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PURPOSE: The study aims to investigate the predictability of the radiological response in intrahepatic cholangiocarcinoma (iCC) patients undergoing Yttrium-90 transarterial radioembolization (TARE) with a combined model built on dynamic magnetic resonance imaging (MRI)-based radiomics and clinical features. METHODS: Thirty-six naive iCC patients who underwent TARE were included in this study. The tumor segmentation was performed on the axial T2-weighted (T2W) without fat suppression, axial T2W with fat suppression, and axial T1-weighted (T1W) contrast-enhanced (CE) sequence in equilibrium phase (Eq). At the sixth month MRI follow-up, all patients were divided into responders and non-responders according to the modified Response Evaluation Criteria in Solid Tumors. Subsequently, a radiomics score (rad-score) and a combined model of the rad-score and clinical features for each sequence were generated and compared between the groups. RESULTS: Thirteen (36.1%) patients were considered responders, and the remaining 23 (63.9%) were non-responders. Responders exhibited significantly lower rad-scores than non-responders (P < 0.050 for all sequences). The radiomics models showed good discriminatory ability with an area under the curve (AUC) of 0.696 [95% confidence interval (CI), 0.522-0.870] for the axial T1W-CE-Eq, AUC of 0.839 (95% CI, 0.709-0.970) for the axial T2W with fat suppression, and AUC of 0.836 (95% CI, 0.678-0.995) for the axial T2W without fat suppression. CONCLUSION: Radiomics models created by pre-treatment MRIs can predict the radiological response to Yttrium-90 TARE in iCC patients with high accuracy. Combining radiomics with clinical features could increase the power of the test. Large-scale studies of multi-parametric MRIs with internal and external validations are needed to determine the clinical value of radiomics in iCC patients. [ABSTRACT FROM AUTHOR]

Background. The significance of the current study was to determine normative levels of PIVKA-II and AFP in patients with unresectable HCC and healthy participants. The second goal was to assess the roles of PIVKA-II and AFP in predicting radiological response after loco-regional therapy. Methods. This prospective cohort study enrolled consecutive samples of HCC patients and healthy controls. Venous blood samples were obtained at baseline and after interventions to determine serum levels of PIVKA-II and AFP using the chemiluminescent microparticle immunoassay method. Radiologic responses were determined based on the WHO criteria. Results. Fifty-four HCC patients (mean age 58.9 years, 49 males) and 40 healthy controls (mean age 33.5 years, 26 males) were recruited. The median serum levels of PIVKA-II and AFP in HCC vs. healthy controls were 988.4 vs. 24.2 mAU/ml and 13.6 vs. 1.7 ng/ml, respectively (both p<0:001). With ROC curve analysis, the area under the curve (AUC) for PIVKA-II was 0.95 95% CI [0.90≥0.99], and for AFP it was 0.98, 95% CI [0.95≥1.0]). The cut-off value for PIVKA-II was 41.4 mAU/ml, and AFP was 4.8 ng/ml. PIVKA-II levels correlated significantly with radiological responses (r D0:64, pD0:02) but not AFP (r D0:09, pD0:2). Conclusion. PIVKA-II and AFP levels are distinctive between unresectable HCC and healthy controls. However, PIVKA-II, not AFP, can predict the radiological response after loco-regional therapy. [ABSTRACT FROM AUTHOR]

The aim of this study was to assess the association between radiological and histopathological response after neoadjuvant radiotherapy (nRT) in soft tissue sarcoma (STS), as well as the prognostic value of the different response evaluation methods on the oncological outcome. A retrospective cohort of patients with localized STS of the extremity and trunk wall, treated with nRT followed by resection were included. The radiological response was assessed by RECIST 1.1 (RECIST) and MR-adapted Choi (Choi), histopathologic response was evaluated according to the EORTC-STBSG recommendations. Oncological outcome parameters of interest were local recurrence-free survival (LRFS), disease metastases-free survival (DMFS), and overall survival (OS). For 107 patients, complete pre- and postoperative pathology and imaging datasets were available. Most tumors were high-grade (77%) and the most common histological subtypes were undifferentiated pleomorphic sarcoma/not otherwise specified (UPS/NOS, 40%), myxoid liposarcoma (MLS, 21%) and myxofibrosarcoma (MFS, 16%). When comparing RECIST to Choi, the response was differently categorized in 58%, with a higher response rate (CR + PR) with Choi. Radiological responders showed a significant lower median percentage of viable cells (RECIST p =.050, Choi p =.015) and necrosis (RECIST p <.001), and a higher median percentage of fibrosis (RECIST p =.005, Choi p =.008), compared to radiological non-responders (SD + PD). RECIST, Choi, fibrosis, and viable cells were not significantly associated with altered oncological outcome, more necrosis was associated with poorer OS (p =.038). RECIST, Choi and the EORTC-STBSG response score show incongruent results in response evaluation. The radiological response was significantly correlated with a lower percentage of viable cells and necrosis, but a higher percentage of fibrosis. Apart from necrosis, radiological nor other histopathological parameters were associated with oncologic outcomes. [ABSTRACT FROM AUTHOR]

Simple Summary: With the emergence of the concepts of transarterial chemoembolization (TACE) refractoriness and unsuitability and recent advances in systemic therapy, treatment options for intermediate-stage, unresectable hepatocellular carcinoma (u-HCC) are increasing. However, the efficacy of lenvatinib and its combination with TACE in clinical practice has not yet been adequately investigated. This study investigated the efficacy of lenvatinib and its combination with TACE after lenvatinib in patients with intermediate-stage u-HCC who were mainly judged to be TACE-refractory or -unsuitable. The results demonstrated the efficacy of lenvatinib and confirmed that further improvements in prognosis could be obtained with TACE after lenvatinib induction. In the intermediate-stage u-HCC, the results suggest it may be important to consider not only the use of lenvatinib but also its combination with TACE to improve patients' prognosis further, even if they are deemed TACE-refractory or -unsuitable. Transarterial chemoembolization (TACE) has been the standard treatment for intermediate-stage, unresectable hepatocellular carcinoma (u-HCC). However, with recent advances in systemic therapy and the emergence of the concept of TACE-refractory or -unsuitable, the effectiveness of systemic therapy, as well as TACE, has been demonstrated for patients judged to be TACE-refractory or -unsuitable. In this study, the efficacy of lenvatinib and its combination with TACE after lenvatinib was investigated in 140 patients with intermediate-stage u-HCC treated with lenvatinib mainly because of being judged to be TACE-refractory or -unsuitable. Median overall survival (OS) and progression-free survival (PFS) were 24.4 and 9.0 months, respectively, indicating a good response rate. In multivariate analysis, modified albumin–bilirubin (mALBI) grade and up to seven criteria were identified as independent factors for OS, and mALBI grade and tumor morphology were identified as independent factors for PFS. While 95% of all patients were TACE-refractory or -unsuitable, the further prognosis was prolonged by the combination with TACE after lenvatinib initiation. These findings suggest that systemic therapy should be considered for intermediate-stage u-HCC, even in patients judged to be TACE-refractory or -unsuitable. The use of TACE after the start of systemic therapy may further improve prognosis. [ABSTRACT FROM AUTHOR]

Complete pathological response (CPR) is achieved with various pretransplant locoregional treatments for hepatocellular carcinoma (HCC). This study aimed to investigate pretransplant expression of HCC tumor markers in liver transplantation (LT) recipients showing CPR. For the CPR group, 166 patients were selected from a single-institution LT database. Two control groups of 332 patients without HCC and 184 patients with partial pathological response (PPR) were also selected. The model for end-stage liver disease score in the CPR group was 11.5 ± 7.7. The number of transcatheter arterial chemoembolization sessions before LT was one in 68 patients (14.0%), two in 38 patients (22.9%), and three or more in 60 patients (36.1%). A solitary non-viable tumor was identified in 120 (86.4%) of the explant livers and the largest tumor size was 2.4 ± 1.3 cm. Living-donor and deceased-donor LTs were performed in 152 (91.6%) and 14 (8.4%) patients, respectively. The median levels of α-fetoprotein (AFP) and protein induced by Vitamin K absence or antagonist-II (PIVKA-II) measured within two weeks before LT were 4.2 ng/mL and 20 mAU/mL, respectively. These tumor marker levels were comparable to those in the no-HCC control group, but much lower than those in the PPR group (p < 0.001). Receiver operating characteristic curve analysis of AFP and PIVKA-II showed no definite cutoff values for CPR in the cohort of CPR and no-HCC patients, but significant cutoffs of 6.5 ng/mL for AFP and 29 mAU/mL for PIVKA-II were obtained in the cohort of CPR and PPR patients. The 1-, 3- and 5-year HCC recurrence and overall patient survival rates of the CPR group were 5.1% and 93.3%, 7.6% and 89.6%, and 7.6% and 89.6%, respectively. These tumor recurrence rates were much lower than those in the PPR group (p < 0.001). In conclusion, the present study results suggest that normalizing AFP and PIVKA-II after locoregional treatment is indicative of CPR. However, some CPR patients showed high expression of tumor markers; thus, pretransplant values of HCC tumor markers should be interpreted with caution. [ABSTRACT FROM AUTHOR]

Background: Long-term survival after liver transplantation (LT) for hepatocellular cancer (HCC) continues to increase along with the modification of inclusion criteria. This study aimed at identifying risk factors for 5- and 10-year overall and HCC-specific death after LT. Methods: A total of 1,854 HCC transplant recipients from 10 European centers during the period 1987–2015 were analyzed. The population was divided in three eras, defined by landmark changes in HCC transplantability indications. Multivariable logistic regression analyses were used to evaluate the significance of independent risk factors for survival. Results: Five- and 10-year overall survival (OS) rates were 68.1% and 54.4%, respectively. Two-hundred forty-two patients (13.1%) had HCC recurrence. Five- and 10-year recurrence rates were 16.2% and 20.3%. HCC-related deaths peaked at 2 years after LT (51.1% of all HCC-related deaths) and decreased to a high 30.8% in the interval of 6 to 10 years after LT. The risk factors for 10-year OS were macrovascular invasion (OR = 2.71; P = 0.001), poor grading (OR = 1.56; P = 0.001), HCV status (OR = 1.39; P = 0.001), diameter of the target lesion (OR = 1.09; P = 0.001), AFP slope (OR = 1.63; P = 0.006), and patient age (OR = 0.99; P = 0.01). The risk factor for 10-year HCC-related death were AFP slope (OR = 4.95; P < 0.0001), microvascular (OR = 2.13; P < 0.0001) and macrovascular invasion (OR = 2.32; P = 0.01), poor tumor grading (OR = 1.95; P = 0.001), total number of neo-adjuvant therapies (OR = 1.11; P = 0.001), diameter of the target lesion (OR = 1.11; P = 0.002), and patient age (OR = 0.97; P = 0.001). When analyzing survival rates in function of LT era, a progressive improvement of the results was observed, with patients transplanted during the period 2007–2015 showing 5- and 10-year death rates of 26.8% and 38.9% (vs. 1987–1996, P < 0.0001; vs. 1997–2006, P = 0.005). Conclusions: LT generates long-term overall and disease-free survival rates superior to all other oncologic treatments of HCC. The role of LT in the modern treatment of HCC becomes even more valued when the follow-up period reaches at least 10 years. The results of LT continue to improve even when prudently widening the inclusion criteria for transplantation. Despite the incidence of HCC recurrence is highest during the first 5 years post-transplant, one-third of them occur later, indicating the importance of a life-long follow-up of these patients. [ABSTRACT FROM AUTHOR]

Purpose: The Vesical Imaging-Reporting and Data System (VI-RADS) criteria are expanding, providing fine differentiation of bladder wall layers involvement. We aimed to explore the feasibility of a novel categorical scoring, the Neoadjuvant chemotherapy VI-RADS (nacVI-RADS) for radiologic assessment of response (RaR), to define the spectrum of treatment response among patients with muscle invasive bladder cancer (MIBC). Methods: Ten consecutive patients diagnosed with non-metastatic MIBC were prospectively enrolled and addressed to NAC and underwent mpMRI before staging resection and after the chemotherapy cycles. The follow-up MRI assessment was performed using the nacVI-RADS algorithm for evaluation of response to therapy. NacVI-RADS categorically define complete RaR, based on prior VI-RADS score, presence of residual disease, tumor size, and infiltration of the muscularis propria. Results: NacVI-RADS categories were able to match all the final radical cystectomy pathology both for complete pT0 responders and for the patients defined as partial or minimal responders, who only showed some RaR inter-scoring class downstaging. Conclusion: This report is the preliminary evidence of the feasibility of nacVI-RADS criteria. These findings might lead to possible paradigmatic shifts for cancer-specific survival risk assessment and to possibly drive the therapeutic decision through active surveillance programs, bladder-sparing modalities, or to the standard of care. [ABSTRACT FROM AUTHOR]

Background: Pathological complete response (pCR), in breast cancers, after neoadjuvant chemotherapy is linked to improved survival. Determining complete response to chemotherapy prior to surgery has remained elusive even using a combination of pathological factors and imaging modalities, making surgery still a necessity. Methods: A retrospective analysis was performed from a single institution from 2013 to 2018. Breast cancer patients treated with neoadjuvant chemotherapy with pre‐ and post‐chemotherapy magnetic resonance imaging (MRI) were included. Patients receiving other neoadjuvant modalities were excluded. Imaging characteristics, including response to chemotherapy and pathological factors, were recorded. Results: Analysis showed 134 patients were identified with 40/134 (29.9%) noted to have radiological complete response and 34/134 (25.6%) had pCR. The positive predictive value for MRI to detect pCR was greatest for oestrogen receptor (ER) negative and human epidermal growth factor receptor 2 (HER2) negative tumours at 81.8% and worst for ER+ HER2− tumours at 25%. The negative predictive value was greatest for ER+ HER2− tumours at 93.9% and worst for ER− HER2− tumours at 77.4%. Conclusion: MRI after neoadjuvant chemotherapy for breast cancer even combined with tumour factors is not an accurate predictor of pCR. [ABSTRACT FROM AUTHOR]

Highlights • Radiological response was significantly better in the metformin group than the control group (overall P = 0.002). • Metformin did not significantly prolong OS (HR = 0.57, CI 0.24–1.3); however, OS was better in the metformin vs. control group (5.3 vs. 5.8 months). • Metformin did not significantly prolong PFS (HR = 0.311, CI 0.063–1.5); however, OS was better in the metformin vs. control group (4.4 vs. 5.1 months). Background: Mounting evidence suggests that metformin halts cancer spread and acts as an antimetastatic drug. Patients and Methods: Fifty women diagnosed with stage IV breast cancer were allocated randomly into two groups. The control group received chemotherapy and the metformin group received metformin plus chemotherapy for 3 months. Main outcome included measuring changes in tumors using Response Evaluation Criteria in Solid Tumors (RECIST) to evaluate disease progression before and after 3 months, whereas secondary outcomes included, overall survival (OS) and progression free survival (PFS). Results: The control group had a significantly worse RECIST response rate than the metformin group. The metformin group had a slightly longer OS and higher PFS than the control group, but this difference was not statistically significant. Hazards of mortality and disease progression were reduced with metformin use. Conclusion: Metformin use significantly improved the radiologic response rate in nondiabetic patients with metastatic breast cancer but did not significantly prolonged OS or PFS. Our results suggest that randomized clinical trials in patients with metastatic breast cancer are warranted. [ABSTRACT FROM AUTHOR]

Background: We analyzed different methods used to assess the radiological responses of patients undergoing neoadjuvant chemotherapy and metastasectomy treatment for liver metastases associated with colorectal cancer (CRC) by comparing the response evaluation criteria in solid tumors (RECIST) 1.1, the modified RECIST, and the criteria of the European Association for the Study of the Liver (EASL) methods and the histological response obtained after metastasectomy. Objectives: We aimed to determine the optimal radiological method to assess the response of colorectal liver metastases to neoadjuvant chemotherapy. Materials and Methods: We conducted a retrospective study of CRC patients treated for liver metastases who had received neoadjuvant chemotherapy in our hospital between January 2000 and December 2017. We analyzed the agreement between the methods for analyzing the radiological response using the quadratic weighted kappa coefficient (κ). We studied the overall survival and analyzed factors related to survival using the Kaplan-Meier method. We performed multivariate analysis to study the prognostic factors of survival. We analyzed the relationship between the radiological and histological responses using Goodman and KruskaPs gamma (γ)- Results: A significant agreement was observed between the modified RECIST and EASL methods (κ = 0.841, P< 0.0 01). Cox regression multivariate analysis indicated the RECIST 1.1 criteria as an independent prognostic factor (P = 0.03). The γ value showed a significant relationship between the three radiological response methods and histological response. Conclusion: In our study, we showed that using RECIST 1.1 criteria is the ideal radiological analysis method for studying CRC liver metastases treated with neoadjuvant chemotherapy when compared to other methods that are based on functional imaging markers. [ABSTRACT FROM AUTHOR]

Aim: Repeated transarterial chemoembolization (TACE) for intermediate‐stage hepatocellular carcinoma (HCC) eventually leads to either deteriorated hepatic reserve or TACE refractoriness. Switching to molecular targeted agents after TACE requires preservation of hepatic reserve. This study aimed to investigate the predictive factors associated with early deterioration of hepatic reserve by repeated TACE prior to refractoriness. Methods: Ninety‐three patients with intermediate‐stage HCC who underwent TACE as the first‐line treatment and had a Child–Pugh class A hepatic reserve were retrospectively analyzed. The time to Child–Pugh class deterioration (TTCPD), defined as the duration from initial TACE to the diagnosis of Child–Pugh class B or C prior to TACE refractoriness, was assessed. Patients who progressed to TACE refractoriness prior to Child–Pugh class deterioration were censored at TACE refractoriness. Results: The radiological response to initial TACE was assessed as responders and non‐responders in 59 (63.4%) and 34 (36.6%) patients, respectively. The median TTCPD was 40.6 months in all patients. The hepatic reserve in 31 (33.3%) patients deteriorated to Child–Pugh class B or C prior to TACE refractoriness. In the multivariate analysis, non‐response to initial TACE, albumin–bilirubin grade 2, and non‐selective TACE were identified as independent predictors associated with a shortened TTCPD. The TTCPD was significantly shorter in the non‐responders than in the responders to initial TACE (median, 19.6 vs. 55.9 months; P < 0.001). Conclusions: Failure to respond to initial TACE was a predictive factor for early deterioration of hepatic reserve prior to TACE refractoriness in intermediate‐stage HCC patients with repeated TACE. [ABSTRACT FROM AUTHOR]

Glioblastoma (GBM) is the most common and aggressive primary brain tumor in adults. We present a case of a 42-year-old male patient presenting with headache and vomiting. Imaging demonstrated obstructive hydrocephalus and a ring-enhancing lesion in the right posterior thalamus. After endoscopic third ventriculostomy and stereotactic biopsy, the histopathologic diagnosis of a malignant glioma was confirmed by DNA methylation array as GBM isocitrate dehydrogenase wild type. The patient was treated with combined treatment of chemoradiation with temozolomide (TMZ) including proton boost, TMZ maintenance, and tumor-treating fields. In this case report, complete radiological response was observed 1 year after the end of radiation therapy. [ABSTRACT FROM AUTHOR]

Background: Magnetic resonance imaging (MRI) is the modality of choice for local staging and response evaluation of Ewing sarcoma (EwS). Aim of this study was to determine the relevance of tumor volume response (TVR) in relation to histological response (HisRes) and survival, in order to evaluate if early modification of chemotherapy might be indicated in patients with inadequate TVR. Methods: Three dimensional (3D)‐tumor volume data at diagnosis, during early induction phase (1‐3 courses of chemotherapy; n = 195) and/or late induction phase (4‐6 courses; n = 175) from 241 localized patients were retrospectively analyzed. A distinction was made between adequate response (reduction ≥67%) and inadequate response (reduction <67% or progression). Correlations between TVR, HisRes, event free survival (EFS), and overall survival (OS) were analyzed using chi‐square tests, log‐rank tests, and the Cox‐regression model. Results: Early adequate TVR, noted in 41% of patients, did not correlate with EFS (P = 0.92) or OS (P = 0.38). During late induction phase 62% of patients showed an adequate TVR. EFS for patients with late adequate TVR was better (78%) than for those with inadequate late TVR (61%) (P = 0.01); OS was 80% and 69% (P = 0.26), respectively. No correlation was found between TVR and HisRes. Multivariate analysis showed that poor HisRes, pelvic location and late inadequate TVR were associated with poor outcome. Conclusions: Early inadequate TVR does not predict adverse outcome; therefore, changing the treatment to second line chemotherapy is not indicated in case of inadequate early TVR. Late adequate TVR and good HisRes correlate with better EFS; patients with late inadequate TVR might benefit from augmented therapy. Early adequate tumor volume response (TVR) does not predict outcome, so modification of chemotherapy in case of an inadequate early TVR may not be justifiable. However, late adequate TVR and poor histological response were independent predictors of adverse outcome; therefore, patients with late‐phase inadequate TVR might benefit from augmented treatment. [ABSTRACT FROM AUTHOR]

Background Clinical benefits of presurgical axitinib therapy for renal cell carcinoma (RCC) extending into the inferior vena cava (IVC) remain unclear. We aimed to investigate surgical benefits and pathological antitumor effects of presurgical axitinib therapy for RCC with IVC thrombus. Methods Of 56 consecutive RCC patients with IVC thrombus between January 1994 and December 2016, 41 patients who underwent radical nephrectomy (RN) were categorized as upfront RN (Upfront group) or presurgical axitinib followed by RN (Presurgical group). We retrospectively evaluated safety, radiologic tumor responses, and Ki-67 proliferation index before and after axitinib administration in the Presurgical group. Surgical outcomes, postoperative complications, and fibrosis within the IVC thrombus were compared between the Upfront and Presurgical groups. Results The number of patients in the Upfront and Presurgical groups was 31 and 10, respectively. Major presurgical axitinib-related adverse events were grade 2 or 3 hypertension (50%). The median radiological tumor response in the renal tumor, IVC thrombus length, and IVC thrombus volume were -19%, -21 mm, and -54%, respectively. The fibrosis within the IVC thrombus was significantly higher in the Presurgical group (10%) than in the Upfront group (3.4%). The Ki-67 proliferation index was significantly decreased in RN specimens (7.3%) versus needle biopsy specimens (23%) in the Presurgical group. Blood loss and operative duration were significantly lower and shorter, respectively, in the Presurgical group than in the Upfront group. Conclusions Presurgical axitinib therapy enhanced tumor reduction accompanied by fibrosis and may contribute to surgical risk reduction for selected patients. [ABSTRACT FROM AUTHOR]

Background and aims. Percutaneous ethanol injection (PEI) is a well-established therapeutic option in patients with cirrhosis and hepatocellular carcinoma (HCC). The modified-Response Evaluation Criteria in Solid Tumors (m-RECIST) are an important tool for the assessment of HCC response to therapy. The aim was to evaluate whether HCC response according to the m-RECIST criteria could be an effective predictor of long-term survival in Barcelona Clinic Liver Cancer (BCLC) stage 0 and A HCC patients undergoing PEI. Material and methods. 79 patients were followed-up for median time of 26.8 months. HCC diagnosis was based on the current guidelines of the American Association for Study of the Liver Diseases (AASLD) and European Association for Study of the Liver (EASL). Patient survival was calculated from the first PEI session to the end of the follow-up. Results. The 1-, 3-, and 5-year overall survival rates were 79, 48 and 37%, respectively. In the multivariate analysis, Child-Pugh-Turcotte (CPT) (p = 0.022) and the response to m-RECIST criteria (p = 0.016) were associated with patient survival. CPT A patients who achieved Complete Response (CR) 1 month after PEI presented a 5-year survival rate of 55%. By contrast, the worst scenario, the group with CPT B but without CR had a 5-year survival rate of 9%, while the group with either CPT A or CR as a survival predictor had a 5-year survival rate of 31%. In conclusion, in BCLC stage 0 and A HCC-patients, m-RECIST at 1 month and Child A may predict survival rates after PEI. [ABSTRACT FROM AUTHOR]

Phantoms are suitable tools to simulate body tissues and organs in radiology and radiation therapy. This study presents the development of a physical head and neck phantom and its radiological response for simulating brain pathology. The following features on the phantom are addressed and compared to human data: mass density, chemical composition, anatomical shape, computerized tomography images and Hounsfield Units. Mass attenuation and kerma coefficients of the synthetic phantom and normal tissues, as well as their deviations, were also investigated. Radiological experiments were performed, including brain tumors and subarachnoid hemorrhage simulations. Computerized tomography images of such pathologies in phantom and human were obtained. The anthropometric dimensions of the phantom present anatomical conformation similar to a human head and neck. Elemental weight percentages of the equivalent tissues match the human ones. Hounsfield Unit values of the main developed structures are presented, approaching human data. Kerma and mass attenuation coefficients spectra from human and phantom are presented, demonstrating smaller deviations in the radiological X-ray spectral domain. In conclusion, the phantom presented suitable normal and pathological radiological responses relative to those observed in humans. It may improve radiological protocols and education in medical imaging. [ABSTRACT FROM PUBLISHER]

Simple Summary: With the recent increase in the number of drug therapy options for unresectable hepatocellular carcinoma (u-HCC), the key issue has become how to prolong overall survival (OS). The aim was to evaluate the association between radiological response and OS in patients treated with lenvatinib as a first-line systemic treatment for u-HCC. Radiological response using both Response Evaluation Criteria in Solid Tumors (RECIST) and modified Response Evaluation Criteria in Solid Tumors (mRECIST) is a predictor of OS and achieving an objective response at the first evaluation is an independent prognostic factor for OS. In addition, if an objective response is obtained at the initial evaluation, continuation of treatment appears desirable because prolonged OS can be expected; but, if stable disease is obtained at the initial evaluation, one should determine whether to continue or switch to the next treatment, with careful consideration of factors related to the tumor and hepatic reserve at the initial evaluation. The association between radiological response and overall survival (OS) was retrospectively evaluated in patients treated with lenvatinib as a first-line systemic treatment for unresectable hepatocellular carcinoma. A total of 182 patients with Child–Pugh class A liver function and an Eastern Cooperative Oncology Group performance status of zero or one were enrolled. Radiological evaluation was performed using Response Evaluation Criteria in Solid Tumors (RECIST) and modified Response Evaluation Criteria in Solid Tumors (mRECIST). Initial radiological evaluation confirmed significant stratification of OS by efficacy judgment with both RECIST and mRECIST, and that initial radiological response was an independent prognostic factor for OS on multivariate analysis. Furthermore, in patients with stable disease (SD) at initial evaluation, macrovascular invasion at the initial evaluation on RECIST and modified albumin–bilirubin grade at initial evaluation on mRECIST were independent predictors of OS on multivariate analysis. In conclusion, if objective response is obtained at the initial evaluation, continuation of treatment appears desirable because prolonged OS can be expected; but, if SD is obtained at the initial evaluation, one should determine whether to continue or switch to the next treatment, with careful consideration of factors related to the tumor and hepatic reserve at the initial evaluation. [ABSTRACT FROM AUTHOR]

Conclusion: A complete clinical and radiological response observed following chemotherapy and radiotherapy is not predictive of the absence of residual disease. Moreover, salvage neck surgery does not always seem to be an effective strategy. Consequently, early neck dissection should be advised for patients with complete clinical and radiological response (CCRR) after chemoradiotherapy for tumors with N2–N3 disease. Background: We retrospectively reviewed the outcome of 28 patients with N2–N3 disease treated initially with chemotherapy and radiotherapy. Patients and methods: A neck dissection was performed for all patients with residual disease in the neck. Results: A CCRR in the neck was achieved in 25 of 28 patients. The remaining three patients with residual neck mass underwent a salvage neck dissection: the pathological examination confirmed the persistence of tumoral disease. No regional failure was observed in these three patients. In 25 patients considered to have CCRR in the neck, 5 patients (20%) developed regional recurrence. Successful salvage approach was not possible for any of these patients. [ABSTRACT FROM AUTHOR]