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European Journal of Nuclear Medicine and Molecular Imaging
Erschienen in: European Journal of Nuclear Medicine and Molecular Imaging 3/2015

01.03.2015 | Original Article

Early post-treatment FDG PET predicts survival after 90Y microsphere radioembolization in liver-dominant metastatic colorectal cancer

verfasst von: Amir Sabet, Carsten Meyer, Anas Aouf, Amin Sabet, Shahab Ghamari, Claus C. Pieper, Karin Mayer, Hans-Jürgen Biersack, Samer Ezziddin

Erschienen in: European Journal of Nuclear Medicine and Molecular Imaging | Ausgabe 3/2015

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Abstract

Purpose

The aim of this study was to evaluate the predictive value of early metabolic response 4 weeks post-treatment using 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET)/CT in patients with unresectable hepatic metastases of colorectal cancer (CRC) undergoing radioembolization (RE) with 90Y-labelled microspheres.

Methods

A total of 51 consecutive patients with liver-dominant metastases of CRC were treated with RE and underwent 18F-FDG PET/CT at baseline and 4 weeks after RE. In each patient, three hepatic metastases with the highest maximum standardized uptake value (SUVmax) were selected as target lesions. Metabolic response was defined as >50 % reduction of tumour to liver ratios. Survival analyses using Kaplan-Meier and multivariate analyses were performed to identify prognostic factors for overall survival (OS). Investigated baseline characteristics included age (>60 years), performance status (Eastern Cooperative Oncology Group >1), bilirubin (>1.0 mg/dl), hepatic tumour burden (>25 %) and presence of extrahepatic disease.

Results

The median OS after RE was 7 months [95 % confidence interval (CI) 5–8]; early metabolic responders (n = 33) survived longer than non-responders (p < 0.001) with a median OS of 10 months (95 % CI 3–16) versus 4 months (95 % CI 2–6). Hepatic tumour burden also had significant impact on treatment outcome (p < 0.001) with a median OS of 5 months (95 % CI, 3–7) for patients with >25 % metastatic liver replacement vs 14 months (95 % CI 6–22) for the less advanced patients. Both factors (early metabolic response and low hepatic tumour burden) remained as independent predictors of improved survival on multivariate analysis.

Conclusion

These are the first findings to show that molecular response assessment in CRC using 18F-FDG PET/CT appears feasible as early as 4 weeks post-RE, allowing risk stratification and potentially facilitating early response-adapted treatment strategies.
Literatur
1.
Edwards BK, Noone AM, Mariotto AB, Simard EP, Boscoe FP, Henley SJ, et al. Annual Report to the Nation on the status of cancer, 1975–2010, featuring prevalence of comorbidity and impact on survival among persons with lung, colorectal, breast, or prostate cancer. Cancer 2014;120:1290–314.
2.
Liu LX, Zhang WH, Jiang HC. Current treatment for liver metastases from colorectal cancer. World J Gastroenterol 2003;9:193–200.PubMed
3.
Jegatheeswaran S, Mason JM, Hancock HC, Siriwardena AK. The liver-first approach to the management of colorectal cancer with synchronous hepatic metastases: a systematic review. JAMA Surg 2013;148:385–91.CrossRefPubMed
4.
Garrean S, Muhs A, Bui JT, Blend MJ, Owens C, Helton WS, et al. Complete eradication of hepatic metastasis from colorectal cancer by yttrium-90 SIRT. World J Gastroenterol 2007;13:3016–9.PubMedCentralPubMed
5.
Benson 3rd AB, Geschwind JF, Mulcahy MF, Rilling W, Siskin G, Wiseman G, et al. Radioembolisation for liver metastases: results from a prospective 151 patient multi-institutional phase II study. Eur J Cancer 2013;49:3122–30.CrossRefPubMed
6.
Cosimelli M, Golfieri R, Cagol PP, Carpanese L, Sciuto R, Maini CL, et al. Multi-centre phase II clinical trial of yttrium-90 resin microspheres alone in unresectable, chemotherapy refractory colorectal liver metastases. Br J Cancer 2010;103:324–31.CrossRefPubMedCentralPubMed
7.
Kennedy AS, Coldwell D, Nutting C, Murthy R, Wertman DE, Loehr SP, et al. Resin 90Y-microsphere brachytherapy for unresectable colorectal liver metastases: modern USA experience. Int J Radiat Oncol Biol Phys 2006;65:412–25.CrossRefPubMed
8.
Wiering B, Krabbe PF, Jager GJ, Oyen WJ, Ruers TJ. The impact of fluor-18-deoxyglucose-positron emission tomography in the management of colorectal liver metastases. Cancer 2005;104:2658–70.CrossRefPubMed
9.
Flamen P, Stroobants S, Van Cutsem E, Dupont P, Bormans G, De Vadder N, et al. Additional value of whole-body positron emission tomography with fluorine-18–2-fluoro-2-deoxy-D-glucose in recurrent colorectal cancer. J Clin Oncol 1999;17:894–901.PubMed
10.
11.
Wong CY, Salem R, Raman S, Gates VL, Dworkin HJ. Evaluating 90Y-glass microsphere treatment response of unresectable colorectal liver metastases by [18F]FDG PET: a comparison with CT or MRI. Eur J Nucl Med Mol Imaging 2002;29:815–20.CrossRefPubMed
12.
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.CrossRefPubMed
13.
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;53:6591–603.CrossRefPubMed
14.
Scott AM, Gunawardana DH, Bartholomeusz D, Ramshaw JE, Lin P. PET changes management and improves prognostic stratification in patients with head and neck cancer: results of a multicenter prospective study. J Nucl Med 2008;49:1593–600.CrossRefPubMed
15.
Kalff V, Hicks RJ, Ware RE, Hogg A, Binns D, McKenzie AF. The clinical impact of (18)F-FDG PET in patients with suspected or confirmed recurrence of colorectal cancer: a prospective study. J Nucl Med 2002;43:492–9.PubMed
16.
Castellucci P, Nanni C, Farsad M, Alinari L, Zinzani P, Stefoni V, et al. Potential pitfalls of 18F-FDG PET in a large series of patients treated for malignant lymphoma: prevalence and scan interpretation. Nucl Med Commun 2005;26:689–94.CrossRefPubMed
17.
Vallböhmer D, Hölscher AH, Dietlein M, Bollschweiler E, Baldus SE, Mönig SP, et al. [18F]-Fluorodeoxyglucose-positron emission tomography for the assessment of histopathologic response and prognosis after completion of neoadjuvant chemoradiation in esophageal cancer. Ann Surg 2009;250:888–94.CrossRefPubMed
18.
Castaldi P, Rufini V, Bussu F, Miccichè F, Dinapoli N, Autorino R, et al. Can “early” and “late”18F-FDG PET-CT be used as prognostic factors for the clinical outcome of patients with locally advanced head and neck cancer treated with radio-chemotherapy? Radiother Oncol 2012;103:63–8.CrossRefPubMed
19.
Zerizer I, Al-Nahhas A, Towey D, Tait P, Ariff B, Wasan H, et al. The role of early (18)F-FDG PET/CT in prediction of progression-free survival after (90)Y radioembolization: comparison with RECIST and tumour density criteria. Eur J Nucl Med Mol Imaging 2012;39:1391–9.CrossRefPubMed
20.
Fendler WP, Philippe Tiega DB, Ilhan H, Paprottka PM, Heinemann V, Jakobs TF, et al. Validation of several SUV-based parameters derived from 18F-FDG PET for prediction of survival after SIRT of hepatic metastases from colorectal cancer. J Nucl Med 2013;54:1202–8.CrossRefPubMed
21.
Andre T, Boni C, Mounedji-Boudiaf L, Navarro M, Tabemero J, Hickish T, et al. Oxaliplatin, fluorouracil, and leucovorin as adjuvant treatment for colon cancer. N Engl J Med 2004;350:2343–51.CrossRefPubMed
22.
Goldberg RM, Tabah-Fisch I, Bleiberg H, de Gramont A, Tournigand C, Andre T, et al. Pooled analysis of safety and efficacy of oxaliplatin plus fluorouracil/leucovorin administered bimonthly in elderly patients with colorectal cancer. J Clin Oncol 2006;24:4085–91.CrossRefPubMed
23.
Tournigand C, André T, Achille E, Lledo G, Flesh M, Mery-Mignard D, et al. FOLFIRI followed by FOLFOX6 or the reverse sequence in advanced colorectal cancer: a randomized GERCOR study. J Clin Oncol 2004;22:229–37.CrossRefPubMed
24.
Schmoll HJ, Cartwright T, Tabernero J, Nowacki MP, Figer A, Maroun J, et al. Phase III trial of capecitabine plus oxaliplatin as adjuvant therapy for stage III colon cancer: a planned safety analysis in 1,864 patients. J Clin Oncol 2007;25:102–9.CrossRefPubMed
25.
Porschen R, Arkenau HT, Kubicka S, Greil R, Seufferlein T, Freier W, et al. Phase III study of capecitabine plus oxaliplatin compared with fluorouracil and leucovorin plus oxaliplatin in metastatic colorectal cancer: a final report of the AIO Colorectal Study Group. J Clin Oncol 2007;25:4217–23.CrossRefPubMed
26.
Cassidy J, Clarke S, Díaz-Rubio E, Scheithauer W, Figer A, Wong R, et al. Randomized phase III study of capecitabine plus oxaliplatin compared with fluorouracil/folinic acid plus oxaliplatin as first-line therapy for metastatic colorectal cancer. J Clin Oncol 2008;26:2006–12.CrossRefPubMed
27.
Fuchs CS, Marshall J, Mitchell E, Wierzbicki R, Ganju V, Jeffery M, et al. Randomized, controlled trial of irinotecan plus infusional, bolus, or oral fluoropyrimidines in first-line treatment of metastatic colorectal cancer: results from the BICC-C Study. J Clin Oncol 2007;25:4779–86.CrossRefPubMed
28.
Hochster HS, Hart LL, Ramanathan RK, Childs BH, Hainsworth JD, Cohn AL, et al. Safety and efficacy of oxaliplatin and fluoropyrimidine regimens with or without bevacizumab as first-line treatment of metastatic colorectal cancer: results of the TREE study. J Clin Oncol 2008;26:3523–9.CrossRefPubMed
29.
Sobrero AF, Maurel J, Fehrenbacher L, Scheithauer W, Abubakr YA, Lutz MP, et al. EPIC: phase III trial of cetuximab plus irinotecan after fluoropyrimidine and oxaliplatin failure in patients with metastatic colorectal cancer. J Clin Oncol 2008;26:2311–9.CrossRefPubMed
30.
Salem R, Thurston KG. Radioembolization with 90yttrium microspheres: a state-of-the-art brachytherapy treatment for primary and secondary liver malignancies. Part 1: technical and methodologic considerations. J Vasc Interv Radiol 2006;17:1251–78.CrossRefPubMed
31.
Kennedy A, Nag S, Salem R, Murthy R, McEwan AJ, Nutting C, et al. Recommendations for radioembolization of hepatic malignancies using yttrium-90 microsphere brachytherapy: a consensus panel report from the radioembolization brachytherapy oncology consortium. Int J Radiat Oncol Biol Phys 2007;68:13–23.CrossRefPubMed
32.
Ahmadzadehfar H, Biersack HJ, Ezziddin S. Radioembolization of liver tumors with yttrium-90 microspheres. Semin Nucl Med 2010;40:105–21.CrossRefPubMed
33.
Jerusalem G, Beguin Y, Fassotte MF, Najjar F, Paulus P, Rigo P, et al. Persistent tumor 18F-FDG uptake after a few cycles of polychemotherapy is predictive of treatment failure in non-Hodgkin’s lymphoma. Haematologica 2000;85:613–8.PubMed
34.
de Geus-Oei LF, van Laarhoven HW, Visser EP, Hermsen R, van Hoom BA, Kamm YJ, et al. Chemotherapy response evaluation with FDG-PET in patients with colorectal cancer. Ann Oncol 2008;19:348–52.CrossRefPubMed
35.
Juweid ME, Cheson BD. Positron-emission tomography and assessment of cancer therapy. N Engl J Med 2006;354:496–507.CrossRefPubMed
36.
Ott K, Weber W, Siewert JR. The importance of PET in the diagnosis and response evaluation of esophageal cancer. Dis Esophagus 2006;19:433–42.CrossRefPubMed
37.
Farrag A, Ceulemans G, Voordeckers M, Everaert H, Storme G. Can 18F-FDG-PET response during radiotherapy be used as a predictive factor for the outcome of head and neck cancer patients? Nucl Med Commun 2010;31:495–501.PubMed
38.
Spaepen K, Stroobants S, Dupont P, Vandenberghe P, Thomas J, de Groot T, et al. Early restaging positron emission tomography with (18)F-fluorodeoxyglucose predicts outcome in patients with aggressive non-Hodgkin’s lymphoma. Ann Oncol 2002;13:1356–63.CrossRefPubMed
39.
Mikhaeel NG, Hutchings M, Fields PA, O’Doherty MJ, Timothy AR. FDG-PET after two to three cycles of chemotherapy predicts progression-free and overall survival in high-grade non-Hodgkin lymphoma. Ann Oncol 2005;16:1514–23.CrossRefPubMed
40.
Haioun C, Itti E, Rahmouni A, Brice P, Rain JD, Belhadi K, et al. [18F]fluoro-2-deoxy-D-glucose positron emission tomography (FDG-PET) in aggressive lymphoma: an early prognostic tool for predicting patient outcome. Blood 2005;106:1376–81.CrossRefPubMed
41.
Haug AR, Heinemann V, Bruns CJ, Hoffmann R, Jakobs T, Bartenstein P, et al. 18F-FDG PET independently predicts survival in patients with cholangiocellular carcinoma treated with 90Y microspheres. Eur J Nucl Med Mol Imaging 2011;38:1037–45.CrossRefPubMed
42.
Haug AR, Tiega Donfack BP, Trumm C, Zech CJ, Michl M, Laubender RP, et al. 18F-FDG PET/CT predicts survival after radioembolization of hepatic metastases from breast cancer. J Nucl Med 2012;53:371–7.CrossRefPubMed
43.
Higashi T, Hatano E, Ikai I, Nishii R, Nakamoto Y, Ishizu K, et al. FDG PET as a prognostic predictor in the early post-therapeutic evaluation for unresectable hepatocellular carcinoma. Eur J Nucl Med Mol Imaging 2010;37:468–82.CrossRefPubMed
44.
Gulec SA, Suthar RR, Barot TC, Pennington K. The prognostic value of functional tumor volume and total lesion glycolysis in patients with colorectal cancer liver metastases undergoing 90Y selective internal radiation therapy plus chemotherapy. Eur J Nucl Med Mol Imaging 2011;38:1289–95.CrossRefPubMed
45.
Kennedy AS, Nutting C, Coldwell D, Gaiser J, Drachenberg C. Pathologic response and microdosimetry of (90)Y microspheres in man: review of four explanted whole livers. Int J Radiat Oncol Biol Phys 2004;60:1552–63.CrossRefPubMed
Metadaten
Titel
Early post-treatment FDG PET predicts survival after 90Y microsphere radioembolization in liver-dominant metastatic colorectal cancer
verfasst von
Amir Sabet
Carsten Meyer
Anas Aouf
Amin Sabet
Shahab Ghamari
Claus C. Pieper
Karin Mayer
Hans-Jürgen Biersack
Samer Ezziddin
Publikationsdatum
01.03.2015
Verlag
Springer Berlin Heidelberg
Erschienen in
European Journal of Nuclear Medicine and Molecular Imaging / Ausgabe 3/2015
Print ISSN: 1619-7070
Elektronische ISSN: 1619-7089
DOI
https://doi.org/10.1007/s00259-014-2935-z

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