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European Journal of Nuclear Medicine and Molecular Imaging

Published in:

01-06-2011 | Original Article

¹⁸F-FDG PET independently predicts survival in patients with cholangiocellular carcinoma treated with ⁹⁰Y microspheres

Authors: Alexander R. Haug, Volker Heinemann, Christiane J. Bruns, Ralf Hoffmann, Tobias Jakobs, Peter Bartenstein, Marcus Hacker

Published in: European Journal of Nuclear Medicine and Molecular Imaging | Issue 6/2011

Abstract

Purpose

⁹⁰Y radioembolization has emerged as a valuable therapy for intrahepatic cholangiocellular carcinomas (ICC). We aimed to evaluate the prognostic power of FDG PET/CT and that of pretherapeutic scintigraphy with ^99mTc-labelled macroagglutinated albumin (MAA), an index of tumour vascularization.

Methods

The study group comprised 26 consecutive patients suffering from nonresectable ICC. Before treatment with radioembolization, all patients underwent MRI of the liver, as well as MAA scintigraphy, which was followed immediately by SPECT(/CT) to quantify the liver–lung shunt fraction. Using image fusion, regions of interest were drawn around the tumours and the entire liver, and the tumour-to-liver quotient was calculated. In addition, FDG PET/CT was performed at baseline and 3 months after radioembolization, and the percentage changes in peak (ΔSUV_max) and mean (ΔSUV_mean) FDG uptake and in metabolic tumour volume (ΔVol_2SD) relative to baseline were calculated. Treatment response at 3 months was also assessed using contrast-enhanced MRI and CT on the basis of standard criteria.

Results

Of 23 patients in whom follow-up MRI was available, 5 (22%) showed a partial response, 15 (65%) stable disease and 3 (13%) progressive disease. The change in all FDG values significantly predicted survival by Kaplan-Meier analysis after radioembolization; ΔVol_2SD responders had a median survival of 97 weeks versus 30 weeks in nonresponders (P = 0.02), whereas ΔSUV_max and ΔSUV_mean responders had a median survival of 114 weeks (responder) versus 19 weeks (nonresponder) and 69 weeks in patients with stable disease (P < 0.05). Pretherapeutic MAA scintigraphy or MRI did not predict survival, nor did the presence of extrahepatic metastases, or prior therapies. Only ΔVol_2SD was significantly associated with survival by univariate analysis (hazard ratio 0.25; P = 0.04) and multivariate analysis (hazard ratio 0.20, P = 0.04).

Conclusion

FDG PET/CT was able to predict patient outcome after radioembolization treatment, with the change in metabolically active tumour volume at 3 months being the best independent predictor. High tumour vascularization, as indicated by MAA scintigraphy, was not a prerequisite for successful radioembolization and was even associated with a tendency towards shorter survival.

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Title: 18F-FDG PET independently predicts survival in patients with cholangiocellular carcinoma treated with 90Y microspheres
Authors: Alexander R. Haug
Volker Heinemann
Christiane J. Bruns
Ralf Hoffmann
Tobias Jakobs
Peter Bartenstein
Marcus Hacker
Publication date: 01-06-2011
Publisher: Springer-Verlag
Published in: European Journal of Nuclear Medicine and Molecular Imaging / Issue 6/2011
Print ISSN: 1619-7070
Electronic ISSN: 1619-7089
DOI: https://doi.org/10.1007/s00259-011-1736-x

At a glance: The STEP trials

Springer Medicine

¹⁸F-FDG PET independently predicts survival in patients with cholangiocellular carcinoma treated with ⁹⁰Y microspheres

Abstract

Purpose

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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