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Effect of Thalidomide in Hepatocellular Carcinoma: Assessment with Power Doppler US and Analysis of Circulating Angiogenic Factors¹

¹ From the Departments of Oncology (C.H., C.Y.W., A.L.C.), Surgery (C.N.C.), Internal Medicine (C.H., A.L.C.), and Obstetrics and Gynecology (F.J.H.), National Taiwan University Hospital, 7 Chung-Shan South Road, Taipei, Taiwan 100; Graduate Institute of Clinical Medicine (C.H.) and Institute of Toxicology (A.L.C.), National Taiwan University College of Medicine, Taipei, Taiwan; Division of Cancer Research, National Health Research Institutes, Taipei, Taiwan (L.T.C., A.L.C.); and Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan (L.T.C.). Received February 12, 2004; revision requested April 20; revision received June 9; accepted July 21. Supported by grant NHRI-EX90-S829P from National Health Research Institutes, Taiwan, and grant 91–2314-B-002–176 from National Science Council, Taiwan. Address correspondence to A.L.C. (e-mail: andrew@ha.mc.ntu.edu.tw).

View larger version (31K): [in a new window]   Figure 1. Graphs show percent change in vascularity index (VI) and in levels of circulating angiogenic factors after thalidomide treatment for nonresponders versus responders. Four of five patients with response had a decrease in vascularity index, but 20 of 36 patients without response to thalidomide also had a decrease in vascularity index. Most patients had an increased level of PlGF after thalidomide therapy, without consistent changes in levels of VEGF and bFGF.

View larger version (113K): [in a new window]   Figure 2a. (a, c, e) Serial CT scans and (b, d, f) power Doppler US images in patient with partial response to thalidomide show HCC (a, b) before treatment, (c, d) at day 27 of treatment, and (e, f) at day 97 of treatment. Imaging level was varied slightly between CT examinations to depict the maximal dimensions of the tumor. Arrows in b, d, and f indicate the vascular signal.

View larger version (89K): [in a new window]   Figure 2b. (a, c, e) Serial CT scans and (b, d, f) power Doppler US images in patient with partial response to thalidomide show HCC (a, b) before treatment, (c, d) at day 27 of treatment, and (e, f) at day 97 of treatment. Imaging level was varied slightly between CT examinations to depict the maximal dimensions of the tumor. Arrows in b, d, and f indicate the vascular signal.

View larger version (109K): [in a new window]   Figure 2c. (a, c, e) Serial CT scans and (b, d, f) power Doppler US images in patient with partial response to thalidomide show HCC (a, b) before treatment, (c, d) at day 27 of treatment, and (e, f) at day 97 of treatment. Imaging level was varied slightly between CT examinations to depict the maximal dimensions of the tumor. Arrows in b, d, and f indicate the vascular signal.

View larger version (78K): [in a new window]   Figure 2d. (a, c, e) Serial CT scans and (b, d, f) power Doppler US images in patient with partial response to thalidomide show HCC (a, b) before treatment, (c, d) at day 27 of treatment, and (e, f) at day 97 of treatment. Imaging level was varied slightly between CT examinations to depict the maximal dimensions of the tumor. Arrows in b, d, and f indicate the vascular signal.

View larger version (105K): [in a new window]   Figure 2e. (a, c, e) Serial CT scans and (b, d, f) power Doppler US images in patient with partial response to thalidomide show HCC (a, b) before treatment, (c, d) at day 27 of treatment, and (e, f) at day 97 of treatment. Imaging level was varied slightly between CT examinations to depict the maximal dimensions of the tumor. Arrows in b, d, and f indicate the vascular signal.

View larger version (86K): [in a new window]   Figure 2f. (a, c, e) Serial CT scans and (b, d, f) power Doppler US images in patient with partial response to thalidomide show HCC (a, b) before treatment, (c, d) at day 27 of treatment, and (e, f) at day 97 of treatment. Imaging level was varied slightly between CT examinations to depict the maximal dimensions of the tumor. Arrows in b, d, and f indicate the vascular signal.

View larger version (19K): [in a new window]   Figure 3. Plot shows approximately parallel trends in serum AFP level and vascularity index values obtained at baseline and at various follow-up intervals in patient with partial tumor response to thalidomide.