Retrospective Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Dec 21, 2016; 22(47): 10406-10414
Published online Dec 21, 2016. doi: 10.3748/wjg.v22.i47.10406
Prognostic value of pre-treatment F-18-FDG PET-CT in patients with hepatocellular carcinoma undergoing radioembolization
Yazan Abuodeh, Arash O Naghavi, Kamran A Ahmed, Puja S Venkat, Youngchul Kim, Bela Kis, Junsung Choi, Benjamin Biebel, Jennifer Sweeney, Daniel A Anaya, Richard Kim, Mokenge Malafa, Jessica M Frakes, Sarah E Hoffe, Ghassan El-Haddad
Yazan Abuodeh, Arash O Naghavi, Kamran A Ahmed, Puja S Venkat, Youngchul Kim, Jessica M Frakes, Sarah E Hoffe, Department of Radiation Oncology, H Lee Moffitt Cancer Center and Research Institute, Tampa, FL 33612, United States
Bela Kis, Junsung Choi, Benjamin Biebel, Jennifer Sweeney, Ghassan El-Haddad, Department of Interventional Radiology, H Lee Moffitt Cancer Center and Research Institute, Tampa, FL 33612, United States
Daniel A Anaya, Richard Kim, Mokenge Malafa, Department of Gastrointestinal Oncology, H Lee Moffitt Cancer Center and Research Institute, Tampa, FL 33612, United States
Author contributions: Abuodeh Y, Naghavi AO, Ahmed KA, Venkat PS, Kim Y, Hoffe SE and El-Haddad G participated in conception and design, acquisition of data, or analysis and interpretation of data; Abuodeh Y, Naghavi AO, Ahmed KA, Venkat PS, Kis B, Choi J, Biebel B, Sweeney J, Anaya DA, Kim R, Malafa M, Frakes JM, Hoffe SE and El-Haddad G were involved in drafting or revising of the manuscript critically for important intellectual content; Abuodeh Y, Naghavi AO, Ahmed KA, Venkat PS, Kim Y, Kis B, Choi J, Biebel B, Sweeney J, Anaya DA, Kim R, Malafa M, Frakes JM, Hoffe SE and El-Haddad G approved final manuscript for submission and publication.
Institutional review board statement: The study was reviewed and approved by university of South Florida IRB, protocol IRB No. CR4_Pro00003382.
Informed consent statement: This is a retrospective review and had no increase in risk on subjects; a waiver of informed consent was approved by IRB.
Conflict-of-interest statement: All authors have no conflict of interest.
Data sharing statement: IRB approved waiver of HIPAA authorization, as data are anonymized and risk of identification is low.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Ghassan El-Haddad, MD, Department of Interventional Radiology, H Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Drive, Tampa, FL 33612, United States. ghassan.elhaddad@moffitt.org
Telephone: +1-813-7458425 Fax: +1-813-7451535
Received: August 27, 2016
Peer-review started: August 28, 2016
First decision: September 28, 2016
Revised: October 15, 2016
Accepted: November 16, 2016
Article in press: November 16, 2016
Published online: December 21, 2016
Abstract
AIM

To evaluate the value of pre-treatment 18F-FDG PET/CT in patients with HCC following liver radioembolization.

METHODS

We identified 34 patients with HCC who underwent an FDG PET/CT scan prior to hepatic radioembolization at our institution between 2009 and 2013. Patients were seen in clinic one month after radioembolization and then at 2-3 mo intervals. We assessed the influence of FDG tumor uptake on outcomes including local liver control (LLC), distant liver control (DLC), time to distant metastases (DM), progression free survival (PFS) and overall survival (OS).

RESULTS

The majority of patients were males (n = 25, 74%), and had Child Pugh Class A (n = 31, 91%), with a median age of 68 years (46-84 years). FDG-avid disease was found in 19 (56%) patients with SUVmax ranging from 3 to 20. Female patients were more likely to have an FDG-avid HCC (P = 0.02). Median follow up of patients following radioembolization was 12 months (1.2-62.8 mo). FDG-avid disease was associated with a decreased 1 year LLC, DLC, DM and PFS (P < 0.05). Using multivariate analysis, FDG avidity predicted for LLC, DLC, and PFS (all P < 0.05).

CONCLUSION

In this retrospective study, pre-treatment HCC FDG-avidity was found to be associated with worse LLC, DLC, and PFS following radioembolization. Larger studies are needed to validate our initial findings to assess the role of F-18-FDG PET/CT scans as biomarker for patients with HCC following radioembolization.

Keywords: F-18 fluorodeoxyglucose PET, Hepatocellular carcinoma, Radioembolization, Prognosis, Biomarker

Core tip: Positron emission tomography (PET)/computed tomography is not currently incorporated in the workup for hepatocellular carcinoma. We reviewed PET scans and analyzed outcomes for patient with hepatocellular carcinoma who had been treated with radioembolization and we showed that patients with FDG avid disease had worse control of the disease inside the liver.