Survival in patients with hepatocellular carcinoma treated with 90Y-microsphere radioembolization. Prediction by 18F-FDG PET.
OBJECTIVE
This retrospective study aims to evaluate the predictive value of FDG PET/CT in patients with unresectable hepatocellular carcinoma (HCC) undergoing radioembolization with yttrium-90 labeled microspheres (RE).


METHODS
The study cohort comprised 33 patients who were treated with RE at our institution and underwent FDG PET/CT at baseline and four weeks after radioembolization. According to the baseline FDG metabolic status of the HCC lesions, patients were divided into two groups: FDG-negative (n = 12) and FDG-positive (n = 21) HCC. FDG-positive patients were further divided into early metabolic responders and non-responders according to the relative change in SUVmax of the treated lesions. Survival analyses were performed with the Kaplan-Meier method (log-rank test, p < 0.05). Multivariate analysis was performed to assess the influence of prognostic factors on overall survival (OS).


RESULTS
FDG-negative patients had a significantly longer OS (13 months, 95%CI 7-19) than FDG-positive patients (9 months, 95%CI 7-11; p = 0.010). Among FDG-positive patients, metabolic responders survived significantly longer than metabolic non-responders (10 months, 95%CI 8-12 vs. 5 months, 95%CI 4-6; p = 0.003). From the other baseline factors (including performance status, hepatic tumour burden, presence of extra-hepatic disease, administered activity) only the BCLC stage had a significant impact on OS (p = 0.028).


CONCLUSIONS
Pre- and post-therapeutic FDG PET independently predicts overall survival in patients with HCC undergoing radioembolization. Interestingly, early metabolic response seems to be assessable as early as four weeks post-treatment.
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A
Sabet
H
H
Ahmadzadehfar
J
J
Bruhman
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A
Sabet
C
C
Meyer
J-C
JC
Wasmuth
C-C
CC
Pieper
H-J
HJ
Biersack
Samer Ezziddin, MD, Department of Nuclear Medicine University Hospital, Sigmund-Freud-Str. 25, 53105 Bonn, Germany, Tel. +49/(0)228/28 71 91 74, Fax +49/(0)228/28 79 01 91 74, E-mail: samer.ezziddin@ukb.uni-bonn.de.
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Ezziddin
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy; D006528:Carcinoma, Hepatocellular / Q000000981:diagnostic imaging* / Q000532:radiotherapy*; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008113:Liver Neoplasms / Q000000981:diagnostic imaging* / Q000532:radiotherapy*; D008297:Male; D008863:Microspheres; D008875:Middle Aged; D049268:Positron-Emission Tomography / Q000379:methods*; D011379:Prognosis; D019275:Radiopharmaceuticals / Q000627:therapeutic use; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D015996:Survival Rate; D015021:Yttrium Radioisotopes / Q000627:therapeutic use
D019275:Radiopharmaceuticals; D015021:Yttrium Radioisotopes; D019788:Fluorodeoxyglucose F18
18F-FDG PET; HCC; SIRT; radioembolization