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HCC Treatment Response DFP

DFP Profile

DFP NAME:


Hepatocellular Carcinoma Treatment Response Disease Focused Panel

 

DFP MISSION:

 

To ensure patients who have undergone locoregional or biological therapy for hepatocellular carcinoma are managed appropriately by enabling radiologists who interpret their post-treatment imaging to positively contribute to their care.

 

BACKGROUND:

 

Imaging of cirrhotic patients with HCC both before and after treatment comprises a large part of abdominal radiology imaging volume. In fact, the number of cirrhotic patients is increasing annually in the United States and internationally, with an increased incidence of HCC as well, which is now not only the 5th most common cancer worldwide, but the 5th leading cause of cancer related death in the United States.  Thus, HCC treatment response is a vital component of the training and clinical practice of abdominal radiologists.  Currently, multiple treatment response classification systems exist, including the newer system termed LI-RADS treatment response.  

 

Incorporating a strategic educational and research support system for abdominal radiologists involved in interpretation of complex cross-sectional imaging after HCC treatment, aligns with the SAR’s mission statement as well as its strategic goals in “providing the highest level of education” and “promoting … best practices in abdominal radiology.”  Additionally, as abdominal radiology seeks to unify LI-RADS treatment response with other treatment response classification systems (such as mRECIST), this DFP will help provide multidisciplinary validation of this system by providing a vehicle for more robust research and technical developments through multi-institutional collaboration. This aligns with SAR strategic goal to “promote excellence in scientific discovery.”

 

Thus, the mission of the SAR HCC treatment response DFP would be to 1) support abdominal imagers through educational initiatives, 2) promote research, and 3) foster inter-societal collaboration. We believe SAR is an essential forum for this mission, as many leaders in hepatic imaging are part of this society.

 

DFP GOALS:

  • Improvements in patient Care

  1. To develop educational material and algorithms which will advance knowledge and facilitate interpretation of complex cross-sectional imaging in patients who have undergone locoregional therapy for HCC in order to ensure best clinical practices and thus improve patient care.
  2. To collaborate with non-abdominal radiology clinicians, such as interventional radiologists, hepatobiliary surgeons, radiation oncologists and hepatologists, to enhance patient care and outcomes by creating algorithms/guidelines for image interpretation after locoregional therapy, by incorporating relevant patient data which would ensure best overall clinical outcomes.

  • Improvements/standards for radiology practice
  1. To create algorithms and templates to facilitate reporting of complex findings after locoregional therapy for HCC in order to improve reporting of these cases in radiology practices.
  2. To create a platform for national and international multi-institutional research and educational collaborations.

DFP MEMBERSHIP:

 

Please check back Soon. Membership list being finalized

 

LEADERSHIP PLAN:

 

Chair or Co-chairs:

 

Mishal Mendiratta-Lala - University of Michigan

  1. Chair of LIRADS treatment response working group; extensive research experience, including translational research, NIH funded research and multi-institutional research; Involved in Liver tumor board for 10 years at a major transplant institute; Radiology lead for liver tumor board at University of Michigan for last 3 years; CSIR trained with extensive procedural experience in liver ablations, including creating an ablation division at a major transplant institution;
  2. Leadership responsibility: overall responsibility and coordination of multi-institutional research efforts

Vahid Yaghmai

  1. Member of LIRADS treatment response working group for several years. Extensive research and numerous publications in assessment of HCC response to therapy and imaging biomarkers. Co-investigator in NIH and NCCN-funded trials. Full member of Robert H Lurie Comprehensive Cancer Center (RHLCC); member of RHLCC National Clinical Trials Network Oversight Committee; NCCN Imaging Expert Panel- Hepatobiliary Imaging; Executive Director of Quantitative Imaging Core Lab of Northwestern University; member of Northwestern GI Oncology Tumor Board
  2. Leadership responsibility: coordination of educational efforts and assist in coordination of multi-institutional research efforts

Specify Any Other Leadership Plans: n/a

 

Communication Plan (other than annual meeting):

 

HCC Treatment Response DFP Group Communication: email discussions, web surveys, teleconferences approximately 3/year for 60-minute duration; in-person meetings at select major conferences (SAR and RSNA annual meetings).

 

We will work as a group to create a social media plan.  We can seek advice from the current social media coordinator from the HCC DFP.  We will find a member by the end of the 2020 SAR meeting to oversee this task as part of his/her responsibility.

 

SHORT-TERM GOALS AND PROJECTS TO SUPPORT GOALS (within next 2 years): 

  1. Establish HCC Treatment response members to include SAR members and non-radiology consultants with expertise in tumor response after treatment.
  2. Improve interdisciplinary collaboration with clinicians from other specialties/societies (such as Hepatology (ASCO), radiation oncology (ASTRO), interventional radiology (SIR, SIO) and hepatobiliary surgery (APHBA)) who have an interest in HCC tumor response.
    1. The goals would be to expand and enhance the educational mission as well as develop research collaborations and academic partnerships in small research projects to support the mission of improving tumor response assessment after locoregional treatment for HCC. The goal is that by SAR 2022, to have publications through our DFP, as described in the research plan below in D and E.
    2. These efforts will help to engender trust among subspecialties and create a pathway towards better communication with the ultimate goals of improving patient care. We aim to accomplish our goal by SAR 2022 as described below in C.
    3. Furthermore, collaborations with the above mentioned societies will enhance patient care and outcomes by creating algorithms/guidelines for image interpretation after locoregional therapy, by incorporating relevant patient data which would ensure best overall clinical outcomes.  We aim to accomplish our goal by SAR 2022 as described below in C and D.
  3. Develop a standardized template to facilitate HCC treatment response reporting, which helps guide radiologists to include vital imaging information to appropriately characterize tumor response to treatment, in order to facilitate improved inter and intra reader accuracy and homogeneity when reporting HCC treatment response over multiple time points.  We aim to accomplish this goal by SAR 2021. We will work in conjunction with the LI-RADS treatment response working group to create a standardized template. The LI-RADS treatment response working group has multiple non-radiologist panel members (radiation oncology/hepatology) who can help. A survey for abdominal radiologists, interventional radiologists, and non-radiology clinicians has already been created to identify key facets required for an informative radiology report in this cohort of patients. We hope to have this approved by the LI-RADS reporting committee by SAR 2021.
  4. Develop educational material and algorithms which will advance knowledge and facilitate interpretation of complex cross-sectional imaging in patients who have undergone locoregional therapy for HCC in order to ensure best clinical practices and thus improve patient care.  We aim to accomplish this goal by SAR 2021, by which time we intend to submit 1 review paper and 1 additional paper by 2022. We will work in conjunction with members from the LI-RADS treatment response working group in order to ensure multi-disciplinary efforts. These review papers will aim to address knowledge gaps in image interpretation after locoregional therapy. In addition, we hope to work with non-radiology specialties through LI-RADS and this SAR DFP to create management guidelines based on findings in the images post-treatment.

  5. Coordinate at least two multi-institutional research projects that are impactful, achievable, and focus on HCC treatment response in the field of abdominal radiology. Examples include: a white paper on the LI-RADS treatment response classification system, focused manuscripts on the application of LI-RADS treatment response after various forms of locoregional therapy at multiple time points, and multi-institutional validation studies of the LI-RADS treatment response classification system. (By SAR 2022 we hope to have 2 multi-institutional studies completed. As co-chair of the LI-RADS treatment response working group, I have already proposed multi-institutional studies and created research designs. Once IRB approval is obtained at different institutions, multi-reader studies can begin in hope to accomplish the listed goals. With the new LI-RADS version currently underway, completion of this task is critical to adoption of any changes in the new version.

PROPOSED CONTRIBUTIONS TO SAR EDUCATIONAL PROGRAM:
  1. Provide recommendations of topics and speakers to the educational committee for the annual meeting
  2. Coordinate an educational program at the SAR with additional SAR DFP’s (ie additional liver and HCC DFP’s) which includes didactic and hands-on workshop sessions, as well as plenary lectures.
    1. Include non-radiology consultants in hands-on workshop sessions and plenary lectures when possible.
  3. Create a pictoral based educational algorithm for the LI-RADS treatment response classification system for the various different forms of locoregional therapy at various time points after treatment, in order to ensure best clinical practices with improved inter and intra reader accuracy.
  4. To create a platform for national and international multi-institutional research and educational collaborations.

RESOURCES:

 

Articles

  1. Natural history of hepatocellular carcinoma after stereotactic body radiation therapy
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