Metabolic tumor volume and total lesion glycolysis on FDG-PET/CT can predict overall survival after 90Y radioembolization of colorectal liver metastases: A comparison with SUVmax, SUVpeak, and RECIST 1.0

Abstract

Purpose To compare the performance of 4 metrics of metabolic response on FDG-PET/CT against RECIST 1.0 for determining response and predicting overall survival (OS) following 90Y resin microspheres radioembolization of colorectal liver metastases (CLM). Methods We conducted an IRB-waived retrospective review of our radioembolization database to identify patients with unresectable CLM treated between December 2009 and December 2013. We included patients who had both PET/CT and contrast enhanced CT (CECT) available at baseline and on the first follow-up post-radioembolization. On baseline CECT up to five target tumors were chosen per patient according to RECIST 1.0. Four metrics of FDG-avidity (SUVmax, SUVpeak, metabolic tumor volume (MTV), and total lesion glycolysis (TLG)) on PET/CT were measured for the same target tumors. Using RECIST 1.0, patients were classified as no progression (partial response or stable disease) and progression. For each PET metric, a cut-off point of ≥30% decrease was chosen to define response. OS was calculated from the time of radioembolization using Kaplan-Meier methodology. The log-rank test was used for univariate analysis to identify predictors of OS. Results The study enrolled 49 patients with 119 target tumors; a median of 2 (range: 1–5) tumors were selected per patient. Median OS was 12.7 months (95%CI: 7.2–16.7). Response by MTV (P=0.035) and TLG (P=0.044) reached statistical significance in predicting OS. Response by SUVmax (P=0.21), SUVpeak (P=0.20) or no progression by RECIST1.0 (P=0.44) did not predict OS. Conclusion Metabolic response based on changes in MTV and TLG can predict OS post-radioembolization of CLM.

Quantitative Imaging Biomarkers for 90Y Distribution on Bremsstrahlung SPECT After Resin-Based Radioembolization

“…Previous studies have shown the feasibility and value of quantitative SPECT for the evaluation of the extra-and intrahepatic distribution of 90 Y and absorbed dose quantifications after TARE (19). More recently, several studies investigating hepatic metastases found CT perfusion imaging and metabolic response assessment using PET predictive of tumor response early after TARE (20). This study introduces TNR as a quantitative surrogate on SPECT as a readily applicable predictor for enhancement-based tumor response after TARE in HCC (P 5 0.038).…”

Targeted Radionuclide Therapy: An Evolution Toward Precision Cancer Treatment

“…Shady et al [50] showed that the Response Evaluation Criteria in Solid Tumors 1.1 (RECIST 1.1) have poor sensitivity in this clinical setting and that the Choi criteria or metabolic criteria such as European Organization for Research and Treatment of Cancer or PET Response Evaluation Criteria in Solid Tumors applied to PET with FDG are more relevant. The same group of investigators also showed that metabolic response on FDG PET/CT can predict overall survival [51]. Another group of investigators suggested that dose volume histograms derived from PET/MRI of 90 Y distribution in tumor can be helpful in predicting responders and nonresponders [52].…”

Probing carbohydrate metabolism using hyperpolarized 13C‐labeled molecules

“…It has been demonstrated that areas of high 18 F‐FDG uptake and [1‐ 13 C] lactate production from hyperpolarized [1‐ 13 C] pyruvate did not correlate with each other in a large heterogeneous canine tumor, suggesting that elevated glucose uptake and high lactate production occurs in different tumor regions (Figure ) . There is growing evidence that the assessment of tumor metabolic activity may reflect treatment response more accurately than reduction in tumor size . However, it should be noted that this is not necessarily a measure of long term survival.…”