Sager Sait, Akgün Elife, Uslu-Beşli Lebriz, Asa Sertaç, Akovali Burak, Sahin Onur, Yeyin Nami, Demir Mustafa, Abuqbeitah Mohammad, Gülsen Fatih, Sayman Haluk, Sönmezoglu Kerim
Departments of Nuclear Medicine.
Radiology, Medical Faculty, Istanbul University-Cerrahpaşa, Istanbul, Turkey.
Nucl Med Commun. 2019 May;40(5):461-468. doi: 10.1097/MNM.0000000000001014.
Yttrium-90 (Y) 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 Y therapy within the same group of patients.
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 (F-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 Y microsphere therapy, F-FDG PET/CT scan was performed to evaluate tumor response using PERCIST and RECIST criteria. Overall survival was calculated using Kaplan-Meier method.
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 cm, respectively. The average MTV of these lesions on PET images was calculated as 68.142 mm before therapy and 56.945 mm after treatment. In patients with mCRC, the mean tumor volume was 52.32 cm before therapy and 54.52 cm after therapy. The average MTV was calculated as 41.720 mm before and 44.967 mm 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.
Y 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.
钇-90（Y）微球治疗已越来越多地用于治疗肝细胞癌（HCC）和结直肠癌肝转移（mCRC）。本研究旨在比较同一组患者接受Y治疗后用于评估治疗反应的两种不同标准。
本研究共纳入21例HCC患者和19例mCRC患者，分别有36个和42个肝脏病灶。在治疗前后通过CT、MRI和氟-18氟脱氧葡萄糖（F-FDG）PET/CT对病灶进行评估。分析了几个代谢参数，包括最大和平均标准化摄取值、峰值标准化摄取值、代谢肿瘤体积（MTV）和总病灶糖酵解。使用CT或MRI图像确定所有病灶的肿瘤体积，并估计所施加的活度可为治疗的肝叶提供120±20 Gy的剂量。Y微球治疗六周后，进行F-FDG PET/CT扫描，使用实体瘤疗效评价标准（PERCIST）和实体瘤反应评价标准（RECIST）评估肿瘤反应。采用Kaplan-Meier法计算总生存期。
共治疗78个肝脏病灶，无任何严重并发症。通过CT或MRI计算，HCC病灶治疗前后的平均肿瘤体积分别为84.38 cm和86.62 cm。这些病灶在PET图像上的平均MTV治疗前为68.142 mm，治疗后为56.945 mm。在mCRC患者中，治疗前平均肿瘤体积为52.32 cm，治疗后为54.52 cm。同一患者组治疗前和治疗后的平均MTV分别计算为41.720 mm和44.967 mm。在HCC诊断患者的36个病灶中有7个以及mCRC患者的42个病灶中有7个出现实体瘤反应评价标准（RECIST）与实体瘤PET反应标准不相符的情况。HCC患者的平均总生存期计算为13.09个月，mCRC患者为10.6个月。
可通过RECIST和欧洲癌症研究与治疗组织标准评估Y治疗反应。然而，可发现RECIST与欧洲癌症研究与治疗组织标准不相符的情况。评估HCC反应的解剖学方法相对更准确，而PET/CT扫描引导的代谢参数在评估肝mCRC反应中显示出更大的重要性。
