Assessment of response to treatment of unresectable liver tumours with 90Y microspheres: Value of FDG PET versus computed tomography

Abstract

FDG PET imaging is more sensitive than CT in the assessment of early response to SIR spheres, allowing clinicians to proceed with further therapeutic options.

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

“…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.…”

An uncommon cause of gastro-duodenal ulceration

“…Radiogenic ulceration led to significant symptoms associated with a sustained decline in the quality of life and an enduring influence on the nutritional status of the patient. There are several options for pre-treatment planning before the use of SIRT including CT-and PET-scans, visceral angiography and the application of 99m-Technetium macroaggregated albumin to assess tumour vasculature, tumour volume and extrahepatic shunting [9,[14][15][16] . With regard to the frequently occurring side-effects of SIRT, the importance of pre-treatment assessment and pre-therapeutic embolization of arterial shunts to neighbouring organs must be established in order to avoid inappropriate loss of quality of life in these patients.…”

Validation of Several SUV-Based Parameters Derived from 18F-FDG PET for Prediction of Survival After SIRT of Hepatic Metastases from Colorectal Cancer

“…Whereas changes in tumor mass can be assessed with morphologic MR imaging or CT, metabolic response can be measured with PET with the glucose analog of 18 F-FDG. In patients with a variety of tumor types, 18 F-FDG PET has proven superior to morphologic imaging for monitoring therapy response and predicting survival (8)(9)(10)(11)(12). Initial studies of patients with intrahepatic cholangiocellular carcinoma or hepatic metastasis of breast cancer have indicated a high prognostic value of 18 F-FDG PET in the prediction of survival after SIRT (13)(14).…”

“…To evaluate the prognostic value of metabolic parameters, most 18 F-FDG PET studies have endeavored to correlate tracer uptake in the tumor with CT or MR imaging volumes, with duration of posttreatment survival being the standard endpoint (6,7,(15)(16)(17)(18)(19). However, there is yet no standardized approach for response stratification by means of metabolic imaging, although the maximum 18 F-FDG standardized uptake value within the tumor (SUV max ) is traditionally taken as an indicator of tumor vitality.…”