Published online Jul 7, 2018. doi: 10.3748/wjg.v24.i25.2710
Peer-review started: March 6, 2018
First decision: March 14, 2018
Revised: April 1, 2018
Accepted: April 9, 2018
Article in press: April 9, 2018
Published online: July 7, 2018
Processing time: 121 Days and 11.6 Hours
To compare therapeutic responses of a vascular-disrupting-agent, combretastatin-A4-phosphate (CA4P), among hepatocellular carcinomas (HCCs) and implanted rhabdomyosarcoma (R1) in the same rats by magnetic-resonance-imaging (MRI), microangiography and histopathology.
Thirty-six HCCs were created by diethylnitrosamine gavage in 14 rats that were also intrahepatically implanted with one R1 per rat as monitored by T2-/T1-weighted images (T2WI/T1WI) on a 3.0T clinical MRI-scanner. Vascular response and tumoral necrosis were detected by dynamic contrast-enhanced (DCE-) and CE-MRI before, 1 h after and 12 h after CA4P iv at 10 mg/kg (treatment group n = 7) or phosphate-buffered saline at 1.0 mL/kg (control group n = 7). Tumor blood supply was calculated by a semiquantitative DCE parameter of area under the time signal intensity curve (AUC30). In vivo MRI findings were verified by postmortem techniques.
On CE-T1WIs, unlike the negative response in all tumors of control animals, in treatment group CA4P caused rapid extensive vascular shutdown in all R1-tumors, but mildly or spottily in HCCs at 1 h. Consequently, tumor necrosis occurred massively in R1-tumors but patchily in HCCs at 12 h. AUC30 revealed vascular closure (66%) in R1-tumors at 1 h (P < 0.05), followed by further perfusion decrease at 12 h (P < 0.01), while less significant vascular clogging occurred in HCCs. Histomorphologically, CA4P induced more extensive necrosis in R1-tumors (92.6%) than in HCCs (50.2%) (P < 0.01); tumor vascularity heterogeneously scored +~+++ in HCCs but homogeneously scored ++ in R1-tumors.
This study suggests superior performance of CA4P in metastatic over primary liver cancers, which could guide future clinical applications of vascular-disrupting-agents.
Core tip: Complex animal models combining primary and secondary liver malignancies proved feasible in rats. The therapeutic efficacy of the leading vascular disrupting agent combretastatin-A4-phosphate (CA4P) could be intra-individually compared between primary and secondary liver malignancies in the same cirrhotic rats. Clinical 3.0T magnetic resonance imaging allowed real-time monitoring of in vivo therapeutic responses within 12 h, and ex vivo microangiography and histopathology could validate the CA4P-induced tumoricidal effects. The therapeutic responses appeared superior with secondary liver tumors over that with primary hepatocellular carcinomas, which are of translational significance for planning future clinical trials of CA4P in cancer patients.