Quantitative pretreatment VOI analysis of liver metastases

Summary

Using quantitive VOI analysis, the percentage ^99mTc-MAA uptake and SUVmax and mean values of liver metastases obtained prior to SIRT were related to treatment response using both a lesion-based and clinical dichotomous approach. Based on the VOI % of ^99mTc-MAA activity, the estimated ⁹⁰Y-microspheres activity/cc (MBq/cc) was calculated from the effective dose injected. Baseline VOI FDG PET SUVmean and max values and estimated MBq/cc values were related to treatment response using a lesionbased approach (% change in SUVmean ≥ 50%) and a clinical dichotomous approach. Fifteen treatment sessions were analyzed (13 patients). Using the lesion-based approach (12 treatment sessions) 40 lesions responded and 37 did not. SUVmax and mean values proved significantly different between non-responding and responding lesions; 18.6 (SD 10.8) versus 13.5 (SD 8.4 ) for SUVmax (p = 0.02) and 11.4 (SD 3.8) versus 6.3 (SD 4.5) for SUVmean (p = 0.002). Using the clinical dichotomous approach (15 treatment sessions / 11 responding), 91 lesions were analyzed; 57 responded. VOI volumes and estimated ⁹⁰Y-loaded glass microspheres activity (MBq/cc) did not differ between responders and non responders; 24 cc (SD 27) versus 21 cc (SD 21 cc) (p = 0.4) and 1.95 MBq/cc (SD 1.1 MBq/cc) versus 1.90 MB/cc (SD 2.7 MBq/cc) (p = 0.92). On the contrary, SUVmax and mean values proved significantly different between responders and nonresponders; 23.7 (SD 9.8) versus 9.4 (SD 3.8 ) for SUVmax (p = 0.0001) and 13.1 (SD 8.1) versus 4.9 (SD 1.4) for SUVmean. Conclusion: These findings suggest that in patients presenting with high baseline SUVmax and mean values, the administration of higher activities or alternatively, other potentially more useful treatment options might be considered.

Zusammenfassung

Mittels quantitativer VOI-Analyse wurden die prozentuale ^99mTc-MAA Aufnahme, SUVmax und die vor einer SIRT ermittelten Mittelwerte von Lebermetastasen mit dem Ansprechen auf die Behandlung in Beziehung gesetzt, wobei sowohl ein läsionsbasierter als auch ein klinischer dichotomer Ansatz gewählt wurden. Basierend auf den VOI % der ^99mTc-MAA Aktivität wurde die geschätzte Aktivität/cm³ der ⁹⁰Y-Mikrosphären (MBq/cm³) aus der injizierten effektiven Dosis berechnet. Die mittleren und maximalen VOI FDG PET SUV-Werte bei Baseline und die geschätzten MBq/cm³-Werte wurden anhand eines läsionsbasierten (% Veränderung bei SUVmean ≥50%) sowie eines klinisch-dichotomen Ansatzes mit dem therapeutischen Ansprechen korreliert. Es wurden 15 Behandlungssitzungen (13 Patienten) analysiert. Mit dem läsionsbasierten Ansatz (12 Behandlungen) sprachen 40 Läsionen an und 37 nicht. Die mittleren und maximalen SUV-Werte waren zwischen den nicht ansprechenden und den ansprechenden Läsionen signifikant unterschiedlich; 18,6 (SD 10,8) versus 13,5 (SD 8,4) für SUVmax (p = 0,02) und 11,4 (SD 3,8) versus 6,3 (SD 4,5) für SUVmean (p = 0,002). Anhand des klinisch-dichotomen Ansatzes (15 Behandlungen / 11 erfolgreich) wurden 91 Läsionen analysiert; 57 sprachen an. Die VOI-Volumina und die geschätzte Aktivität der ⁹⁰Y markierten Glas-Mikrosphären (MBq/cm³) unterschieden sich nicht zwischen Respondern und Non-Respondern; 24 cm³ (SD 27) versus 21 cm³ (SD 21 cm³) (p = 0,4) und 1.95 MBq/ cm³ (SD 1,1 MBq/cm³) versus 1,90 MB/cm³ (SD 2,7 MBq/cm³) (p = 0,92). Hingegen wichen die maximalen und die mittleren SUV-Werte der Responder signifikant von denen der Non-Responder ab; 23,7 (SD 9,8) versus 9,4 (SD 3,8) für SUVmax (p = 0,0001) und 13,1 (SD 8,1) versus 4,9 (SD 1,4) für SUVmean. Schlussfolgerung: Diese Ergebnisse lassen vermuten, dass bei Patienten mit hohen mittleren und maximalen SUV-Ausgangswerten die Gabe höherer Aktivitäten oder, alternativ, andere, potenziell wirksamere Behandlungsmöglichkeiten in Betracht gezogen werden sollten.

Keywords

SIRT-VOI analysis-treatment response

Schlüsselwörter

SIRT-VOI-Analyse - therapeutisches Ansprechen

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