Page 194 - ebook HCC

192 PROGRAMME AND ABSTRACTS GENEVA, SWITZERLAND EASL HCC SUMMIT 193
FEBRUARY 13 - 16, 2014

RADIOLOGY IN ASSESSING RESPONSE OR AS BEST SUPPORTIVE CARE FOR
PREDICTIVE TOOL HEPATOCELLULAR CARCINOMA

Rita Golfieri 1 Jean-Luc Raoul 1
1 Azienda Ospedaliero-Universitaria di Bologna, Policlinico S.Orsola-Malpighi, 1 Paoli-Calmettes Institute, Marseille, France
Bologna, Italy
Corresponding author’s e-mail: RAOULJL@ipc.unicancer.fr
Corresponding author’s e-mail: rita.golfieri@aosp.bo.it

Best supportive care are the only recognized treatment for end-stage hepatocellular
Survival has the key role in the assessment of treatment efficacy in solid tumors, but carcinoma (HCC) and must be used in other stages if required. Best supportive care aim
objective radiologic response has been widely accepted as an auxiliary surrogate end to treat symptoms in order to improve patients’ quality of life, eventually performance
point. For radiologic response evaluation, in 1979 the World Health Organization (WHO) status and survival. In the field of HCC the main symptoms physician will have to treat
response criteria were introduced, based on the sum of bidimensional perpendicular are pain, fatigue, anorexia, depression, encephalopathy and ascitis. Pain can be related
products and in 2000 the Response Evaluation Criteria in Solid Tumors (RECIST) were to the tumor itself or to extrahepatic metastases (particularly bones). End stage patients
introduced, based on the sum of the unidimensional longest diameters, further revised will have impaired drug metabolism and frequently also impaired renal function restricting
to version 1.1 in 2009. Both WHO and RECIST criteria were designed for the evaluation our analgesic choice. Paracetamol at reduced doses (2 – 3 g/d) can be used for mild pain
of cytotoxic agents, aimed at reducing tumor size, and have been proven as valuable in patients not actively drinking alcohol. The liver is the main site of metabolism for most
response assessment methods to well reflect patient survival. By converse, molecular opioids. Half-life of morphine is double and opioids can increase the risk for encephalopathy.
targeted therapy or locoregional treatments frequently induce necrosis without tumor Hydromorphone and fentanyl derivatives may be the best choices; the initial doses may be
shrinkage in size and, therefore, clinical benefit could be only correlated with necrosis reduce and the interval initially increased but that needs to be reassessed daily. NSAIDs
of a viable tumor. To overcome these limitations, recently, the European Association must be avoided due to the high risk of hepatorenal syndrome. If pain is related to a well
CLINICAL SPEAKERS ABSTRACTS lesion modifying WHO (into EASL) and RECIST (into mRECIST) criteria, respectively. encephalopathy are still based on lactulose. Anorexia is very common and participates CLINICAL SPEAKERS ABSTRACTS
for the Study of the Liver (EASL) and the American Association for the Study of Liver
recognized abnormality, specific treatment can be given (radiotherapy / cementoplasty if
Disease (AASLD) have proposed new methods, including the concept of viable enhancing
bone metastases).Primary and secondary prophylaxis but also treatment of overt hepatic
in malnutrition. Parenteral nutrition is poorly tolerated and its efficacy questionable; the
Viability defined as contrast enhancement is one of the key patterns of HCC and is more
important for assessing clinically response after locoregional treatments in HCC patients,
best option is to propose oral nutritional supplements and dietetary counseling are useful.
since WHO and RECIST criteria underestimate complete or partial responses based on
More than half of patients complained of unsatisfactory sleep and fatigue at extreme with
inversion of sleep pattern (particularly in case of encephalopathy); behavioral modifications
necrosis development without lesion shrinkage. In fact, some studies confirmed that, after
TACE, 38–50% of Partial Response and 58–86% of Stable Disease according to RECIST
in HCC patients and amplifies pain and other symptoms. Non pharmacological treatment
were reclassified to complete response and objective response in EASL. The presence
are the first line and antidepressants (Selective Serotonin Reuptake Inhibitors) initially
of response according to EASL and mRECIST was demonstrated as independent are a better solution than sedatives. Depression is present in > 50% of cirrhotic and more
predictors of survival in HCC patients undergoing TACE. However, EASL and mRECIST at low dose can be useful.To conclude, best supportive cares are very important in HCC
methods should be further extensively validated upon their correlation with the survival patients particularly in end-stage; due to impaired liver function the use of most drugs is
in HCC patients undergoing locoregional and molecular targeted therapies, also taking difficult.
into account some limitations in their practical applicability, due to imaging complexities
still unaddressed, as recently advised.Furthermore, the optimal method for response
evaluation, chosen among CEUS, CT, PET-CT and MRI, to be employed in the follow up
after locoregional treatments has still to be clearly addressed.