Assessment of local control after laser-induced thermotherapy of liver metastases from colorectal cancer: contribution of FDG-PET in patients with clinical suspicion of progressive disease.
BACKGROUND
Management of patients after locally ablative treatment of liver metastases requires exact information about local control and systemic disease status. To fulfill these requirements, whole-body imaging using positron emission tomography with (18)F-fluorodeoxyglucose (FDG-PET) is a promising alternative to morphologic imaging modalities such as computed tomography (CT) and magnetic resonance imaging (MRI).


OBJECTIVE
To evaluate FDG-PET for the assessment of local control and systemic disease in patients with clinical suspicion of tumor progression after laser-induced thermotherapy (LITT) of colorectal liver metastases.


METHODS
In 21 patients with suspicion of progressive disease after LITT, whole-body FDG-PET was performed. The presence of viable tumor within treated lesions, new liver metastases, and extrahepatic disease was evaluated visually and semiquantitatively (maximal standard uptake value [SUV(max)], tumor-to-normal ratio [T/N]). The standard of reference was histopathology (n = 25 lesions) and/or clinical follow-up (>12 months) including contrast-enhanced MRI of the liver.


RESULTS
Among 54 metastases treated with LITT, 29 had residual tumor. Receiver operating characteristic (ROC) analysis of SUV(max) (area under the curve (AUC) 0.990) and T/N (AUC 0.968) showed a significant discrimination level of negative or positive lesion status with an equal accuracy of 94% (51/54). The overall accuracy of visual FDG-PET was 96% (52/54), with one false-negative lesion among six examined within 3 days after LITT, and one false-positive lesion examined 54 days after LITT. In the detection of new intra- and extrahepatic lesions, FDG-PET resulted in correct alteration of treatment strategy in 43% of patients (P = 0.007).


CONCLUSIONS
FDG-PET is a promising tool for the assessment of local control and whole-body restaging in patients with clinical suspicion of tumor progression after locally ablative treatment of colorectal liver metastases with LITT.
Denecke
T
T
Klinik für Strahlenheilkunde, Bereiche Radiologie und Nuklearmedizin, Medizinische Klinik mit Schwerpunkt Hämatologie Onkologie, Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Germany.
Steffen
I
I
Hildebrandt
B
B
Rühl
R
R
Streitparth
F
F
Lehmkuhl
L
L
Langrehr
J
J
Ricke
J
J
Amthauer
H
H
Hänninen
E Lopez
EL
D000328:Adult; D000368:Aged; D017115:Catheter Ablation; D015179:Colorectal Neoplasms / Q000473:pathology*; D003951:Diagnostic Errors; D018450:Disease Progression; D005260:Female; D019788:Fluorodeoxyglucose F18; D005500:Follow-Up Studies; D006801:Humans; D006979:Hyperthermia, Induced / Q000379:methods; D053685:Laser Therapy / Q000379:methods; D008113:Liver Neoplasms / Q000000981:diagnostic imaging* / Q000556:secondary* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D018365:Neoplasm, Residual / Q000000981:diagnostic imaging*; D049268:Positron-Emission Tomography / Q000379:methods*; D012372:ROC Curve; D012680:Sensitivity and Specificity
D019788:Fluorodeoxyglucose F18