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Jean Francois H Geschwind - One of the best experts on this subject based on the ideXlab platform.

  • predicting treatment response to intra arterial therapies for hepatocellular carcinoma with the use of supervised machine learning an artificial intelligence concept
    Journal of Vascular and Interventional Radiology, 2018
    Co-Authors: Aaron Abajian, Nikitha Murali, Lynn Jeanette Savic, Fabian Max Laagegaupp, Nariman Nezami, J S Duncan, Todd Schlachter, Mingde Lin, Jean Francois H Geschwind
    Abstract:

    Abstract Purpose To use magnetic resonance (MR) imaging and clinical patient data to create an artificial intelligence (AI) framework for the prediction of therapeutic outcomes of transarterial Chemoembolization by applying machine learning (ML) techniques. Materials and Methods This study included 36 patients with hepatocellular carcinoma (HCC) treated with transarterial Chemoembolization. The cohort (age 62 ± 8.9 years; 31 men; 13 white; 24 Eastern Cooperative Oncology Group performance status 0, 10 status 1, 2 status 2; 31 Child-Pugh stage A, 4 stage B, 1 stage C; 1 Barcelona Clinic Liver Cancer stage 0, 12 stage A, 10 stage B, 13 stage C; tumor size 5.2 ± 3.0 cm; number of tumors 2.6 ± 1.1; and 30 conventional transarterial Chemoembolization, 6 with drug-eluting embolic agents). MR imaging was obtained before and 1 month after transarterial Chemoembolization. Image-based tumor response to transarterial Chemoembolization was assessed with the use of the 3D quantitative European Association for the Study of the Liver (qEASL) criterion. Clinical information, baseline imaging, and therapeutic features were used to train logistic regression (LR) and random forest (RF) models to predict patients as treatment responders or nonresponders under the qEASL response criterion. The performance of each model was validated using leave-one-out cross-validation. Results Both LR and RF models predicted transarterial Chemoembolization treatment response with an overall accuracy of 78% (sensitivity 62.5%, specificity 82.1%, positive predictive value 50.0%, negative predictive value 88.5%). The strongest predictors of treatment response included a clinical variable (presence of cirrhosis) and an imaging variable (relative tumor signal intensity >27.0). Conclusions Transarterial Chemoembolization outcomes in patients with HCC may be predicted pre-procedurally by combining clinical patient data and baseline MR imaging with the use of AI and ML techniques.

  • lack of response after initial Chemoembolization for hepatocellular carcinoma does it predict failure of subsequent treatment
    Radiology, 2012
    Co-Authors: Christos S Georgiades, Jean Francois H Geschwind, Neil A Harrison, Andrew Hinesperalta, Eleni Liapi, Kelvin Hong, Ihab R Kamel, Constantine Frangakis
    Abstract:

    PURPOSE To (a) evaluate the response of hepatocellular carcinoma (HCC) to Chemoembolization after initial nonresponse, as determined with European Association for the Study of the Liver (EASL) criteria and modified Response Evaluation Criteria in Solid Tumors (mRECIST), and (b) compare posttreatment survival of initial nonresponders versus that of initial responders. MATERIALS AND METHODS The institutional review board approved this retrospective study, which was compliant with HIPAA. A total of 116 consecutive patients (96 men, 20 women; mean age, 63 years) with unresectable HCC who underwent at least two Chemoembolization procedures were included. The Chemoembolization mixture consisted of 100 mg of cisplatin, 50 mg of doxorubicin, and 10 mg of mitomycin C mixed 1:1 with iodized oil. Tumor response at magnetic resonance imaging was evaluated after each Chemoembolization procedure according to EASL criteria and mRECIST. The survival rate in each subgroup was calculated and correlated with response. The Wilcoxon test was used to test group comparability. Kaplan-Meier estimators were used to generate survival curves and compared by using the log-rank test. RESULTS No response to initial Chemoembolization was seen in 43% and 50% of patients according to EASL criteria and mRECIST, respectively. After a second Chemoembolization procedure, 44% (EASL) and 47% (mRECIST) of initial nonresponders showed a significant response. With EASL criteria, the 1-, 2-, and 3-year survival rates (±standard error of the mean) after two Chemoembolization procedures were 39%±10, 14%±7, and 0%, respectively, for nonresponders and 68%±10, 50%±11, and 37%±11 for responders (P=.036, P=.006, and P<.005 at 1, 2, and 3 years). With mRECIST, the 1-, 2-, and 3-year survival rates after two Chemoembolization procedures were 49%±9, 20%±8, and 7%±6 for nonresponders and 67%±9, 44%±10, and 36%±9 for responders (P=.174, P=.046, and P=.011 at 1, 2, and 3 years). CONCLUSION Patients who underwent Chemoembolization for HCC showed a response (with both EASL criteria and mRECIST) and improved survival after the second Chemoembolization treatment. At least two Chemoembolization procedures should be performed in the same targeted lesions before further treatment is abandoned.

  • Transcatheter Arterial Chemoembolization for Liver Cancer: Is It Time to Distinguish Conventional from Drug-Eluting Chemoembolization?
    Cardiovascular and interventional radiology, 2010
    Co-Authors: Eleni Liapi, Jean Francois H Geschwind
    Abstract:

    Conventional transcatheter arterial Chemoembolization and Chemoembolization with drug-eluting beads are increasingly being performed interchangeably in many institutions throughout the world. As both therapies continue to being tested in many phase II and III studies and in combination with other therapies, especially targeted agents, for treatment of primary and metastatic liver cancer, it is imperative to review their current status and evaluate their impact on patient survival. This review critically assesses patient selection, indications, contraindications, techniques, materials, safety, and clinical outcomes of patients treated with conventional Chemoembolization and Chemoembolization with drug-eluting beads.

  • Chemoembolization of liver tumor in a rabbit model assessment of tumor cell death with diffusion weighted mr imaging and histologic analysis
    Journal of Vascular and Interventional Radiology, 2000
    Co-Authors: Jean Francois H Geschwind, Dimitri Artemov, Susan C Abraham, David G Omdal, Michael Huncharek, Carolyn Mcgee, Aravind Arepally, Drew L Lambert, Anthony C Venbrux, Gunnar B Lund
    Abstract:

    PURPOSE To assess the efficacy of Chemoembolization of liver tumors by determining the fraction of viable tumor cells remaining after treatment with use of diffusion magnetic resonance (MR) imaging and histologic analysis. MATERIALS AND METHODS VX2 tumor was grown in the livers of 12 rabbits. Animals were divided into a Chemoembolization group and an untreated group. Conventional, perfusion, and diffusion MR imaging was performed on all rabbits. Histopathologic analysis of explanted livers was performed to document tumor cell death and measure Bcl-2 levels (inhibitor of apoptosis). RESULTS Diffusion-weighted MR imaging delineated zones of tumor cell death as regions of lower signal intensity in both groups. Apparent diffusion coefficients were significantly greater in the area of tumor necrosis than in the area of viable tumor. Histologic analysis demonstrated a significantly lower percentage of viable cells in the treated group ( CONCLUSIONS Chemoembolization causes extensive tumor cell destruction. Diffusion MR imaging can detect tumor cell death and can be used to assess the efficacy of Chemoembolization. Bcl-2 was expressed in the treated group, suggesting an apoptotic pathway of cell death.

Riad Salem - One of the best experts on this subject based on the ideXlab platform.

  • Transarterial Chemoembolization and radioembolization
    Seminars in liver disease, 2014
    Co-Authors: Bruno Sangro, Riad Salem
    Abstract:

    Transarterial Chemoembolization (TACE) and radioembolization (RE) are frequently used to treat patients with hepatocellular carcinoma who cannot receive curative therapies. Transarterial Chemoembolization is a heterogeneous group of procedures; based on two positive clinical trials and three meta-analyses, conventional TACE is the standard of care for patients in the intermediate stage. Transarterial Chemoembolization with drug-eluting beads has been recently introduced as a more standardized way of performing TACE with similar outcomes and less systemic effects. Radioembolization is a form of brachytherapy in which microspheres are used as a source of internal radiation. Evidence supporting the use of RE derives from consistent, large-cohort series involving patients with more advanced hepatocellular carcinoma, not suitable for TACE or for those who have failed TACE. Transarterial Chemoembolization and RE should not be considered competing therapies, but rather complementary tools. The clinical indications for TACE and RE will be further refined as results of ongoing large-scale studies become available.

  • radioembolization results in longer time to progression and reduced toxicity compared with Chemoembolization in patients with hepatocellular carcinoma
    Gastroenterology, 2011
    Co-Authors: Riad Salem, Robert J Lewandowski, Laura Kulik, Edward Wang, Ahsun Riaz, Robert K Ryu, Kent T Sato, Ramona Gupta, Paul Nikolaidis, Frank H Miller
    Abstract:

    Background & Aims Chemoembolization is one of several standards of care treatment for hepatocellular carcinoma (HCC). Radioembolization with Yttrium-90 microspheres is a novel, transarterial approach to radiation therapy. We performed a comparative effectiveness analysis of these therapies in patients with HCC. Methods We collected data from 463 patients who were treated with transarterial locoregional therapies (Chemoembolization or radioembolization) over a 9-year period. We excluded patients who were not appropriate for comparison and analyzed data from 245 (122 who received Chemoembolization and 123 who received radioembolization). Patients were followed for signs of toxicity; all underwent imaging analysis at baseline and follow-up time points. Overall survival was the primary outcome measure. Secondary outcomes included safety, response rate, and time-to-progression. Uni- and multivariate analyses were performed. Results Abdominal pain and increased transaminase activity were more frequent following Chemoembolization ( P .05). There was a trend that patients treated with radioembolization had a higher response rate than with Chemoembolization (49% vs 36%, respectively, P = .104). Although time-to-progression was longer following radioembolization than Chemoembolization (13.3 months vs 8.4 months, respectively, P = .046), median survival times were not statistically different (20.5 months vs 17.4 months, respectively, P = .232). Among patients with intermediate-stage disease, survival was similar between groups that received Chemoembolization (17.5 months) and radioembolization (17.2 months, P = .42). Conclusions Patients with HCC treated by Chemoembolization or radioembolization with Yttrium-90 microspheres had similar survival times. Radioembolization resulted in longer time-to-progression and less toxicity than Chemoembolization. Post hoc analyses of sample size indicated that a randomized study with > 1000 patients would be required to establish equivalence of survival times between patients treated with these two therapies.

Nishita Kothary - One of the best experts on this subject based on the ideXlab platform.

  • Comparison of Opioid Medication Use after Conventional Chemoembolization versus Drug-Eluting Embolic Chemoembolization.
    Journal of vascular and interventional radiology : JVIR, 2020
    Co-Authors: Mohamed H. Khalaf, Rajesh P. Shah, Victoria Green, Alexander Vezeridis, Tie Liang, Nishita Kothary
    Abstract:

    PURPOSE To assess the use of opioid analgesics and/or antiemetic drugs for pain and nausea following selective Chemoembolization with doxorubicin-based conventional (c)-transarterial Chemoembolization versus drug-eluting embolic (DEE)-transarterial Chemoembolization for hepatocellular carcinoma (HCC). MATERIALS AND METHODS From October 2014 to 2016, 283 patients underwent 393 selective Chemoembolization procedures including 188 patients (48%) who underwent c-transarterial Chemoembolization and 205 (52%) who underwent DEE-transarterial Chemoembolization. Medical records for all patients were retrospectively reviewed. Administration of postprocedural opioid and/or antiemetic agents were collated. Time of administration was stratified as phase 1 recovery (0-6 hours) and observation (6-24 hours). Logistic regression model was used to investigate the relationship of transarterial Chemoembolization type and use of intravenous and/or oral analgesic and antiemetic medications while controlling for other clinical variables. RESULTS More patients treated with DEE-transarterial Chemoembolization required intravenous analgesia in the observation (6-24 hours) phase (18.5%) than those treated with c-transarterial Chemoembolization (10.6%; P = .033). Similar results were noted for oral analgesic agents (50.2% vs. 31.4%, respectively; P < .001) and antiemetics (17.1% vs. 7.5%, respectively; P = .006) during the observation period. Multivariate regression models identified DEE-transarterial Chemoembolization as an independent predictor for oral analgesia (odds ratio [OR], 1.84; P = .011), for intravenous and oral analgesia in opioid-naive patients (OR, 2.46; P = .029) and for antiemetics (OR, 2.56; P = .011). CONCLUSIONS Compared to c-transarterial Chemoembolization, DEE-transarterial Chemoembolization required greater amounts of opioid analgesic and antiemetic agents 6-24 hours after the procedure. Surgical data indicate that a persistent opioid habit can develop even after minor surgeries, therefore, caution should be exercised, and a regimen of nonopiate pain medications should be considered to reduce postprocedural pain after transarterial Chemoembolization.

  • utility of c arm ct in patients with hepatocellular carcinoma undergoing transhepatic arterial Chemoembolization
    Journal of Vascular and Interventional Radiology, 2010
    Co-Authors: A Tognolini, John D Louie, Gloria L Hwang, Lawrence V Hofmann, Daniel Y Sze, Nishita Kothary
    Abstract:

    Purpose To evaluate the utility of C-arm computed tomography (CT) on treatment algorithms in patients undergoing transhepatic arterial Chemoembolization for hepatocellular carcinoma (HCC). Materials and Methods From March 2008 to July 2008, 84 consecutive patients with HCC underwent 100 consecutive transhepatic arterial Chemoembolizations with iodized oil. Unenhanced and iodinated contrast medium–enhanced C-arm CT with planar and three-dimensional imaging were performed in addition to conventional digital subtraction angiography (DSA) in all patients. The effect on diagnosis and treatment was determined by testing the hypotheses that C-arm CT, in comparison to DSA, provides ( a ) improved lesion detection, ( b ) expedient identification and mapping of arterial supply to a tumor, ( c ) improved characterization of a lesion to allow confident differentiation of HCC from pseudolesions such as arterioportal shunts, and ( d ) an improved evaluation of treatment completeness. The effect of C-arm CT was analyzed on the basis of information provided with C-arm CT that was not provided or readily apparent at DSA. Results C-arm CT was technically successful in 93 of the 100 procedures (93%). C-arm CT provided information not apparent or discernible at DSA in 30 of the 84 patients (36%) and resulted in a change in diagnosis, treatment planning, or treatment delivery in 24 (28%). The additional information included, amongst others, visualization of additional or angiographically occult tumors in 13 of the 84 patients (15%) and identification of incomplete treatment in six (7.1%). Conclusions C-arm CT is a useful collaborative tool in patients undergoing transhepatic arterial Chemoembolization and can affect patient care in more than one-fourth of patients.

Bruno Sangro - One of the best experts on this subject based on the ideXlab platform.

  • Transarterial Chemoembolization and radioembolization
    Seminars in liver disease, 2014
    Co-Authors: Bruno Sangro, Riad Salem
    Abstract:

    Transarterial Chemoembolization (TACE) and radioembolization (RE) are frequently used to treat patients with hepatocellular carcinoma who cannot receive curative therapies. Transarterial Chemoembolization is a heterogeneous group of procedures; based on two positive clinical trials and three meta-analyses, conventional TACE is the standard of care for patients in the intermediate stage. Transarterial Chemoembolization with drug-eluting beads has been recently introduced as a more standardized way of performing TACE with similar outcomes and less systemic effects. Radioembolization is a form of brachytherapy in which microspheres are used as a source of internal radiation. Evidence supporting the use of RE derives from consistent, large-cohort series involving patients with more advanced hepatocellular carcinoma, not suitable for TACE or for those who have failed TACE. Transarterial Chemoembolization and RE should not be considered competing therapies, but rather complementary tools. The clinical indications for TACE and RE will be further refined as results of ongoing large-scale studies become available.

  • Chemoembolization and radioembolization.
    Best practice & research. Clinical gastroenterology, 2014
    Co-Authors: Bruno Sangro
    Abstract:

    Chemoembolization and radioembolization are at the core of the treatment of patients with hepatocellular carcinoma who cannot receive potentially curative therapies such as transplantation, resection or percutaneous ablation. They differ in the mechanism of action (ischaemia and increase cytotoxic drug exposure for Chemoembolization, internal irradiation for radioembolization) and may target different patient populations. Chemoembolization with cytotoxic drug-eluting beads is a more standardized although not necessarily more effective way of performing Chemoembolization. Cytoreduction is achieved in most patients but complete tumor ablation may be achieved and lead to extended survival. Grade 1 level of evidence support the use of Chemoembolization for the treatment of patients in the early and intermediate stages while grade 2 evidence supports the use of radioembolization for the treatment of patients in intermediate to advanced stages. Selecting the best candidates for both techniques is still a work in progress that ongoing clinical trials are trying to address.

Michael B. Pitton - One of the best experts on this subject based on the ideXlab platform.