Positron Emission Tomography/Computed Tomography and Biomarkers for Early Treatment Response Evaluation in Metastatic Colon Cancer

Abstract

Purpose. The indication for liver transplantation in malignant liver tumors has been controversial due to disappointing results and shortage of donor organs. The authors evaluated the experience and results of a single center in order to define present indications and selection criteria in hepatobiliary malignancy. Patients and Methods. Retrospective analysis of 212 patients who underwent liver transplantation for malignant tumors between 1972 and 1995: Primary hepatobiliary tumors: hepatocellular carcinoma, n = 124 (with underlying cirrhosis, n = 86; fibrolamellar subtype, n = 8); intrahepatic bile duct (cholangiocellular) carcinoma, n = 24; proximal bile duct carcinoma, n = 29; other uncommon entities (n = 15); secondary liver tumors: neuroendocrine, n = 11, and nonendocrine, n = 9. Results. Survival rates in primary liver cancer were correlated to International Union Against Cancer (UICC) tumor stage. For hepatocellular and proximal bile duct carcinoma significantly better outcome was found in UICC‐tumor stage I and II versus III and IV. No long‐term survival was found after transplantation for intrahepatic bile duct carcinoma, hemangiosarcoma and nonendocrine liver metastases. Comparison of transplant and resected patients with hepatocellular carcinoma stage I and II with underlying cirrhosis showed better survival after transplantation: 1‐, 3‐, 5‐year survival rate of 83.3% versus 76.9%, 75.8% versus 44.0%, 60.6% versus 44.0%, and median survival 96.5 versus 23.2 months. Although this difference was not significant, no patient died from tumor recurrence in the transplant group versus three in the resection group. Discussion and Conclusions. Patients with malignant tumors can be selected for transplantation with predictable likelihood for long‐term survival. According to the present data, liver transplantation can be considered in unresectable UICC‐stage II hepatocellular and proximal bile duct carcinoma, the uncommon entities fibrolamellar carcinoma, epithelioid hemangioendothelioma and hepatoblastoma as well as liver metastases from neuroendocrine tumors. UICC‐stage III and IV hepatocellular carcinoma as well as intrahepatic bile duct carcinoma, hemangiosarcoma and metastases from nonendocrine tumors should be excluded from transplantation alone. For hepatocellular carcinoma, multimodality treatment protocols have had a proven impact on the prevention of early recurrence and prolongation of survival. There is evidence that liver transplantation in still resectable hepatocellular carcinoma with underlying cirrhosis might be more appropriate in order to cure the cancer‐bearing disease.

Monitoring metabolic response using FDG PET-CT during targeted therapy for metastatic colorectal cancer

“…In the current study, target lesions were defined on the baseline FDG PET-CT according to strict criteria: FDG avidity (higher than two times the normal liver/thoracic aorta uptake) and size (more than 15 mm). More recently, some studies showed that an FDG PET-CT evaluation after a single course of chemotherapy is able to discriminate, with a high NPV, patients unlikely to benefit from the treatment in terms of both tumoural shrinkage and general outcome (PFS/OS) [ 9 , 10 , 12 ].…”

18F-FDG PET/CT response in a phase 1/2 trial of nab-paclitaxel plus gemcitabine for advanced pancreatic cancer

“…The maximum SUV (SUV max ) of all target lesions within a patient was then summed and served as a measure of tumor burden at the baseline time point, referred to as SUV max Total. Note that SUV max has been commonly used, particularly at the time this study was conducted, to evaluate tumor burden and change in tumor burden by PET [ 3 – 7 , 12 , 23 ]. Nontarget lesions were noted, and the anatomical location of both target and nontarget lesions was recorded.…”

Predictive value of positron emission tomography for the prognosis of molecularly targeted therapy in solid tumors

“…Of these articles, 12 were on non-small cell lung cancer (NSCLC) (49.48% of patients),2,3,16,18,19,21,22,24,26,27,35,38 two on malignant glioma (5.90% of patients),23,34 two on metastatic colorectal cancer (CRC) (7.63% of patients),31,36 two on gastrointestinal stromal tumor (GIST) (7.28% of patients),29,30 two on metastatic renal cell carcinoma (RCC) (9.60% of patients),25,37 and five on other solid tumors (metastatic gastric adenocarcinoma, metastatic breast cancer, metastatic melanoma, biliary tract cancer, and mixed kinds of tumors; 20.12% of patients) 17,20,28,32,33. Meanwhile, all of these articles coped with molecularly targeted therapy: six with erlotinib,3,16,21,22,24,27 six with bevacizumab,23,26,28,31,34,36 four with gefitinib,2,19,35,38 three with imatinib,17,29,32 two with sunitinib,25,30 one with cetuximab,33 and three with mixed kinds of molecularly targeted agents 18,20,37. PET-CT/PET was performed pretherapy and posttreatment.…”

“…Owing to the absence of consensus on metabolic response criteria, the participants were assigned to PET response or PET nonresponse group based on the change of SUVmax in each article. Of all the eligible studies, 17 provided an extractable HR value for PFS,3,16,18,20,21,23–26,28,30–32,35,36,38 19 for OS,2,3,16,17,19,21–28,31,33–37 and five for TTP 2,17,27,29,33. The principal characteristics and further details are summarized in Table 1.…”