title: Metabolic tumor volume and total lesion glycolysis on FDG-PET/CT can predict overall survival after (90)Y radioembolization of colorectal liver metastases: A comparison with SUVmax, SUVpeak, and RECIST 1.0.
abstract: OBJECTIVE
  To compare the performance of 4 metrics of metabolic response on FDG-PET/CT against RECIST 1.0 for determining response and predicting overall survival (OS) following (90)Y resin microspheres radioembolization of colorectal liver metastases (CLM).
  
  
  METHODS
  We conducted an IRB-waived retrospective review of our radioembolization database to identify patients with unresectable CLM treated between December 2009 and December 2013. We included patients who had both PET/CT and contrast enhanced CT (CECT) available at baseline and on the first follow-up post-radioembolization. On baseline CECT up to five target tumors were chosen per patient according to RECIST 1.0. Four metrics of FDG-avidity (SUVmax, SUVpeak, metabolic tumor volume (MTV), and total lesion glycolysis (TLG)) on PET/CT were measured for the same target tumors. Using RECIST 1.0, patients were classified as no progression (partial response or stable disease) and progression. For each PET metric, a cut-off point of ≥30% decrease was chosen to define response. OS was calculated from the time of radioembolization using Kaplan-Meier methodology. The log-rank test was used for univariate analysis to identify predictors of OS.
  
  
  RESULTS
  The study enrolled 49 patients with 119 target tumors; a median of 2 (range: 1-5) tumors were selected per patient. Median OS was 12.7 months (95%CI: 7.2-16.7). Response by MTV (P=0.035) and TLG (P=0.044) reached statistical significance in predicting OS. Response by SUVmax (P=0.21), SUVpeak (P=0.20) or no progression by RECIST 1.0 (P=0.44) did not predict OS.
  
  
  CONCLUSIONS
  Metabolic response based on changes in MTV and TLG can predict OS post-radioembolization of CLM.
authors.affiliation: Section of Interventional Radiology, Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, United States.
authors.forename: Waleed
authors.initials: W
authors.lastname: Shady
authors.affiliation: Department of Nuclear medicine, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, United States.
authors.forename: Sirish
authors.initials: S
authors.lastname: Kishore
authors.affiliation: Department of Nuclear medicine, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, United States.
authors.forename: Somali
authors.initials: S
authors.lastname: Gavane
authors.affiliation: Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, United States.
authors.forename: Richard K
authors.initials: RK
authors.lastname: Do
authors.affiliation: Department of Nuclear medicine, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, United States.
authors.forename: Joseph R
authors.initials: JR
authors.lastname: Osborne
authors.affiliation: Department of Nuclear medicine, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, United States.
authors.forename: Gary A
authors.initials: GA
authors.lastname: Ulaner
authors.affiliation: Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, United States.
authors.forename: Mithat
authors.initials: M
authors.lastname: Gonen
authors.affiliation: Section of Interventional Radiology, Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, United States.
authors.forename: Etay
authors.initials: E
authors.lastname: Ziv
authors.affiliation: Section of Interventional Radiology, Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, United States.
authors.forename: Franz E
authors.initials: FE
authors.lastname: Boas
authors.affiliation: Section of Interventional Radiology, Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, United States. Electronic address: sofoclec@mskcc.org.
authors.forename: Constantinos T
authors.initials: CT
authors.lastname: Sofocleous
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy / Q000379:methods*; D015179:Colorectal Neoplasms / Q000473:pathology*; D005260:Female; D019788:Fluorodeoxyglucose F18; D006019:Glycolysis / Q000502:physiology*; D006801:Humans; D008099:Liver / Q000000981:diagnostic imaging / Q000378:metabolism / Q000473:pathology; D008113:Liver Neoplasms / Q000473:pathology / Q000532:radiotherapy* / Q000556:secondary; D008297:Male; D008875:Middle Aged; D000072078:Positron Emission Tomography Computed Tomography; D011237:Predictive Value of Tests; D019275:Radiopharmaceuticals; D066066:Response Evaluation Criteria in Solid Tumors; D012189:Retrospective Studies; D016019:Survival Analysis; D047368:Tumor Burden / Q000502:physiology*; D015021:Yttrium Radioisotopes / Q000627:therapeutic use
chemical_list: D019275:Radiopharmaceuticals; D015021:Yttrium Radioisotopes; D019788:Fluorodeoxyglucose F18
keywords: Colorectal liver metastases; Overall survival; PET/CT; RECIST 1.0; Radioembolization