Role of FDG-PET in Yttrium-90 treatment response evaluation

Objectives: Yttrium-90 is an effective therapy for patients with intermediate stage hepatocellular carcinoma. Y-90 is a pure beta-emitter which induces cell death inside the cancerous lesions of the liver. Our goal in this study is to monitor the treatment response of Y-90 in the liver with the appl...

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Bibliographic Details
Published inThe Journal of nuclear medicine (1978) Vol. 59; p. 1376
Main Authors Seraj, Siavash Mehdizadeh, Jahangiri, Pegah, Zadeh, Mahdi Zirakchian, Al-zaghal, Abdullah, Werner, Thomas, Zhuang, Hongming, Alavi, Abass, Hunt, Stephen
Format Journal Article
LanguageEnglish
Published New York Society of Nuclear Medicine 01.05.2018
Subjects
Adaptive systems
Cancer therapies
Cell death
Clinical outcomes
Computed tomography
Data analysis
Emitters
Females
Glycolysis
Hepatocellular carcinoma
Lesions
Liver
Liver cancer
Males
Metastases
Microspheres
Patients
Polyvinyl chloride
Population studies
Positron emission
Positron emission tomography
Statistical analysis
Statistical significance
Tomography
Tumors
Yttrium
Yttrium isotopes
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Summary:Objectives: Yttrium-90 is an effective therapy for patients with intermediate stage hepatocellular carcinoma. Y-90 is a pure beta-emitter which induces cell death inside the cancerous lesions of the liver. Our goal in this study is to monitor the treatment response of Y-90 in the liver with the application of FDG PET using an adaptive threshold system.Methods: 14 patients (7 males and 7 females) with the average age of 63 who had undergone radioembolization of metastatic hepatic tumors with Yttrium-90 were studied. Subjects having multifocal liver metastases underwent FDG PET/CT before and after the treatment with Y-90 microspheres. Both scans were performed 60 minutes after tracer injection. All the images were analyzed using an adaptive thresholding system (ROVER software; ABX GmbH, Radeberg, Germany). Malignant lesions were localized from different lobes of the liver and global mean standardized uptake volume (SUVmean), max SUV (SUVmax) and partial volume effect corrected SUV mean (pvc SUVmean), total lesion glycolysis (TLG) and total lesion glycolysis corrected (TLG corrected) were calculated. A paired T-test was used to assess the changes between baseline and after treatment. Results: The baseline and post-treatment SUVmean(±SE) were 5.54(±0.62) and 3.92(±0.34), respectively (p=0.02). The baseline and post-treatment SUVmax were 10.17(±1.16) and 6.64(±0.52), respectively (p=0.009). The change of pvc SUVmean was not statistically significant (p=0.06). There was a decrease in TLG and TLG corrected in all 14 patients but the changes were not statistically significant, possibly due to small study population (p=0.08) and (p=0.057). Conclusion: Our study shows that FDG PET with an automated adaptive thresholding system can be an effective imaging technique to monitor the Y-90 treatment response using the global FDG uptake and volume of tumors, with the SUVmax and SUVmean measurements demonstrating the greatest change with treatment. Larger sample size is needed to confirm our findings.
ISSN:0161-5505
1535-5667