Early Response to Anti-Tumoral Treatment in Hepatocellular Carcinoma - Can Quantitative Contrast-Enhanced Ultrasound Predict Outcome?

Purpose: In order to detect an early response to anti-angiogenic therapy, this study aims at analyzing specific effects of a sorafenib-based regime on intra-tumoral D-CEUS flow parameters of patients with HCC. Materials and Methods: Videos of the arterial phase were captured before initiation of a therapy with sorafenib and 1 and 3 months after (n = 9). Patients receiving a non-anti-angiogenic therapy (TACE, n = 10) served as a comparison group. Cross-sectional imaging was performed at the same time points and patients were followed up for 1 year. Results: In the responder group (RE), the absolute (percentage) UP was 11.28 s +/- 2.03 s (1.00) before treatment, 13.60 s +/- 1.52s (1.53 +/- 0.08) after one month (p = 0.0405), and 16.17s +/- 2.35 s (1.46 +/- 0.07) after three months of treatment (p = 0.0071). The UP increased significantly in the RE group as early as 1 month after initiation of sorafenib compared to the non-responder group. There were no significant diffeiences in the non-responder group or between the NR and the TACE group at any time point. D-CEUS values from all sorafenib-treated patients showed good accordance with RECICL (response evaluation criteria in cancer of the liver) criteria (R-2=0.7154, p = 0.0001). Conclusions: Quantitative CEUS reveals variations of dynamic parameters of blood flow during anti-tumoral therapy in liver cancer patients. Further investigations and clinical trails have to confirm that. the UP is a promising parameter in the prediction of early response to sorafenib-based therapy.