Hepatocellular carcinoma treated with sorafenib: early detection of treatment response and major adverse events by contrast‐enhanced US

Background & Aims Early prediction of tumour response and major adverse events ( AE s), especially liver failure, in patients with hepatocellular carcinoma ( HCC ) is essential for maximizing the clinical benefits of sorafenib. To evaluate the usefulness of dynamic contrast‐enhanced ultrasound ( DCE ‐ US ) for the early prediction of tumour response and major AE s in HCC patients. Methods Thirty‐seven HCC patients were started on a reduced dosage of sorafenib, subsequently increased to the standard dosage. Tumour response at 1 month was assessed by CT using the R esponse E valuation C riteria in S olid T umors ( RECIST ). Major AE s were defined as grade 3 or higher. DCE ‐ US was performed before treatment (day 0) and on days 7, 14 and 28. Changes in perfusion parameters in the tumour and liver parenchyma between day 0 and later time points were compared between treatment responders and nonresponders based on RECIST and between patients who experienced major AE s and those who did not. Tumour results were also compared with progression‐free survival ( PFS ) and overall survival ( OS ). Results Tumour perfusion parameters based on the area under the time‐intensity curve ( AUC ) were statistically significant, with AUC during washin on day 14, the most relevant for tumour response ( P  = 0.0016) and AUC during washin on day 7, the most relevant for both PFS ( P  = 0.009) and OS ( P  = 0.037). A decrease in total AUC between days 0 and 7 in the liver parenchyma was strongly correlated with major AE s ( P  = 0.0002). Conclusion DCE ‐ US may be useful for the early prediction of tumour response and major AE s in patients with HCC .