Hepatic arterial infusional (HAI) therapy in patients with unresectable primary liver cancer: Use of dynamic contrast enhanced MRI to evaluate response.

4597 Background: This study reports the final results of HAI with floxuridine (FUDR) and dexamethasone (Dex) in patients (pts) with unresectable intrahepatic cholangiocarcinoma (ICC) or hepatocellular carcinoma (HCC) and the utility of DCE MRI to predict treatment response.,34 unresectable pts (26 ICC, 8 HCC) were treated with HAI FUDR/Dex over 14 days on a 4-week cycle. DCE-MRI scans were performed at baseline and at 2-month intervals using a conventional 1.5 Tesla GE scanner. A bolus injection of constant dose Gd- complex contrast agent (0.1 mM/kg) was given and images acquired with temporal resolution of 1 second. Dynamic and pharmacokinetic parameters related to tumor perfusion were analyzed and correlated with response (RECIST) and survival.,At a median followup of 35 months (mos), 1- and 2-year survival was 88% and 68%, respectively; median survival was 29 mos. Two pts with HCC responded (25%), and 3 had stable disease; 15 pts with ICC (58%) had partial response, and 10 (38%) had stable disease. One ICC patient subsequently underwent resection. For all patients, median time to progression was 7.4 mos and response duration was 11.9 mos (range 4.1-14.7). Treatment was well-tolerated: grade 3 AST and alkaline phosphatase elevations were seen in 5 (15%) and 4 (12%) pts, respectively. Grade 3/4 bilirubin elevations were seen in 3 pts, but none developed strictures. Preliminary analysis of DCE-MRI data showed the baseline area under the curve at 180 seconds (AUC180), a global assessment of tumor perfusion, was significantly associated with survival (p=0.02, Cox regression). Pts with AUC180 > 0.18 had a median survival of 32 mos versus 19 mos in those with AUC180 < 0.18 (p=0.04).,HAI therapy with FUDR + Dex provides an overall response rate of 50% and a median survival of 29 mos in pts with unresectable primary liver cancer. Pretreatment DCE MRI assessment of tumor perfusion characteristics appears to have important prognostic value regarding treatment outcome. [Table: see text].