Perfusion computed tomography in patients with hepatocellular carcinoma treated with thalidomide: Initial experience

OBJECTIVE: The objective of the study was to evaluate the role of perfusion computed tomography (CT) for monitoring and predicting therapy response in patients with hepatocellular carcinoma treated with thalidomide. METHODS: Twenty-four patients with advanced hepatocellular carcinoma were treated with thalidomide. Perfusion and conventional CT were performed at baseline and every 2 months until disease progression. Baseline tumor size and enhancement characteristics, as well as baseline perfusion parameters and their changes after therapy, were explored and tested for association with therapy response. RESULTS: Perfusion CT was feasible in 18 patients. Baseline tumor size and enhancement characteristics showed no predictive value, whereas baseline blood flow and blood volume were higher in patients with progressive disease (P <0.042), with cutoff values for blood flow (16.7 mL/100 g per minute) and blood volume (1.84 mL/100 g) predicting progressive disease in 83.3% and 77.8% of patients, respectively. Significant changes were observed after 2, 4, and 6 months in blood flow (P <0.031), blood volume after 4 months (P = 0.018), and mean transit time after 4 and 6 months (P = 0.030) in patients with stable disease at 6 months. CONCLUSIONS: Baseline blood flow and blood volume predicted response to therapy in our cohort.