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Evaluation of the Response to Selective Internal Radiation Therapy in Patients With Hepatocellular Cancer According to Pretreatment 99mTc-MAA Uptake

Kucuk, Ozlem N. MD; Soydal, Cigdem MD; Araz, Mine MD; Ozkan, Elgin MD; Aras, Gulseren MD

doi: 10.1097/RLU.0b013e31828162e8
Original Articles

Aim The aim of the study was to evaluate if there is a prognostic importance of pretreatment 99mTc-MAA uptake of liver lesion of patients who received 90Y selective internal radiation therapy (SIRT) treatment for hepatocellular cancer (HCC) or not.

Methods Nineteen patients (5 female and 14 male patients; mean age, 64.5 ± 14.7 years; range, 57–73 years) who received SIRT treatment in our department for HCC between June 2008 and May 2011 were included in the study. All the patients have undergone 99mTc-MAA scintigraphy within 2 weeks’ period before treatment for evaluation of presence of extrahepatic uptake. Patients were evaluated according to their lesions’ 99mTc-MAA uptake patterns. Response to the treatment, presence of progression after treatment, and progression-free survival of all the patients were calculated.

Results Treatment has been administered on the right and left lobes of the liver in 18 and 1 patient, respectively. The mean treatment dose was estimated as 1.4 + 1.0 GBq. In the pretreatment 99mTc-MAA scintigraphy, liver lesions of 5 patients were hypoactive, and 14 patients were hyperactive. In the hypoactive group, whereas 2 patients (40%) were responders to treatment, 3 were nonresponders (60%). In the hyperactive group, 8 (58%) and 6 (42%) patients were responders and nonresponders, respectively (P = 0.51). Disease progression was seen in 4 (80%) and 8 patients (58%) in the hypoactive group and hyperactive groups, respectively (P = 0.36). Progression-free survival of the hypoactive group was calculated as 8 ± 4.3 months and of the hyperactive group 11 ± 4.7 months (P = 0.22).

Conclusions Despite the small number of patients, this study revealed that there is no significance between tumor response and progression rates of patients who received SIRT for HCC with or without pretreatment 99mTc-MAA uptake in liver lesions. Selective internal radiation therapy could be safely performed in patients who have hypoactive lesions in 99m Tc-MAA scintigraphy.

From the Department of Nuclear Medicine, Ankara University Medical School, Ankara, Turkey.

Received for publication July 15, 2012; and accepted for publication (after revision) November 14, 2012.

Conflicts of interest and sources of funding: none declared.

Reprints: Cigdem Soydal, MD, Nuclear Medicine Department, Medical Faculty, Ankara University, Cebeci, Ankara, Turkey 06590.

© 2013 by Lippincott Williams & Wilkins