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Topcuoglu OM, Orhan T, Gormez A, Alan N. Are survival outcomes dependent on the tumour dose threshold of 139 Gy in patients with chemorefractory metastatic colorectal cancer treated with yttrium-90 radioembolization using glass particles? A real-world single-centre study. Br J Radiol 2024; 97:1255-1260. [PMID: 38730551 DOI: 10.1093/bjr/tqae096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 04/10/2024] [Accepted: 05/05/2024] [Indexed: 05/13/2024] Open
Abstract
OBJECTIVES To compare the survival and objective response rate (ORR) of the patients receiving estimated tumour absorbed dose (ETAD) <140 Gy versus ETAD ≥140 Gy in patients with advanced chemorefractory colorectal carcinoma liver metastases (CRCLM) treated with yttrium-90 transarterial radioembolization (90Y TARE). METHODS Between August 2016 and August 2023 adult patients with unresectable, chemorefractory CRCLM treated with 90Y TARE using glass particles, were retrospectively enrolled. Primary outcomes were overall survival (OS) and hepatic progression free survival (hPFS). Secondary outcome was ORR. RESULTS A total of 40 patients with a mean age of 66.2 ± 7.8 years met the inclusion criteria. Mean ETAD for group 1 (ETAD <140 Gy) and group 2 (ETAD ≥140) were 131.2 ± 17.4 Gy versus 195 ± 45.6 Gy, respectively. The mean OS and hPFS for group 1 versus group 2 were 12 ± 10.3 months and 8.1 ± 9.3 months versus 9.3 ± 3 months and 7.1 ± 8.4 months, respectively and there were no significant differences (P = .181 and P = .366, respectively). ORR did not show significant difference between the groups (P = .432). CONCLUSION In real-world practice, no significant difference was found in OS, hPFS, and ORR between patients who received ETAD <140 Gy versus ETAD ≥140 Gy in patients with CRCLM, in this series. ADVANCES IN KNOWLEDGE This study demonstrated that increased tumour absorbed doses in radioembolization may not provide additional significant advantage for OS and hPFS for patients with CRCLM.
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Affiliation(s)
| | - Tolga Orhan
- Department of Radiology, Yeditepe University Hospitals, Kosuyolu 34718, Turkey
| | - Ayşegul Gormez
- Department of Radiology, Yeditepe University Hospitals, Kosuyolu 34718, Turkey
| | - Nalan Alan
- Department of Nuclear Medicine, Yeditepe University Hospitals, Kosuyolu 34718, Turkey
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Qu X, Zhang F. Yttrium-90 Transarterial Radioembolization: An Effective Primary or Salvage Therapy to Bridge the Patients with Hepatocellular Carcinoma to Liver Transplantation. Acad Radiol 2024; 31:1836-1838. [PMID: 38472023 DOI: 10.1016/j.acra.2024.02.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 02/15/2024] [Accepted: 02/16/2024] [Indexed: 03/14/2024]
Affiliation(s)
- Xudong Qu
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University School of Medicine, Shanghai, China
| | - Feng Zhang
- Department of Radiology, University of Washington School of Medicine, Seattle, Washington 98109, USA.
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Coskun N, Kartal MO, Kartal AS, Cayhan V, Ozdemir M, Canyigit M, Ozdemir E. Use of dose-volume histograms for metabolic response prediction in hepatocellular carcinoma patients undergoing transarterial radioembolization with Y-90 resin microspheres. Ann Nucl Med 2024:10.1007/s12149-024-01926-4. [PMID: 38647875 DOI: 10.1007/s12149-024-01926-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 03/25/2024] [Indexed: 04/25/2024]
Abstract
INTRODUCTION Voxel-based dosimetry offers improved outcomes in the treatment of hepatocellular carcinoma (HCC) with transarterial radioembolization (TARE) using glass microspheres. However, the adaptation of voxel-based dosimetry to resin-based microspheres has been poorly studied, and the prognostic relevance of heterogeneous dose distribution remains unclear. This study aims to explore the use of dose-volume histograms for resin microspheres and to determine thresholds for objective metabolic response in HCC patients treated with resin-based TARE. METHODS We retrospectively reviewed HCC patients who underwent TARE with Y-90-loaded resin microspheres in our institution between January 2021 and December 2022. Voxel-based dosimetry was performed on post-treatment Y-90 PET/CT images to extract parameters including mean dose absorbed by the tumor (mTD), the percentage of the targeted tumor volume (pTV), and the minimum doses absorbed by consecutive percentages within the tumor volume (D10, D25, D50, D75, D90). Assessment of metabolic response was done according to PERCIST criteria with F-18 FDG PET/CT imaging at 8-12 weeks after the treatment. RESULTS This study included 35 lesions targeted with 22 TARE sessions in 19 patients (15 males, 4 females, mean age 60 ± 13 years). Objective metabolic response was achieved in 43% of the lesions (n = 15). Responsive lesions had significantly higher mTD, pTV, and D25-D90 values (all p < 0.05). Optimal cut-off values for mTD, pTV, and D50 were 94.6 Gy (sensitivity 73%, specificity 70%, AUC 0.72), 94% (sensitivity 73%, specificity 55%, AUC 0.64), and 91 Gy (sensitivity 80%, specificity 80%, AUC 0.80), respectively. CONCLUSION Parameters derived from dose-volume histograms could offer valuable insights for predicting objective metabolic response in HCC patients treated with resin-based TARE. If verified with larger prospective cohorts, these parameters could enhance the precision of dose distribution and potentially optimize treatment outcomes.
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Affiliation(s)
- Nazim Coskun
- Department of Nuclear Medicine, Ankara Yildirim Beyazit University, Ankara, Turkey.
- Department of Nuclear Medicine, Ankara Bilkent City Hospital, Cankaya, Ankara, Turkey.
| | - Mehmet Oguz Kartal
- Department of Nuclear Medicine, Ankara Bilkent City Hospital, Cankaya, Ankara, Turkey
| | - Aysenur Sinem Kartal
- Department of Nuclear Medicine, Ankara Bilkent City Hospital, Cankaya, Ankara, Turkey
| | - Velihan Cayhan
- Department of Interventional Radiology, Ankara Bilkent City Hospital, Ankara, Turkey
| | - Mustafa Ozdemir
- Department of Interventional Radiology, Ankara Bilkent City Hospital, Ankara, Turkey
- Department of Interventional Radiology, University of Health Sciences, Ankara, Turkey
| | - Murat Canyigit
- Department of Interventional Radiology, Ankara Bilkent City Hospital, Ankara, Turkey
- Department of Interventional Radiology, Ankara Yildirim Beyazit University, Ankara, Turkey
| | - Elif Ozdemir
- Department of Nuclear Medicine, Ankara Yildirim Beyazit University, Ankara, Turkey
- Department of Nuclear Medicine, Ankara Bilkent City Hospital, Cankaya, Ankara, Turkey
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Yu Q, Neale M, Ungchusri E, Rothenberger NJ, Liao C, Patel M, Pillai A, Navuluri R, Ahmed O, Ha TV. Tumor Size and Watershed Area Correlate with Incomplete Treatment and Tumor Progression after Selective Radioembolization for Hepatocellular Carcinoma. J Vasc Interv Radiol 2024:S1051-0443(24)00125-8. [PMID: 38336031 DOI: 10.1016/j.jvir.2024.01.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 01/26/2024] [Accepted: 01/31/2024] [Indexed: 02/12/2024] Open
Abstract
PURPOSE To identify factors of incomplete treatment after segmental transarterial radioembolization (TARE) for treatment-naive and solitary hepatocellular carcinoma (HCC). MATERIALS AND METHODS A total of 75 consecutive patients (age, 68.5 years [SD ± 8.0]; 25/75 [33.3%] women) with treatment-naive, solitary HCC underwent segmental or subsegmental TARE with glass microspheres (tumor size, 3.8 cm [SD ± 2.2]; administered dose, 222.6 Gy [SD ± 123.9]) at a single institution from November 2015 to June 2022. Radiologic response and progression-free survival (PFS) were assessed as per modified Response Evaluation Criteria in Solid Tumors. RESULTS Complete treatment was achieved in 48 of 75 (64.0%) patients (mean follow-up, 33.2 months [SD ± 27.4]). Patients with incomplete treatment (27/75, 36%) presented with larger tumor size (5.0 [SD ± 2.5] vs 3.1 [SD ± 1.6] cm; P = .0001), with more tumors located in the watershed zone (81.5% vs 41.7%; P = .001). These patients were less likely to be bridged to transplant or resection (22.2% vs 52.1%; P = .015). Watershed tumors demonstrated worse target tumor PFS (median PFS, 19 months vs not reached; P = .0104) and overall PFS (9.1 months vs not reached; P = .0077). Watershed location was associated with worse PFS among tumors >3 cm in size (8.4 months vs not reached; P = .035) but not in tumors ≤3 cm in size (52.2 months vs not reached; P = .915). CONCLUSIONS Tumor size and watershed location were associated with incomplete treatment after segmental TARE for HCC. Watershed tumors were associated with worse PFS, particularly tumors larger than 3 cm. These tumors may require careful treatment planning and repeated treatments to ensure a durable response.
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Affiliation(s)
- Qian Yu
- Department of Radiology, University of Chicago Medical Center, University of Chicago, Chicago, Illinois.
| | - Monika Neale
- Department of Radiology, Cleveland Clinic, Cleveland, Ohio
| | - Ethan Ungchusri
- Department of Radiology, University of Chicago Medical Center, University of Chicago, Chicago, Illinois
| | | | - Chuanhong Liao
- Department of Public Health Sciences, University of Chicago, Chicago, Illinois
| | - Mikin Patel
- Department of Radiology, University of Chicago Medical Center, University of Chicago, Chicago, Illinois
| | - Anjana Pillai
- Department of Hepatology, University of Chicago Medical Center, University of Chicago, Chicago, Illinois
| | - Rakesh Navuluri
- Department of Radiology, University of Chicago Medical Center, University of Chicago, Chicago, Illinois
| | - Osman Ahmed
- Department of Radiology, University of Chicago Medical Center, University of Chicago, Chicago, Illinois
| | - Thuong Van Ha
- Department of Radiology, University of Chicago Medical Center, University of Chicago, Chicago, Illinois
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Villalobos A, Pisanie JLD, Gandhi RT, Kokabi N. Yttrium-90 Radioembolization Dosimetry: Dose Considerations, Optimization, and Tips. Semin Intervent Radiol 2024; 41:63-78. [PMID: 38495257 PMCID: PMC10940044 DOI: 10.1055/s-0044-1779715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Affiliation(s)
- Alexander Villalobos
- Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Johannes L. du Pisanie
- Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Ripal T. Gandhi
- Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Nima Kokabi
- Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Jia Y, Li Z, Akhavanallaf A, Fessler JA, Dewaraja YK. 90Y SPECT scatter estimation and voxel dosimetry in radioembolization using a unified deep learning framework. EJNMMI Phys 2023; 10:82. [PMID: 38091168 PMCID: PMC10719178 DOI: 10.1186/s40658-023-00598-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 11/28/2023] [Indexed: 12/17/2023] Open
Abstract
PURPOSE 90Y SPECT-based dosimetry following radioembolization (RE) in liver malignancies is challenging due to the inherent scatter and the poor spatial resolution of bremsstrahlung SPECT. This study explores a deep-learning-based absorbed dose-rate estimation method for 90Y that mitigates the impact of poor SPECT image quality on dosimetry and the accuracy-efficiency trade-off of Monte Carlo (MC)-based scatter estimation and voxel dosimetry methods. METHODS Our unified framework consists of three stages: convolutional neural network (CNN)-based bremsstrahlung scatter estimation, SPECT reconstruction with scatter correction (SC) and absorbed dose-rate map generation with a residual learning network (DblurDoseNet). The input to the framework is the measured SPECT projections and CT, and the output is the absorbed dose-rate map. For training and testing under realistic conditions, we generated a series of virtual patient phantom activity/density maps from post-therapy images of patients treated with 90Y-RE at our clinic. To train the scatter estimation network, we use the scatter projections for phantoms generated from MC simulation as the ground truth (GT). To train the dosimetry network, we use MC dose-rate maps generated directly from the activity/density maps of phantoms as the GT (Phantom + MC Dose). We compared performance of our framework (SPECT w/CNN SC + DblurDoseNet) and MC dosimetry (SPECT w/CNN SC + MC Dose) using normalized root mean square error (NRMSE) and normalized mean absolute error (NMAE) relative to GT. RESULTS When testing on virtual patient phantoms, our CNN predicted scatter projections had NRMSE of 4.0% ± 0.7% on average. For the SPECT reconstruction with CNN SC, we observed a significant improvement on NRMSE (9.2% ± 1.7%), compared to reconstructions with no SC (149.5% ± 31.2%). In terms of virtual patient dose-rate estimation, SPECT w/CNN SC + DblurDoseNet had a NMAE of 8.6% ± 5.7% and 5.4% ± 4.8% in lesions and healthy livers, respectively; compared to 24.0% ± 6.1% and 17.7% ± 2.1% for SPECT w/CNN SC + MC Dose. In patient dose-rate maps, though no GT was available, we observed sharper lesion boundaries and increased lesion-to-background ratios with our framework. For a typical patient data set, the trained networks took ~ 1 s to generate the scatter estimate and ~ 20 s to generate the dose-rate map (matrix size: 512 × 512 × 194) on a single GPU (NVIDIA V100). CONCLUSION Our deep learning framework, trained using true activity/density maps, has the potential to outperform non-learning voxel dosimetry methods such as MC that are dependent on SPECT image quality. Across comprehensive testing and evaluations on multiple targeted lesions and healthy livers in virtual patients, our proposed deep learning framework demonstrated higher (66% on average in terms of NMAE) estimation accuracy than the current "gold-standard" MC method. The enhanced computing speed with our framework without sacrificing accuracy is highly relevant for clinical dosimetry following 90Y-RE.
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Affiliation(s)
- Yixuan Jia
- Department of Electrical Engineering and Computer Science, University of Michigan, 4125 EECS Bldg., 1301 Beal Ave., Ann Arbor, MI, 48109, USA.
| | - Zongyu Li
- Department of Electrical Engineering and Computer Science, University of Michigan, 4125 EECS Bldg., 1301 Beal Ave., Ann Arbor, MI, 48109, USA
| | | | - Jeffrey A Fessler
- Department of Electrical Engineering and Computer Science, University of Michigan, 4125 EECS Bldg., 1301 Beal Ave., Ann Arbor, MI, 48109, USA
| | - Yuni K Dewaraja
- Department of Radiology, University of Michigan, Ann Arbor, MI, USA
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Boshell D, Bester L. Radioembolisation of liver metastases. J Med Imaging Radiat Oncol 2023; 67:842-852. [PMID: 37343147 DOI: 10.1111/1754-9485.13549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 06/05/2023] [Indexed: 06/23/2023]
Abstract
This review aims to present contemporary data for SIRT in the treatment of secondary hepatic malignancies including colorectal, neuroendocrine, breast and uveal melanoma.
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Affiliation(s)
- David Boshell
- Department of Radiology, St Vincent's Hospital, Sydney, New South Wales, Australia
| | - Lourens Bester
- Department of Radiology, University of Notre Dame, Sydney, New South Wales, Australia
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8
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Doppler M, Reincke M, Bettinger D, Vogt K, Weiss J, Schultheiss M, Uller W, Verloh N, Goetz C. Predictive Value of [ 99mTc]-MAA-Based Dosimetry in Hepatocellular Carcinoma Patients Treated with [ 90Y]-TARE: A Single-Center Experience. Diagnostics (Basel) 2023; 13:2432. [PMID: 37510175 PMCID: PMC10378141 DOI: 10.3390/diagnostics13142432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 07/13/2023] [Accepted: 07/19/2023] [Indexed: 07/30/2023] Open
Abstract
Transarterial radioembolization is a well-established method for the treatment of hepatocellular carcinoma. The tolerability and incidence of hepatic decompensation are related to the doses delivered to the tumor and healthy liver. This retrospective study was performed at our center to evaluate whether tumor- and healthy-liver-absorbed dose levels in TARE are predictive of tumor response according to the mRECIST 1.1 criteria and overall survival. One hundred and six patients with hepatocellular carcinoma were treated with [90Y]-loaded resin microspheres and completed the follow-up. The dose delivered to each compartment was calculated using a compartmental model. The model was based on [99mTc]-labelled albumin aggregate images obtained before the start of therapy. Tumor response was assessed after three months of treatment. Kaplan-Meier analysis was used to assess survival. The mean age of our population was 66 ± 13 years with a majority being BCLC B tumors. Forty-two patients presented with portal vein thrombosis. The response rate was 57% in the overall population and 59% in patients with thrombosis. Target-to-background (TBR) values measured on initial [99mTc]MAA-SPECT-imaging and tumor model dosimetric values were associated with tumor response (p < 0.001 and p = 0.009, respectively). A dosimetric threshold of 136.5 Gy was predictive of tumor response with a sensitivity of 84.2% and specificity of 89.4%. Overall survival was 24.1 months [IQR 13.1-36.4] for patients who responded to treatment compared to 10.4 months [IQR 6.3-15.9] for the remaining patients (p = 0.022). In this cohort, the initial [99mTc]MAA imaging is predictive of response and survival. The dosimetry prior to the application of TARE can be used for treatment planning and our results also suggest that the therapy is well-tolerated. In particular, hepatic decompensation can be predicted even in the presence of PVT.
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Affiliation(s)
- Michael Doppler
- Department of Diagnostic and Interventional Radiology, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, 79085 Freiburg, Germany
| | - Marlene Reincke
- Department of Medicine II, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, 79085 Freiburg, Germany
| | - Dominik Bettinger
- Department of Medicine II, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, 79085 Freiburg, Germany
| | - Katharina Vogt
- Department of Diagnostic and Interventional Radiology, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, 79085 Freiburg, Germany
| | - Jakob Weiss
- Department of Diagnostic and Interventional Radiology, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, 79085 Freiburg, Germany
| | - Michael Schultheiss
- Department of Medicine II, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, 79085 Freiburg, Germany
- Berta-Ottenstein-Programme, Faculty of Medicine, University of Freiburg, 79085 Freiburg, Germany
| | - Wibke Uller
- Department of Diagnostic and Interventional Radiology, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, 79085 Freiburg, Germany
| | - Niklas Verloh
- Department of Diagnostic and Interventional Radiology, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, 79085 Freiburg, Germany
| | - Christian Goetz
- Department of Nuclear Medicine, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, 79085 Freiburg, Germany
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A Theranostic Approach in SIRT: Value of Pre-Therapy Imaging in Treatment Planning. J Clin Med 2022; 11:jcm11237245. [PMID: 36498819 PMCID: PMC9736029 DOI: 10.3390/jcm11237245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 11/24/2022] [Accepted: 12/02/2022] [Indexed: 12/12/2022] Open
Abstract
Selective internal radiation therapy (SIRT) is one of the treatment options for liver tumors. Microspheres labelled with a therapeutic radionuclide (90Y or 166Ho) are injected into the liver artery feeding the tumor(s), usually achieving a high tumor absorbed dose and a high tumor control rate. This treatment adopts a theranostic approach with a mandatory simulation phase, using a surrogate to radioactive microspheres (99mTc-macroaggregated albumin, MAA) or a scout dose of 166Ho microspheres, imaged by SPECT/CT. This pre-therapy imaging aims to evaluate the tumor targeting and detect potential contraindications to SIRT, i.e., digestive extrahepatic uptake or excessive lung shunt. Moreover, the absorbed doses to the tumor(s) and the healthy liver can be estimated and used for planning the therapeutic activity for SIRT optimization. The aim of this review is to evaluate the accuracy of this theranostic approach using pre-therapy imaging for simulating the biodistribution of the microspheres. This review synthesizes the recent publications demonstrating the advantages and limitations of pre-therapy imaging in SIRT, particularly for activity planning.
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Filippi L, Bagni O, Notarianni E, Saltarelli A, Ambrogi C, Schillaci O. PET/CT with 18F-choline or 18F-FDG in Hepatocellular Carcinoma Submitted to 90Y-TARE: A Real-World Study. Biomedicines 2022; 10:biomedicines10112996. [PMID: 36428565 PMCID: PMC9687226 DOI: 10.3390/biomedicines10112996] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 11/14/2022] [Accepted: 11/18/2022] [Indexed: 11/23/2022] Open
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.
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Affiliation(s)
- Luca Filippi
- Nuclear Medicine Unit, “Santa Maria Goretti” Hospital, Via Antonio Canova, 04100 Latina, Italy
- Correspondence: ; Tel.: +39-07736553591
| | - Oreste Bagni
- Nuclear Medicine Unit, “Santa Maria Goretti” Hospital, Via Antonio Canova, 04100 Latina, Italy
| | - Ermanno Notarianni
- Diagnostic and Interventional Unit, “Santa Maria Goretti” Hospital, Via Antonio Canova, 04100 Latina, Italy
| | - Adelchi Saltarelli
- Diagnostic and Interventional Unit, “Santa Maria Goretti” Hospital, Via Antonio Canova, 04100 Latina, Italy
| | - Cesare Ambrogi
- Diagnostic and Interventional Unit, “Santa Maria Goretti” Hospital, Via Antonio Canova, 04100 Latina, Italy
| | - Orazio Schillaci
- Department of Biomedicine and Prevention, University Tor Vergata, Viale Oxford 81, 00133 Rome, Italy
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