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Comparison of PERCIST and RECIST criteria for evaluation of therapy response after yttrium-90 microsphere therapy in patients with hepatocellular carcinoma and those with metastatic colorectal carcinoma

Sager, Saita; Akgün, Elifea; Uslu-Beşli, Lebriza; Asa, Sertaça; Akovali, Buraka; Sahin, Onura; Yeyin, Namia; Demir, Mustafaa; Abuqbeitah, Mohammada; Gülsen, Fatihb; Sayman, Haluka; Sönmezoglu, Kerima

Nuclear Medicine Communications: May 2019 - Volume 40 - Issue 5 - p 461–468
doi: 10.1097/MNM.0000000000001014

Objective Yttrium-90 (90Y) microsphere therapy has been increasingly used to treat hepatocellular carcinoma (HCC) and liver metastasis of colorectal cancer (mCRC). This study aims to compare two different criterias used for therapy response evaluation following 90Y therapy within the same group of patients.

Patients and methods A total of 21 patients with HCC and 19 patients with mCRC were included in this study, with 36 and 42 liver lesions, respectively. The lesions were evaluated before and after therapy by CT or MRI and fluorine-18 fluorodeoxyglucose (18F-FDG) PET/CT. Several metabolic parameters were analyzed including maximum and mean standardized uptake values, peak standardized uptake value, metabolic tumor volume (MTV), and total lesion glycolysis. Tumor volume was determined using CT or MRI images for all lesions, and the applied activity was estimated to deliver 120±20 Gy for the treated lobe. Six weeks after 90Y microsphere therapy, 18F-FDG PET/CT scan was performed to evaluate tumor response using PERCIST and RECIST criteria. Overall survival was calculated using Kaplan–Meier method.

Results A total of 78 liver lesions were treated without any major complication. The mean tumor volumes of HCC lesions calculated by CT or MRI before and after therapy were 84.38 and 86.62 cm3, respectively. The average MTV of these lesions on PET images was calculated as 68.142 mm3 before therapy and 56.945 mm3 after treatment. In patients with mCRC, the mean tumor volume was 52.32 cm3 before therapy and 54.52 cm3 after therapy. The average MTV was calculated as 41.720 mm3 before and 44.967 mm3 after therapy for the same patient group. Response Evaluation Criteria In Solid Tumors (RECIST) and PET Response Criteria In Solid Tumors incompatibility was seen in seven of 36 lesions in HCC-diagnosed patients and seven of 42 lesions in patients with mCRC. The mean overall survival was calculated as 13.09 months in patients with HCC and 10.6 months in patients with mCRC.

Conclusion 90Y therapy response can be evaluated by both RECIST and European Organization for Research and Treatment of Cancer criteria. However, RECIST and European Organization for Research and Treatment of Cancer incompatibility can be seen. The anatomic methods for evaluating HCC response is relatively more accurate, whereas the metabolic parameters guided by PET/CT scan showed greater importance in response to evaluation of liver mCRC.

Departments of aNuclear Medicine

bRadiology, Medical Faculty, Istanbul University-Cerrahpaşa, Istanbul, Turkey

Correspondence to Sait Sager, MD, Department of Nuclear Medicine, Medical Faculty, Istanbul University-Cerrahpaşa, Cerrahpaşa, Fatih, Istanbul 34091, Turkey Tel: +90 212 414 3000/+90 212 412 2984; fax: +90 212 530 8055; e-mail:

Received January 19, 2018

Received in revised form February 26, 2019

Accepted March 3, 2019

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