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Standardized Added Metabolic Activity Predicts Survival After Intra-arterial Resin-Based 90Y Radioembolization Therapy in Unresectable Chemorefractory Metastatic Colorectal Cancer to the Liver
- Source :
- Clinical nuclear medicine. 41(2)
- Publication Year :
- 2015
-
Abstract
- Standardized added metabolic (SAM) activity is a functional objective measurement of the total tumoral metabolic activity that avoids partial volume effect and thresholding, which limit conventional PET parameters. The purpose of this study is to investigate the role of SAM in predicting survival in unresectable, chemorefractory colorectal hepatic metastatic disease treated with resin-based Y radioembolization.This is a prospective correlative study of patients with unresectable, chemorefractory colorectal liver metastasis who underwent F-FDG PET/CT and CT/MRI before and after Y. Target RECIST, PERCIST, change in total glycolytic activity (ΔTGA), and ΔSAM treatment response were assessed. Percentage changes in diameter, SUVpeak, TGA, and SAM were calculated pre- and post-Y therapy and objective response was defined as30% change (responders). Survival analysis by Kaplan-Meier, log-rank, and Cox proportional hazard models were performed and significance was set at0.05.Sixteen patients (mean age of 61.6) were enrolled and performed a total of 20 Y therapies. After Y, target ΔSAM showed an objective response rate of 40% vs. 35%, 30%, and 22.2% based on target ΔTGA, PERCIST, and RECIST criteria, respectively. Median overall survival (OS) of the cohort after Y was 9.2 months (CI 95% 2.2-16.2). Patients demonstrating objective response based on ΔSAM had a median OS of 22.7 months (CI 95% 12.4-33.0) vs. 6.7 (CI 95% 4.2-9.2) in non-responders (P = 0.007). On multivariate analysis, hazard ratios for the objective response group based on target ΔSAM were 0.01 (P = 0.03) vs. 0.05 (P = 0.08), 0.20 (P = 0.29), and 0.91 (P = 0.98) based on target ΔTGA, PERCIST, and RECIST criteria, respectively.In unresectable colorectal liver metastatic disease refractory to standard chemotherapy, ΔSAM predicted OS for assessment of response following Y radioembolization therapy, whereas RECIST, PERCIST, and ΔTGA did not.
- Subjects :
- Adult
Male
Colorectal cancer
Partial volume
030218 nuclear medicine & medical imaging
03 medical and health sciences
0302 clinical medicine
Fluorodeoxyglucose F18
medicine
Intra arterial
Humans
Radiology, Nuclear Medicine and imaging
Yttrium Radioisotopes
Aged
Aged, 80 and over
medicine.diagnostic_test
business.industry
Liver Neoplasms
Objective measurement
General Medicine
Middle Aged
medicine.disease
Embolization, Therapeutic
Positron emission tomography
030220 oncology & carcinogenesis
Positron-Emission Tomography
Female
Radiopharmaceuticals
Metabolic activity
Nuclear medicine
business
Colorectal Neoplasms
Subjects
Details
- ISSN :
- 15360229
- Volume :
- 41
- Issue :
- 2
- Database :
- OpenAIRE
- Journal :
- Clinical nuclear medicine
- Accession number :
- edsair.doi.dedup.....c4bee88c63a8d3b5797344d7d9e1338e