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European Journal of Nuclear Medicine and Molecular Imaging
Published in: European Journal of Nuclear Medicine and Molecular Imaging 3/2015

01-03-2015 | Original Article

Early post-treatment FDG PET predicts survival after 90Y microsphere radioembolization in liver-dominant metastatic colorectal cancer

Authors: Amir Sabet, Carsten Meyer, Anas Aouf, Amin Sabet, Shahab Ghamari, Claus C. Pieper, Karin Mayer, Hans-Jürgen Biersack, Samer Ezziddin

Published in: European Journal of Nuclear Medicine and Molecular Imaging | Issue 3/2015

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Abstract

Purpose

The aim of this study was to evaluate the predictive value of early metabolic response 4 weeks post-treatment using 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET)/CT in patients with unresectable hepatic metastases of colorectal cancer (CRC) undergoing radioembolization (RE) with 90Y-labelled microspheres.

Methods

A total of 51 consecutive patients with liver-dominant metastases of CRC were treated with RE and underwent 18F-FDG PET/CT at baseline and 4 weeks after RE. In each patient, three hepatic metastases with the highest maximum standardized uptake value (SUVmax) were selected as target lesions. Metabolic response was defined as >50 % reduction of tumour to liver ratios. Survival analyses using Kaplan-Meier and multivariate analyses were performed to identify prognostic factors for overall survival (OS). Investigated baseline characteristics included age (>60 years), performance status (Eastern Cooperative Oncology Group >1), bilirubin (>1.0 mg/dl), hepatic tumour burden (>25 %) and presence of extrahepatic disease.

Results

The median OS after RE was 7 months [95 % confidence interval (CI) 5–8]; early metabolic responders (n = 33) survived longer than non-responders (p < 0.001) with a median OS of 10 months (95 % CI 3–16) versus 4 months (95 % CI 2–6). Hepatic tumour burden also had significant impact on treatment outcome (p < 0.001) with a median OS of 5 months (95 % CI, 3–7) for patients with >25 % metastatic liver replacement vs 14 months (95 % CI 6–22) for the less advanced patients. Both factors (early metabolic response and low hepatic tumour burden) remained as independent predictors of improved survival on multivariate analysis.

Conclusion

These are the first findings to show that molecular response assessment in CRC using 18F-FDG PET/CT appears feasible as early as 4 weeks post-RE, allowing risk stratification and potentially facilitating early response-adapted treatment strategies.
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Metadata
Title
Early post-treatment FDG PET predicts survival after 90Y microsphere radioembolization in liver-dominant metastatic colorectal cancer
Authors
Amir Sabet
Carsten Meyer
Anas Aouf
Amin Sabet
Shahab Ghamari
Claus C. Pieper
Karin Mayer
Hans-Jürgen Biersack
Samer Ezziddin
Publication date
01-03-2015
Publisher
Springer Berlin Heidelberg
Published in
European Journal of Nuclear Medicine and Molecular Imaging / Issue 3/2015
Print ISSN: 1619-7070
Electronic ISSN: 1619-7089
DOI
https://doi.org/10.1007/s00259-014-2935-z

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