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01.12.2017 | Original Research | Ausgabe 1/2017 Open Access

EJNMMI Research 1/2017

Clinical and imaging-based prognostic factors in radioembolisation of liver metastases from colorectal cancer: a retrospective exploratory analysis

EJNMMI Research > Ausgabe 1/2017
Kathy P. Willowson, Aimee R. Hayes, David L. H. Chan, Michael Tapner, Elizabeth J. Bernard, Richard Maher, Nick Pavlakis, Stephen J. Clarke, Dale L. Bailey
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Electronic supplementary material

The online version of this article (doi:10.​1186/​s13550-017-0292-1) contains supplementary material, which is available to authorized users.



The aim of this study was to investigate the relationship between absorbed dose and response of colorectal cancer liver metastases treated with [90Y]-resin microspheres and to explore possible clinical and imaging derived prognostic factors.


FDG PET/CT was used to measure response of individual lesions to a measured absorbed dose, derived from post-treatment 90Y PET imaging. Predicted dose was also derived from planning [99mTc]-MAA SPECT data. Peak standardised uptake value and total lesion glycolysis (TLG) were explored as response measures, and compared to dose metrics including average dose (D avg), biologically effective dose, minimum dose to 70% of lesion volume and volume receiving at least 50 Gy. Prognostic factors examined included baseline TLG, RAS mutation status, FDG heterogeneity and dose heterogeneity. In an exploratory analysis, response and clinico-pathological variables were evaluated and compared to overall survival.


Sixty-three lesions were analysed from 22 patients. Poor agreement was seen between predicted and measured dose values. TLG was a superior measure of response, and all dose metrics were significant prognostic factors, with a D avg of ~50 Gy derived as the critical threshold for a significant response (>50% reduction in TLG). No significant correlation was found between baseline TLG or RAS mutation status and response. Measured dose heterogeneity was a significant prognostic factor and when combined with D avg had a positive predictive value for response >80%. In the exploratory analysis for prognostic factors of survival, low hepatic tumour burden and mean reduction in TLG >65% were independently associated with improved overall survival.


Lesions receiving an average dose greater than 50 Gy are likely to have a significant response. For lesions receiving less than 50 Gy, dose heterogeneity is a significant prognostic factor. Lesions receiving an average dose less than 20 Gy are unlikely to respond. A reduction in TLG may be associated with improved overall survival.
Additional file 1: Figure S10. Case studies representing each of the scenarios discussed in the manuscript with regards to lesional dose–response: high average dose (>50 Gy) achieving a CMR (a); intermediate average dose (20–50 Gy) with a low dose CoV achieving a PMR (b); intermediate average dose (20–50Gy) with a high dose CoV achieving SMD (c); low average dose (<20 Gy) achieving PMD (d); and the anomaly of a high average dose (<50 Gy) resulting in only SMD (e). Each row represents a transverse slice through the baseline FDG PET (left), 90Y PET derived dosemap (centre), and follow-up FDG PET (right). The crosshairs identify the lesion of interest. (ZIP 529 kb)
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