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Baseline and Post-treatment 18F-Fluorocholine PET/CT Predicts Outcomes in Hepatocellular Carcinoma Following Locoregional Therapy

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Abstract

Background and Aims

18F-fluorocholine positron emission tomography/computed tomography (18F-FCH PET/CT) is an emerging functional imaging technique in the diagnosis and management of hepatocellular carcinoma (HCC). The aim of this study was to assess the ability of a pre- and post-treatment 18F-FCH PET/CT to predict prognosis and treatment response in early-stage HCC.

Methods

Patients with early- or intermediate-stage HCC planned for locoregional therapy were prospectively enrolled. Baseline demographic and tumor information was collected and baseline and post-treatment 18F-FCH PET/CT performed. Maximum standardized uptake values (SUVmax) were determined for each HCC lesion, and the difference between baseline and post-treatment SUVmax values were compared with progression-free survival outcomes.

Results

A total of 29 patients with 39 confirmed HCC lesions were enrolled from a single clinical center. Patients were mostly men (89.7%) with hepatitis C or alcohol-related cirrhosis (65.5%) and early-stage disease (89.7%). Per-patient and per-lesion sensitivity of 18F-FCH PET/CT was 72.4% and 59.0%, respectively. A baseline SUVmax < 13 was associated with a superior median progression-free survival compared with an SUVmax of > 13 (17.7 vs. 5.1 months; p = 0.006). A > 45% decrease in SUVmax between baseline and post-treatment 18F-FCH PET/CT (“responders”) was associated with a superior mean progression-free survival than a percentage decrease of < 45% (“non-responders,” 36.1 vs. 11.6 months; p = 0.034).

Conclusions

Baseline and post-treatment 18F-FCH PET/CT predicts outcomes in early-stage HCC undergoing locoregional therapy. This technique may identify patients with an objective response post-locoregional therapy who would benefit from further therapy.

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Abbreviations

18F-FCH PET/CT:

18F-fluorocholine positron emission tomography/computed tomography

HCC:

Hepatocellular carcinoma

SUVmax:

Maximum standardized uptake values

EASL:

European Association for the Study of the Liver

AFP:

Alpha fetoprotein

mRECIST:

Modified Response Evaluation Criteria in Solid Tumors

SIRT:

Selective internal radiotherapy

18F-FDG:

18F-fluorodeoxyglucose

AASLD:

American Association for the Study of Liver Diseases

BCLC:

Barcelona Clinic Liver Cancer

TACE:

Transarterial chemoembolization

SBRT:

Stereotactic body radiotherapy

MRI:

Magnetic resonance imaging

CT:

Computed tomography

VOI:

Volume of interest

95% CI:

95% confidence interval

NAFLD:

Nonalcoholic liver disease

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Acknowledgments

The authors would like to thank Elaine Campbell for her help with study management and data collection.

Funding

This study was funded in part by the Cancer and Palliative Care Research and Evaluation Unit Small Grants Scheme of the University of Western Australia and a research grant from the Australian and New Zealand Society of Nuclear Medicine. The sponsors had no role in the conduct of the research; study design; collection, analysis and interpretation of data; writing of the manuscript; or decision to submit the article for publication.

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Authors and Affiliations

  1. Department of Hepatology, Sir Charles Gairdner Hospital, Hospital Avenue, Nedlands, Perth, 6009, WA, Australia

    Michael C. Wallace, Gerry MacQuillan, George Garas, Leon A. Adams & Gary P. Jeffrey

  2. Medical School, University of Western Australia, Nedlands, WA, Australia

    Michael C. Wallace, Roslyn J. Francis, Gerry MacQuillan, George Garas, Leon A. Adams & Gary P. Jeffrey

  3. School of Population and Global Health, University of Western Australia, Nedlands, WA, Australia

    Michael C. Wallace & David B. Preen

  4. Department of Nuclear Medicine, Sir Charles Gairdner Hospital, Nedlands, WA, Australia

    Kenny Sek & Roslyn J. Francis

  5. Department of Radiology, Sir Charles Gairdner Hospital, Nedlands, WA, Australia

    Shaun Samuelson, John Ferguson & Jonathan Tibballs

  6. Department of Medical Technology and Physics, Sir Charles Gairdner Hospital, Nedlands, WA, Australia

    Ali Asad

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  1. Michael C. Wallace
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Correspondence to Michael C. Wallace.

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Wallace, M.C., Sek, K., Francis, R.J. et al. Baseline and Post-treatment 18F-Fluorocholine PET/CT Predicts Outcomes in Hepatocellular Carcinoma Following Locoregional Therapy. Dig Dis Sci 65, 647–657 (2020). https://doi.org/10.1007/s10620-019-05781-6

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