PET/CT with 18F-choline or 18F-FDG in Hepatocellular Carcinoma Submitted to 90Y-TARE: A Real-World Study

Abstract

Our aim was to assess the role of positron emission computed tomography (PET/CT) with 18F-choline (18F-FCH) or 18F-fluorodeoxyglucose (18F-FDG) in hepatocellular carcinoma (HCC) submitted to 90Y-radioembolization (90Y-TARE). We retrospectively analyzed clinical records of 21 HCC patients submitted to PET/CT with 18F-fluorocholine (18F-FCH) or 18F-fluodeoxyglucose (18F-FDG) before and 8 weeks after 90Y-TARE. On pre-treatment PET/CT, 13 subjects (61.9%) were 18F-FCH-positive, while 8 (38.1%) resulted 18F-FCH-negative and 18F-FDG-positive. At 8-weeks post 90Y-TARE PET/CT, 13 subjects showed partial metabolic response and 8 resulted non-responders, with a higher response rate among 18F-FCH-positive with respect to 18F-FDG-positive patients (i.e., 76.9% vs. 37.5%, p = 0.46). Post-treatment PET/CT influenced patients’ clinical management in 10 cases (47.6%); in 8 subjects it provided indication for a second 90Y-TARE targeting metabolically active HCC remnant, while in 2 patients it led to a PET-guided radiotherapy on metastatic nodes. By Kaplan–Meier analysis, patients’ age (≤69 y) and post 90Y-TARE PET/CT’s impact on clinical management significantly correlated with overall survival (OS). In Cox multivariate analysis, PET/CT’s impact on clinical management remained the only predictor of patients’ OS (p < 0.001). In our real-world study, PET/CT with 18F-FCH or 18F-FDG influenced clinical management and affected the final outcome for HCC patients treated with 90Y-TARE.

The Influence of Additional Treatments on the Survival of Patients Undergoing Transarterial Radioembolization (TARE)

“…Person-related predictors of unfavorable outcomes in patients undergoing TARE include an older age (>70 years) [ 29 , 30 ], male sex [ 31 ], a higher tumor grade, a larger tumor size, a later tumor stage, a lack of treatment with surgery or systemic therapy, the presence of lymphatic or vascular invasion [ 32 ], a Child–Pugh score (CPS) of B or C vs. A, and an Eastern Cooperative Oncology Group performance status (ECOG-PS) of 2 or 1 vs. 0 [ 33 , 34 ]. Other factors that positively influence survival in patients receiving TARE are administered activity and mean dose to the tumor [ 35 ].…”

Bench to Bedside Development of [18F]Fluoromethyl-(1,2-2H4)choline ([18F]D4-FCH)

“…Paired [ 18 F]FCH and [ 18 F]FDG PET have been shown to predict a 6-month response to 90 Y-transarterial radioembolisation in hepatocellular carcinoma (HCC) [45]. It also has the potential to identify metabolically active tumour remnants after 90 Y-transarterial radioembolisation in HCC [46].…”

Radioembolisation mit Harz- und Glas-Mikrosphären

“…Bei FDGaviden Tumoren wie CRC ist die Beurteilung des Ansprechens mit der PET der morphologischen Beurteilung nach RECIST-Kriterien überlegen [120,121]. Bei HCC hat neben der FDG-PET auch die PET-Bildgebung mit [18 F]Fluorethylcholin eine hohe prognostische Relevanz [122]. Bei NET ist die PET-Bildgebung mit radioaktiv markierten Somatostatin-Analoga aufgrund der hohen Sensitivität und Spezifität von großer Bedeutung [123,124]…”