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18F-FDOPA PET/CT-Guided Radiofrequency Ablation of Liver Metastases from Neuroendocrine Tumours: Technical Note on a Preliminary Experience

  • Technical Note
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Aim

To review our preliminary experience with 6-l-18F-fluorodihydroxyphenylalanine (18F-FDOPA) PET/CT-guided radiofrequency ablation (RFA) of liver metastases from neuroendocrine tumours (NETs).

Materials and Methods

Three patients (mean age 51.3 years; range 43–56) with gastro-entero pancreatic NET (GEP-NET) liver metastases underwent 18F-FDOPA PET/CT-guided RFA. Patients were referred with oligometastatic hepatic-confined disease (1–6 metastases; <3 cm) on 18F-FDOPA PET/CT; poor lesion visualisation on US, CT, and MR; and ongoing symptoms. Procedures were performed in an interventional PET/CT scanner under general anaesthesia using a split-dose protocol. Lesion characteristics, procedural duration and technical success (accurate probe placement and post-procedural ablation-zone photopaenia), complications, patient and operator dose, and clinical outcomes were evaluated.

Results

Thirteen liver metastases (mean size 11.4 mm, range 8–16) were treated in three patients (two presented with “carcinoid syndrome”). Technical success was 100 % with a mean procedural duration of 173.3 min (range 90–210) and no immediate complications. Mean patient dose was 2844 mGy·cm (range 2104–3686). Operator and radiographer doses were acceptable other than the operator’s right hand in the first case (149 µSv); this normalised in the second case. There was no local tumour or extra-hepatic disease progression at mid-term follow-up (mean 12.6 months; range 6–20); however, two cases progressed with new liver metastases at different sites. There was 100 % clinical success (n = 2) in resolving carcinoid syndrome symptoms.

Conclusion

18F-FDOPA PET/CT-guided RFA appears technically feasible, safe, and effective in patients with GEP-NETs and low-burden hepatic metastases. Further prospective studies are required to elucidate its precise role in tailored multimodality management of GEP-NET liver metastases.

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Authors and Affiliations

  1. Department of Interventional Radiology, Nouvel Hôpital Civil (Hôpitaux Universitaires de Strasbourg, HUS), 1, place de l’Hôpital, 67000, Strasbourg, France

    Roberto Luigi Cazzato, Julien Garnon, Georgia Tsoumakidou, Jean Caudrelier, Pramod Rao, Guillaume Koch & Afshin Gangi

  2. Department of Radiology, Norfolk and Norwich University Hospital, Colney Lane, Norwich, NR4 7UY, UK

    Nitin Ramamurthy

  3. Department of Biophysics and Nuclear Medicine, Hôpital de Hautepierre (Hôpitaux Universitaires de Strasbourg, HUS), Avenue Molière, 67200, Strasbourg, France

    Alessio Imperiale & Izzie Jacques Namer

  4. Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Hôpital de Hautepierre (Hôpitaux Universitaires de Strasbourg, HUS), Avenue Molière, 67200, Strasbourg, France

    Philippe Bachellier

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  1. Roberto Luigi Cazzato
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Correspondence to Roberto Luigi Cazzato.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study formal consent is not required.

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Informed consent was obtained from all individual participants included in the study.

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Cazzato, R.L., Garnon, J., Ramamurthy, N. et al. 18F-FDOPA PET/CT-Guided Radiofrequency Ablation of Liver Metastases from Neuroendocrine Tumours: Technical Note on a Preliminary Experience. Cardiovasc Intervent Radiol 39, 1315–1321 (2016). https://doi.org/10.1007/s00270-016-1334-1

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