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Y90 radioembolization of colorectal cancer liver metastases: response assessment by contrast-enhanced computed tomography with or without PET-CT guidance

      Abstract

      Purpose

      To compare various computed tomography (CT) parameters to the positron emission tomography with computed tomography (PET-CT) response, with or without PET guidance for the response assessment of colorectal cancer (CRC) metastases treated by Y90 radioembolization.

      Methods

      Thirty-six CRC metastases were retrospectively evaluated on 18F-Fluoro-Deoxy-Glucose PET-CT and contrast-enhanced computed tomography (CECT) performed at baseline and 2–3 months after Y90 radioembolization.

      Results

      Median SUVmax values decreased from 11.39 to 6.71 after radioembolization (P<.001), and 23/36 (64%) metastases were categorized metabolic responses according to European Organisation for Research and Treatment of Cancer criteria. Only a decrease of the mean attenuation in the structural (P<.001) and metabolic active volume (P<.001) was observed. The change in these criteria was correlated with the change of SUVmax.

      Abbreviations:

      CEA (carcinoembryonic antigen), CRC (colorectal cancer), CECT (contrast-enhanced computed tomography), EORTC (European Organisation for Research and Treatment of Cancer), FDG (18F-Fluoro-Deoxyglucose), HU (Hounsfield unit), IQR (interquartile range), LDT (liver directed therapies), MAMAV (mean attenuation in the metabolic active volume), MASV (mean attenuation in the structural volume), MD (maximal diameter measured in the axial plane), PET(−CT) (positron emission tomography (with computed tomography)), RECIST (response criteria in solid tumors), S.D. (standard deviation), SPECT (single photon emission computed tomography), SUVmax (maximal standardized uptake value), SV (structural volume), 99Tc-MAA (99Technetium-macroaggregated albumin), VOI (volume of interest), Y90 (90Yttrium)

      Keywords

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      References

        • Schima W
        • Ba-Ssalamah A
        • Kurtaran A
        • Schindl M
        • Gruenberger T
        Post-treatment imaging of liver tumours.
        Cancer Imaging. 2007; 7 ([Spec No A]): S28-S36
        • Eisenhauer EATP
        • Bogaerts J
        • Schwartz LH
        • Sargent D
        • Ford R
        • Dancey J
        • et al.
        New response evaluation criteria in solid tumours: Revised RECIST guideline (version 1.1).
        Eur J Cancer. 2009; 45: 228-247
        • Szyszko T
        • Al-Nahhas A
        • Canelo R
        • Habib N
        • Jiao L
        • Wasan H
        • et al.
        Assessment of response to treatment of unresectable liver tumours with 90Y microspheres: value of FDG PET versus computed tomography.
        Nucl Med Commun. 2007; 28: 15-20
        • Zerizer I
        • Al-Nahhas A
        • Towey D
        • Tait P
        • Ariff B
        • Wasan H
        • et al.
        The role of early (1)(8)F-FDG PET/CT in prediction of progression-free survival after (9)(0)Y radioembolization: comparison with RECIST and tumour density criteria.
        Eur J Nucl Med Mol Imaging. 2012; 39: 1391-1399
        • Miller FH
        • Keppke AL
        • Reddy D
        • Huang J
        • Jin J
        • Mulcahy MF
        • et al.
        Response of liver metastases after treatment with yttrium-90 microspheres: role of size, necrosis, and PET.
        AJR Am J Roentgenol. 2007; 188: 776-783
        • Bienert M
        • McCook B
        • Carr BI
        • Geller DA
        • Sheetz M
        • Tutor C
        • et al.
        90Y microsphere treatment of unresectable liver metastases: changes in 18F-FDG uptake and tumour size on PET/CT.
        Eur J Nucl Med Mol Imaging. 2005; 32: 778-787
        • Wong CY
        • Qing F
        • Savin M
        • Campbell J
        • Gates VL
        • Sherpa KM
        • et al.
        Reduction of metastatic load to liver after intraarterial hepatic yttrium-90 radioembolization as evaluated by [18F]fluorodeoxyglucose positron emission tomographic imaging.
        J Vasc Interv Radiol. 2005; 16: 1101-1106
        • Khatri VP
        • Chee KG
        • Petrelli NJ
        Modern multimodality approach to hepatic colorectal metastases: solutions and controversies.
        Surg Oncol. 2007; 16: 71-83
        • Lewandowski RJ
        • Thurston KG
        • Goin JE
        • Wong CY
        • Gates VL
        • Van Buskirk M
        • et al.
        90Y microsphere (TheraSphere) treatment for unresectable colorectal cancer metastases of the liver: response to treatment at targeted doses of 135-150 Gy as measured by [18F]fluorodeoxyglucose positron emission tomography and computed tomographic imaging.
        J Vasc Interv Radiol. 2005; 16: 1641-1651
        • Choi H
        • Charnsangavej C
        • de Castro Faria S
        • Tamm EP
        • Benjamin RS
        • Johnson MM
        • et al.
        CT evaluation of the response of gastrointestinal stromal tumors after imatinib mesylate treatment: a quantitative analysis correlated with FDG PET findings.
        AJR Am J Roentgenol. 2004; 183: 1619-1628
        • Suzuki C
        • Jacobsson H
        • Hatschek T
        • Torkzad MR
        • Boden K
        • Eriksson-Alm Y
        • et al.
        Radiologic measurements of tumor response to treatment: practical approaches and limitations.
        Radiographics. 2008; 28: 329-344
        • Shah GD
        • Kesari S
        • Xu R
        • Batchelor TT
        • O'Neill AM
        • Hochberg FH
        • et al.
        Comparison of linear and volumetric criteria in assessing tumor response in adult high-grade gliomas.
        Neuro Oncol. 2006; 8: 38-46
        • Prasad SR
        • Jhaveri KS
        • Saini S
        • Hahn PF
        • Halpern EF
        • Sumner JE
        CT tumor measurement for therapeutic response assessment: comparison of unidimensional, bidimensional, and volumetric techniques initial observations.
        Radiology. 2002; 225: 416-419
        • Tochetto SM
        • Rezai P
        • Rezvani M
        • Nikolaidis P
        • Berggruen S
        • Atassi B
        • et al.
        Does multidetector CT attenuation change in colon cancer liver metastases treated with 90Y help predict metabolic activity at FDG PET?.
        Radiology. 2010; 255: 164-172
        • Choi H
        • Charnsangavej C
        • Faria SC
        • Macapinlac HA
        • Burgess MA
        • Patel SR
        • et al.
        Correlation of computed tomography and positron emission tomography in patients with metastatic gastrointestinal stromal tumor treated at a single institution with imatinib mesylate: proposal of new computed tomography response criteria.
        J Clin Oncol. 2007; 25: 1753-1759
        • Therasse P
        • Arbuck SG
        • Eisenhauer EA
        • Wanders J
        • Kaplan RS
        • Rubinstein L
        • et al.
        New guidelines to evaluate the response to treatment in solid tumors. European Organization for Research and Treatment of Cancer, National Cancer Institute of the United States, National Cancer Institute of Canada.
        J Natl Cancer Inst. 2000; 92: 205-216
        • Young H
        • Baum R
        • Cremerius U
        • Herholz K
        • Hoekstra O
        • Lammertsma AA
        • et al.
        Measurement of clinical and subclinical tumour response using [18F]-fluorodeoxyglucose and positron emission tomography: review and 1999 EORTC recommendations. European Organization for Research and Treatment of Cancer (EORTC) PET Study Group.
        Eur J Cancer. 1999; 35: 1773-1782
        • Landis JR
        • Koch GG
        The measurement of observer agreement for categorical data.
        Biometrics. 1977; 33: 159-174
        • Lencioni R
        • Llovet JM
        Modified RECIST (mRECIST) assessment for hepatocellular carcinoma.
        Semin Liver Dis. 2010; 30: 52-60
        • de Geus-Oei LF
        • Ruers TJ
        • Punt CJ
        • Leer JW
        • Corstens FH
        • Oyen WJ
        FDG-PET in colorectal cancer.
        Cancer Imaging. 2006; 6: S71-S81
        • Antoch G
        • Vogt FM
        • Veit P
        • Freudenberg LS
        • Blechschmid N
        • Dirsch O
        • et al.
        Assessment of liver tissue after radiofrequency ablation: findings with different imaging procedures.
        J Nucl Med. 2005; 46: 520-525
        • Wahl RLJH
        • Kasamon Y
        • Lodge MA
        From RECIST to PERCIST: Evolving Considerations for PET response criteria in solid tumors.
        J Nucl Med. 2009; 50: 122S-150S
        • Soydal C
        • Kucuk ON
        • Gecim EI
        • Bilgic S
        • Elhan AH
        The prognostic value of quantitative parameters of 18F-FDG PET/CT in the evaluation of response to internal radiation therapy with yttrium-90 in patients with liver metastases of colorectal cancer.
        Nucl Med Commun. 2013; 34: 501-506
        • Vouche M
        • Kulik L
        • Atassi R
        • Memon K
        • Hickey R
        • Ganger D
        • et al.
        Radiological-pathological analysis of WHO, RECIST, EASL, mRECIST and DWI: Imaging analysis from a prospective randomized trial of Y90 +/- sorafenib.
        Hepatology. 2013; 58: 1655-1666
        • Hendlisz A
        • Golfinopoulos V
        • Garcia C
        • Covas A
        • Emonts P
        • Ameye L
        • et al.
        Serial FDG-PET/CT for early outcome prediction in patients with metastatic colorectal cancer undergoing chemotherapy.
        Ann Oncol. 2012; 23: 1687-1693
        • Heijmen L
        • de Geus-Oei LF
        • de Wilt JH
        • Visvikis D
        • Hatt M
        • Visser EP
        • et al.
        Reproducibility of functional volume and activity concentration in 18F-FDG PET/CT of liver metastases in colorectal cancer.
        Eur J Nucl Med Mol Imaging. 2012; 39: 1858-1867
        • Frings V
        • van Velden FH
        • Velasquez LM
        • Hayes W
        • van de Ven PM
        • Hoekstra OS
        • et al.
        Repeatability of Metabolically Active Tumor Volume Measurements with FDG PET/CT in Advanced Gastrointestinal Malignancies: A Multicenter Study.
        Radiology. 2014; 273: 539-548
        • Tylski P
        • Stute S
        • Grotus N
        • Doyeux K
        • Hapdey S
        • Gardin I
        • et al.
        Comparative assessment of methods for estimating tumor volume and standardized uptake value in (18)F-FDG PET.
        J Nucl Med. 2010; 51: 268-276
        • Flamen P
        • Vanderlinden B
        • Delatte P
        • Ghanem G
        • Ameye L
        • Van Den Eynde M
        • et al.
        Multimodality imaging can predict the metabolic response of unresectable colorectal liver metastases to radioembolization therapy with Yttrium-90 labeled resin microspheres.
        Phys Med Biol. 2008; 53: 6591-6603
        • Riaz A
        • Kulik L
        • Lewandowski RJ
        • Ryu RK
        • Giakoumis Spear G
        • Mulcahy MF
        • et al.
        Radiologic-pathologic correlation of hepatocellular carcinoma treated with internal radiation using yttrium-90 microspheres.
        Hepatology. 2009; 49: 1185-1193
        • Riaz A
        • Memon K
        • Miller FH
        • Nikolaidis P
        • Kulik LM
        • Lewandowski RJ
        • et al.
        Role of the EASL, RECIST, and WHO response guidelines alone or in combination for hepatocellular carcinoma: radiologic-pathologic correlation.
        J Hepatol. 2011; 54: 695-704
        • Memon K
        • Lewandowski RJ
        • Riaz A
        • Salem R
        Chemoembolization and radioembolization for metastatic disease to the liver: available data and future studies.
        Curr Treat Options Oncol. 2012; 13: 403-415