an alkaline phosphatase (AP) of > 350 U/L as signs of extensive hepatic tumor spread. We initiated a 5-FU/oxaliplatin-based combination chemotherapy in both patients. RESULTS: Liver function and clinical performance improved dramatically within the first cycles of therapy in both patients. On radiologic evaluation, we observed 1 partial response and one long-term (10 months) disease stabilization. The toxicity was acceptable in both patients. CONCLUSION: We concluded that oxaliplatin-based combination chemotherapies (eg FOLFOX4) may achieve good tumor response without significant side effects in patients with metastatic colorectal cancer and hepatic dysfunction.

Long-term survival of a HCC-patient with severe liver dysfunction treated with sorafenib.

Hepatocellular carcinoma (HCC) is the most common primary cancer of the liver. Prognosis and treatment options are stage dependent. In general, prognosis of patients with unresectable HCC is poor, especially for those patients with impaired liver function. Whereas treatment with the novel molecular tyrosine kinase inhibitor sorafenib (Nexavar) was shown to result in prolonged survival in patients with preserved liver function, its' possible application in HCC-patients with strongly impaired liver function has not been clearly assessed. Here, we report on a 47-year-old male patient who presented with Child-Pugh class C liver cirrhosis and multifocal, non-resectable HCC. The patient was treated for 27 mo with Sorafenib, which was not associated with major drug-related side effects. During treatment, a reduction in tumour size of 24% was achieved, as assessed by regular CT scan. Moreover, within the 27 mo interval of stable tumour disease, liver function improved from Child-Pugh class C to class A.

Semi-automated measurement of hyperdense, hypodense and heterogeneous hepatic metastasis on standard MDCT slices. Comparison of semi-automated and manual measurement of RECIST and WHO criteria.

As semi-automated measurement would be desirable for lesion quantification and therapy-response control, the purpose of this study was to compare semi-automated measurements with manual assessment of different types of hepatic metastases. Seventy-six patients with known liver metastases were analysed. All of them underwent contrast-enhanced 16-MDCT (16 x 0.75 mm collimation, 120 kV, 0.5 s rotation time, 160 mAs(eff)) for evaluation of follow-up status. On the basis of standard reconstructed 5-mm slices (in 4-mm increments), each lesion was quantified based on RECIST and WHO criteria using a semi-automated software tool (Syngo Oncology) and also manually by an experienced radiologist. Results from the software were compared to manual measurements. Statistical analysis was performed applying the concordance correlation coefficient, and results were represented graphically in Bland-Altman plots. A total of 52 hyperdense, 57 hypodense and 56 heterogeneous metastases were found and correctly measured by the software. All three lesion types revealed a strong correlation agreement between measurement techniques [RECIST diameter: 0.93 (hyperdense), 0.95(hypodense), 0.94 (heterogeneous); WHO area: 0.95, 0.98, 0.93]. Semi-automatic measurement of hyperdense, hypodense and heterogeneous liver metastases showed reliable results on standard axial reconstructions in comparison to manual quantification.