Metabolic activity assessment by ¹⁸F‐fluorodeoxyglucose positron emission tomography in patients with hepatocellular carcinoma undergoing Yttrium‐90 transarterial radioembolization

Abstract

Background and Aim 18F‐fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) is a functional image technique that can inform clinical decisions related to prognosis. We investigated the predictive role of 18F‐fluorodeoxyglucose PET/CT in patients with hepatocellular carcinoma (HCC) undergoing Yttrium‐90 (Y‐90) transarterial radioembolization (TARE). Methods Patients with HCC treated with TARE and pre‐TARE PET/CT scan were recruited between 2009 and 2013. Maximum standardized uptake value and tumor‐to‐non‐tumorous liver uptake ratio (TLR) were measured. Tumor response was evaluated in accordance with modified RECIST criteria at 3‐month intervals after Y‐90 TARE. Results Forty patients were included in the final analysis. The median age was 56.5 years and male predominant. Disease control in treated lesion was achieved in 82.5% (n = 33) of patients. During median 18.3‐month follow‐up, 27.5% (n = 11) of patients achieved progression‐free survival. The cutoff of TLR, which was related to the median value, did not affect disease control rate, progression‐free survival, and overall survival in patients with Y‐90 TARE. Conclusions The TLR‐based stratification may be a simple method, but our study did not show the usefulness in predicting prognosis in HCC patients with Y‐90 TARE. Further studies with large number of patients are needed.

Total Lesion Glycolysis on 18F-FDG PET/CT Is a Better Prognostic Factor Than Tumor Dose on 90Y PET/CT in Patients With Hepatocellular Carcinoma Treated With 90Y Transarterial Radioembolization

“…In contrast, Kucuk et al 14 showed that higher SUV max HCC is associated with better progression-free survival rates in patients with unresectable HCC. In a study by Kim et al 17 involving 40 patients with HCC, TLR (>2.1) on 18 F-FDG PET/CTwas not predictive of treatment response, progression, or death. The controversial results could be attributed to the small number of enrolled patients and heterogeneous clinical conditions among the studies.…”

“…A few studies have evaluated the values of TLR or SUV on 18 F-FDG PET/CT to predict the prognosis of patients with HCC treated with 90 Y TARE. [13][14][15][16][17] Conflicting results, however, were obtained with regard to the value of 18 F-FDG uptake after 90 Y TARE. Abuodeh et al 13 and Jreige et al 15 demonstrated that patients with HCC with 18 F-FDG avidity, high SUV max , or high TLR have a worse prognosis.…”

“…A few studies have evaluated the values of TLR or SUV on 18 F-FDG PET/CT to predict the prognosis of patients with HCC treated with 90 Y TARE 13–17 . Conflicting results, however, were obtained with regard to the value of 18 F-FDG uptake after 90 Y TARE.…”

“…Research has shown that increased 18 F-FDG uptake in association with high histologic grade or aggressiveness 8,9 is a significant predictor for tumor recurrence after surgical resection, liver transplantation, or TACE 10–12 . Few studies, however, have evaluated the prognostic value of 18 F-FDG uptake, measured in SUVs, in patients with HCC undergoing 90 Y TARE 13–17 . Furthermore, the prognostic value of volumetric parameters, which have been shown to be better prognostic factors than SUV for many other cancers, is limited 18–20 .…”

“…[10][11][12] Few studies, however, have evaluated the prognostic value of 18 F-FDG uptake, measured in SUVs, in patients with HCC undergoing 90 Y TARE. [13][14][15][16][17] Furthermore, the prognostic value of volumetric parameters, which have been shown to be better prognostic factors than SUV for many other cancers, is limited. [18][19][20] Although some studies have shown predictive or prognostic value for tumor dose (TD) on 90 Y PET/CT, [21][22][23][24] no studies have evaluated the impact of volumetric parameters on 18 F-FDG PET/CT in comparison with TD on 90 Y PET/CT.…”