Survival in patients with hepatocellular carcinoma treated with 90Y-microsphere radioembolization

A. Sabet; H. Ahmadzadehfar; J. Bruhman; A. Sabet; C. Meyer; J.-C. Wasmuth; C.-C. Pieper; H.-J. Biersack; S. Ezziddin

doi:10.3413/Nukmed-0622-13-09

Nuklearmedizin - NuclearMedicine, Table of Contents

Nuklearmedizin 2014; 53(02): 39-45
DOI: 10.3413/Nukmed-0622-13-09

Original article

Schattauer GmbH

Survival in patients with hepatocellular carcinoma treated with ⁹⁰Y-microsphere radioembolization

Prediction by ¹⁸F-FDG PETRadioembolisation des hepatozellulären Karzinoms mit ⁹⁰Y-MikrosphärenÜberlebensprädiktion durch ¹⁸F-FDG-PET

A. Sabet

¹Department of Nuclear Medicine, University Hospital, Bonn, Germany

,

H. Ahmadzadehfar

¹Department of Nuclear Medicine, University Hospital, Bonn, Germany

,

J. Bruhman

¹Department of Nuclear Medicine, University Hospital, Bonn, Germany

,

A. Sabet

¹Department of Nuclear Medicine, University Hospital, Bonn, Germany

,

C. Meyer

²Department of Radiology, University Hospital, Bonn, Germany

,

J.-C. Wasmuth

³Department of Internal Medicine, University Hospital, Bonn, Germany

,

C.-C. Pieper

²Department of Radiology, University Hospital, Bonn, Germany

,

H.-J. Biersack

¹Department of Nuclear Medicine, University Hospital, Bonn, Germany

,

S. Ezziddin

¹Department of Nuclear Medicine, University Hospital, Bonn, Germany

› Author Affiliations

Abstract

Summary

Aim: 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). Patients, 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-re- sponders according to the relative change in SUV_max 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). Conclusion: 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.

Zusammenfassung

Ziel: In dieser retrospektiven Studie wurde der prädiktive Wert der FDG-PET bei Patienten mit inoperablem hepatozellulärem Karzinom (HCC) untersucht, die sich einer Radioembolisation (RE) mit ⁹⁰Y-Mikrosphären unterzogen. Patienten, Methoden: Das Studienkollektiv umfasste n = 33 RE-Patienten mit basaler sowie 4-Wo-post-therapeut. FDG-PET/ CT. Anhand des basalen FDG-Status der HCC- Tumore wurden FDG-negative (n = 12) und FDG-positive (n = 21) Patienten unterschieden. FDG-positive Patienten wurden des Weiteren anhand der relativen Abnahme des SUV_max der behandelten Läsionen in frühe metabolische Responder und Non-Responder unterteilt. Die Überlebensanalyse erfolgte mittels Kaplan-Meier Kurven (Log-rank-Test mit p > 0.05), die multivariate Analyse zur Ermittlung der Prädiktoren für das Gesamtüberleben (OS). Resultate: FDG-negative Patienten überlebten signifikant länger (median 13 Monate, 95%-CI: 7-19) als FDG-positive (median 9 Monate, 95%-CI: 7-11, p = 0.01). Unter den FDG-positiven Patienten überlebten die frühen metabolischen Responder (median 10 Monate, 95%-CI: 8-12) länger als die restlichen Patienten (median 5 Monate, 95%-CI: 4-6, p = 0.003). Von den anderen Ausgangsvariablen (inklusive Allgemeinzustand, intrahepatischer und extrahepatischer Tumorlast, applizierter Gesamtaktivität) zeigte lediglich das BCLC-Stadium einen signifikanten Einfluss auf das Gesamtüberleben (p = 0.028). Schlussfolgerung: Prä- und posttherapeutisches FDG-PET ist ein unabhängiger Prädiktor des Gesamtüberlebens nach Radio- embolisation von HCC-Patienten. Interessanterweise erscheint das metabolische Frühansprechen bereits vier Wochen nach SIRT bestimmbar zu sein.

Keywords

¹⁸F-FDG PET - radioembolization - SIRT - HCC

Schlüsselwörter

¹⁸F-FDG-PET - Radioembolisation - SIRT - HCC

Full Text

References

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