Ytrrium-90 transarterial radioembolization in patients with gastrointestinal malignancies

Current Evidence on Local Therapies in Advanced Adrenocortical Carcinoma

International guidelines emphasise the role of local therapies (LT) for the treatment of advanced adrenocortical carcinoma (ACC). However, large studies are lacking in this field. Therefore, we performed a review of the literature to synthesise current evidence and develop clinical guidance. PubMed database was searched for systematic literature. We identified 119 potentially relevant articles, of which 21 could be included in our final analysis. All were retrospective and reported on 374 patients treated with LT for advanced ACC (12 studies on radiotherapy, 3 on transarterial chemoembolisation and radioembolisation, 4 on image-guided thermal ablation [radiofrequency, microwave ablation, and cryoablation, and two studies reporting treatment with several different LT]). Radiotherapy was frequently performed with palliative intention. However, in most patients, disease control and with higher dosage also partial responses could be achieved. Data for other LT were more limited, but also point towards local disease control in a significant percentage of patients. Very few studies tried to identify factors that are predictive on response. Patients with a disease-free interval after primary surgery of more than 9 months and lesions<5 cm might benefit most. Underreporting of toxicities may be prevalent, but LT appear to be relatively safe overall. Available evidence on LT for ACC is limited. LT appears to be safe and effective in cases with limited disease and should be considered depending on local expertise in a multidisciplinary team discussion.

The Role of 18F-FLT PET/CT in Assessing Early Response to Transarterial Radioembolization and Chemoembolization in Patients with Primary and Metastatic Liver Tumors

Objectives

Metastases and primary malignancies are common in the liver. Local ablative applications such as transarterial chemoembolization (TACE), and transarterial radioembolization (TARE) provide minimally invasive and safe treatment in unresectable liver tumors. Early detection of response to treatment prevents unnecessary toxicity and cost in non-responder patients and provides an earlier use of other options that may be effective. This study aimed to identify the role of ¹⁸F-fluorothymidine (FLT) positron emission tomography/computed tomography (PET/CT) in the assessment of early response to TACE and TARE treatments in patients with unresectable primary and metastatic liver tumors.

Methods

This single-center study included 63 patients who underwent ¹⁸F-FLT PET/CT for response evaluation after TACE and TARE. After excluding 20 patients whose data were missing 43 TARE-receiving patients were analyzed. The compatibility of change in semi-quantitative values obtained from the ¹⁸F-FLT PET/CT images with the treatment responses detected in ¹⁸F-fluorodeoxyglucose PET/CT, CT, and MR images and survival was evaluated.

Results

There was no correlation between early metabolic, morphological response, and ¹⁸F-FLT uptake pattern, and change in standardized uptake values (SUV) which were ΔSUV_max, ΔSUV_mean, ΔSUV_peak., ΔSUV_mean, Δ SUV_peak values. There was no significant correlation between ¹⁸F-FLT uptake pattern, ΔSUV_max, ΔSUV_mean, ΔSUV_peak, and overall survival, progression-free survival (PFS) for the target lobe PFS for the whole-body. The survival distributions for the patients with >30% change in Δ SUV_max and ΔSUV_peak values were statistically significantly longer than the patients with <30% change (p<0.009 and p<0.024, respectively).

Conclusion

There was significant longer PFS for target liver lobe in patients with more than 30% decrease in ¹⁸F-FLT SUV_max and SUV_peak of the liver lesion in primary and metastatic unresectable liver tumors undergoing TARE.

[Multimodal therapy for liver metastases of colorectal carcinoma in curative intention]

Depending on the patient's constitution, the biological conditions of the primary tumor, the metastases and the liver function and perfusion, a variety of therapeutic options are available. The basis of metastatic surgery of the liver is partial liver resection. Multimodal therapies with local and systemic approaches are used in functionally or oncologically borderline situations. They are intended to improve long-term success and allow curative treatment in more patients. In recent years, for isolated lesions that cannot be removed by partial liver resection, an R0 situation is achieved in selected patients by liver transplantation with good long-term success. The large number of treatment options and the increasing individualization of therapy require treatment planning in the interdisciplinary tumor board. Also, in view of promising studies, for example, in the field of liver transplantation as well as regional therapy methods, the range of treatment options has not yet been exhausted.