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Prognostic Importance of 18F-FDG Uptake Pattern of Hepatocellular Cancer Patients Who Received SIRT

Kucuk, Ozlem N. MD*; Soydal, Cigdem MD*; Araz, Mine MD*; Bilgic, Sadik MD; Ibis, Erkan MD*

doi: 10.1097/RLU.0b013e3182867f17
Original Articles

Purpose The aim of the study was to evaluate the effect of 18F-FDG uptake pattern of liver lesions to treatment response of patients who received yttrium-90 (Y-90) selective internal radiation therapy (SIRT) for hepatocellular cancer (HCC).

Patients and Methods Nineteen patients (5F, 14M, mean age: 64.5 ± 14.7 years old, 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 patients underwent 18F-FDG PET/CT before SIRT for evaluation of disease stage and metabolic activity of liver lesions. Patients were divided into 3 groups according to FDG uptake patterns of primary liver lesions (hypoactive, nonhomogenous, and focal intense). Progression-free survival (PFS) times of each group and patients with hepatic only and hepatic with extrahepatic disease were analyzed. Disease progression criteria were increase in tumor volume, progressive elevation of serum alpha-fetoprotein levels, and detection of extrahepatic metastases. Kaplan-Meier analysis was used for comparison of PFS times.

Results The mean treatment dose was calculated as 1.4 ± 1.0 GBq. While liver lesions of 4 patients were hypoactive in pretreatment 18F-FDG PET/CT, liver lesions of 6 and 9 patients had nonhomogenous and intense FDG uptake, respectively. Mean PFS time of patients who had hypoactive liver lesions was 5.25 ± 1.52 months. In patients who had liver lesions with nonhomogenous uptake, mean PFS time was 12.3 ± 2.6 months. Lastly, in patients with intense uptake in liver lesions, PFS time was calculated as 19.8 ± 5.0 months. Difference between each group was statistically significant (P = 0.017). There was no significant difference in the PFS of the patients with limited hepatic disease and patients with extrahepatic involvement.

Conclusion In patients with unresectable HCC, higher SUVmax lesions unexpectedly had better PFS rates after SIRT, suggesting SIRT has a treatment advantage over other therapeutic options in these patients.

From the *Departments of Nuclear Medicine and †Radiology, Ankara University Medical School, Ankara, Turkey.

Received for publication March 18, 2012; and revision accepted December 29, 2012.

Conflicts of interest and sources of funding: none declared.

Reprints: Mine Araz, MD, Nuclear Medicine Department, Ankara University Medical School, Cebeci, Ankara 06590, Turkey. E-mail:

© 2013 by Lippincott Williams & Wilkins