90Y microsphere treatment of unresectable liver metastases: changes in 18F-FDG uptake and tumour size on PET/CT

Bienert, Maren; McCook, Barry; Carr, Brian I.; Geller, David A.; Sheetz, Mike; Tutor, Cecilia; Amesur, Nikhil B.; Avril, Norbert

doi:10.1007/s00259-004-1752-1

Cited by 60 publications

(30 citation statements)

References 21 publications

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“…On the basis of the criteria of the European Organization for Research and Treatment of Cancer (EORTC) PET Study Group, the SUV of the hottest tumor voxel (SUV max ) has traditionally been considered a hallmark of tumor vitality, useful for predicting metabolic response to treatment (24). Indeed, several studies have reported that SUV max is more accurate than tumor size for prediction of outcome after radioembolization for unresectable liver metastases of different origins (6,7,25). However, a consensus group developed PERCIST to overcome certain limitations of the EORTC criteria and thus to serve as an improved framework for 18 F-FDG PET response assessment (15).…”

Section: Discussionmentioning

confidence: 99%

Use of PERCIST for Prediction of Progression-Free and Overall Survival After Radioembolization for Liver Metastases from Pancreatic Cancer

et al. 2015

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We evaluated the prognostic accuracy of established PET response criteria in patients with liver metastases from pancreatic cancer after treatment with 90 Y microspheres. Methods: Seventeen patients underwent 18 F-FDG PET/CT before and 3 mo after radioembolization for liver metastases from pancreatic cancer. Overall survival, progression-free survival, and time to intrahepatic progression were among other factors correlated with metabolic response as revealed by PERCIST 1.0-defined declining SUV peak and total-lesion glycolysis. Results: Metabolic response by change in SUV peak (7/17) and change in total-lesion glycolysis (7/17) was a predictor for overall survival (P 5 0.039; hazard ratio [HR], 0.24; 95% confidence interval [CI], 0.06-0.93), progression-free survival (P 5 0.016; HR, 0.15; 95% CI, 0.03-0.69), and time to intrahepatic progression (P 5 0.010; HR, 0.16; 95% CI, 0.04-0.65). A summed baseline CT diameter of less than 8 cm for the 2 largest liver metastases predicted time to intrahepatic progression (P 5 0.013; HR, 0.21; 95% CI, 0.06-0.72) but did not predict overall or progression-free survival. Patient outcome was not predicted by other parameters, including baseline SUV peak , baseline total-lesion glycolysis, or change in serum level of carcinoembryonic antigen or carbohydrate antigen 19-9 from baseline to followup (each, P . 0.05). Conclusion: Metabolic response by 18 F-FDG PET/CT predicts overall survival, progression-free survival, and time to intrahepatic progression after radioembolization for liver metastases from pancreatic cancer.

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Section: Discussionmentioning

confidence: 99%

Use of PERCIST for Prediction of Progression-Free and Overall Survival After Radioembolization for Liver Metastases from Pancreatic Cancer

et al. 2015

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“…However, this finding simply underscores the controversies regarding the prognostic value of morphologic tumor response. Although some authors have reported a higher response rate on 18 F-FDG PET than on CT and MRI in patients treated with SIRT (26)(27)(28)(29)(30), the prognostic value of metabolic treatment response assessment has only rarely been evaluated in cases of hepatic metastases. In a preliminary study focusing on cholangiocellular carcinoma (16), we found higher discrimination between SIRT responders and nonresponders for 18 F-FDG PET than for CT or MRI.…”

Section: Discussionmentioning

confidence: 99%

¹⁸F-FDG PET/CT Predicts Survival After Radioembolization of Hepatic Metastases from Breast Cancer

Haug

Donfack²,

Trumm³

et al. 2012

J Nucl Med

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90 Y radioembolization (selective internal radiation therapy [SIRT]) has emerged as a valuable therapeutic option in unresectable, chemotherapy-refractory hepatic metastases from breast cancer. The objective of the present study was to evaluate 18 F-FDG PET/ CT for predicting survival in these patients. Methods: Fifty-eight consecutive patients with hepatic metastases from breast cancer were treated with SIRT. Before therapy, all patients underwent MRI of the liver. 18 F-FDG PET/CT was performed at baseline and 3 mo after SIRT to calculate percentage changes in maximum 18 F-FDG standardized uptake value (SUV max ) relative to baseline. A decrease of more than 30% in the follow-up scan, compared with the baseline examination, indicated therapy response. Treatment response at 3 mo was also assessed in 43 patients using contrastenhanced MRI and CT on the basis of the Response Evaluation Criteria in Solid Tumors. All patients were followed to complete survival data. Results: Overall median survival after SIRT was 47 wk. Response as assessed with SUV max correlated significantly with survival after radioembolization, with responders having significantly longer survival (65 wk) than nonresponders (43 wk; P , 0.05). In multivariate analysis the change in SUV max was identified as the only independent predictor of survival (hazard ratio, 0.23; P , 0.005). Furthermore, a high pretherapeutic SUV max (.20) was associated with a significantly shorter median survival than was an SUV max of 20 or less (21 vs. 52 wk; P , 0.005). The presence of extrahepatic metastases (mean survival in both groups, 47 wk; P 5 0.92), hormone receptor status (estrogen, P 5 0.53; progesterone, P 5 0.79; Her-2/neu, P 5 0.49), and MRI/CT response (P 5 0.91) did not predict survival. Conclusion: The change in SUV max as assessed by 18 F-FDG PET/CT before and 3 mo after SIRT was identified as the only independent predictor of survival in patients with hepatic metastases of breast cancer. Breastcanceri s the most common malignancy affecting women in developed countries. Despite advances in adjuvant treatment, about 20% of patients with initially local disease will still develop metastases (1), frequently involving the liver. In most patients, curative surgical resection of liver metastases is not an option because of the presence of extrahepatic disease or multisegmental involvement of the liver. Other local therapies, such as radiofrequency ablation, are feasible in only a limited number of patients exhibiting only a few, small hepatic metastases. Despite significant advances in chemotherapeutic options in metastatic breast cancer, the presence of liver metastases limits survival in up to 60% of patients. Median survival in women exhibiting liver metastases of breast cancer has been estimated at about 18 mo (2).More recently, radioembolization using 90 Y-microspheres (selective internal radiation therapy [SIRT]) has emerged as a palliative treatment for hepatic metastases of various tumors (3-6). In hepatic metastases of breast cancer (7-9), reported...

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“…In a significant number of cases 'stable disease' could actually be minor, partial, or even complete response. In order to improve sensitivity in assessing tumor response, it is therefore strongly recommended that 18 F-FDG-PET or functional MRI (diffusion-weighted MRI) is added to posttreatment response assessment protocols [56][57][58][59].…”

Section: Discussionmentioning

confidence: 99%

Yttrium-90 microsphere radioembolization for the treatment of liver malignancies: a structured meta-analysis

et al. 2008

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90Y microsphere treatment of unresectable liver metastases: changes in 18F-FDG uptake and tumour size on PET/CT

Abstract: The metabolic information obtained from FDG-PET/CT seems to provide a more accurate and earlier assessment of therapy response following 90Y microsphere treatment than does the anatomical CT information.

Cited by 60 publications

References 21 publications

Use of PERCIST for Prediction of Progression-Free and Overall Survival After Radioembolization for Liver Metastases from Pancreatic Cancer

Use of PERCIST for Prediction of Progression-Free and Overall Survival After Radioembolization for Liver Metastases from Pancreatic Cancer

¹⁸F-FDG PET/CT Predicts Survival After Radioembolization of Hepatic Metastases from Breast Cancer

Yttrium-90 microsphere radioembolization for the treatment of liver malignancies: a structured meta-analysis

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90Y microsphere treatment of unresectable liver metastases: changes in 18F-FDG uptake and tumour size on PET/CT

Abstract: The metabolic information obtained from FDG-PET/CT seems to provide a more accurate and earlier assessment of therapy response following 90Y microsphere treatment than does the anatomical CT information.

Cited by 60 publications

References 21 publications

Use of PERCIST for Prediction of Progression-Free and Overall Survival After Radioembolization for Liver Metastases from Pancreatic Cancer

Use of PERCIST for Prediction of Progression-Free and Overall Survival After Radioembolization for Liver Metastases from Pancreatic Cancer

18F-FDG PET/CT Predicts Survival After Radioembolization of Hepatic Metastases from Breast Cancer

Yttrium-90 microsphere radioembolization for the treatment of liver malignancies: a structured meta-analysis

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¹⁸F-FDG PET/CT Predicts Survival After Radioembolization of Hepatic Metastases from Breast Cancer