European Radiology

, Volume 23, Issue 4, pp 931–937

Added value of FDG-PET imaging in the diagnostic workup for yttrium-90 radioembolisation in patients with colorectal cancer liver metastases

  • Charlotte E. N. M. Rosenbaum
  • M. A. A. J. van den Bosch
  • W. B. Veldhuis
  • J. E. Huijbregts
  • M. Koopman
  • M. G. E. H. Lam
Interventional

Abstract

Objective

Yttrium-90 radioembolisation (Y90-RE) is recommended for unresectable, chemorefractory liver-dominant disease; however, the incidence of extrahepatic disease (EHD) is high. FDG-PET may have additional value to CT in demonstrating EHD. Our aim was to evaluate the added diagnostic value of FDG-PET to abdominal CT and study the influence of FDG-PET findings on treatment decisions.

Methods

All consecutive patients with colorectal cancer liver metastases (CRCLM) referred for Y90-RE were included. Patients who underwent both CT and FDG-PET in the diagnostic workup were selected. Imaging reports were scrutinised for documented sites of EHD, and changes of management due to FDG-PET findings were determined.

Results

A total of 42 patients were included. Findings on CT and FDG-PET matched in 20 patients (no EHD, n = 15; identical EHD, n = 5). In 4 patients, lesions detected on CT were not FDG-avid, and in 18 patients, FDG-PET showed more lesions than CT (P < 0.05). In 7/42 patients (17 %) a change of management was made based on the additional FDG-PET findings, i.e. exclusion from Y90-RE treatment (n = 6) and change in treatment plan (whole liver rather than segmental treatment, n = 1).

Conclusions

In patients with CRCLM referred for Y90-RE, FDG-PET showed significantly more EHD and led to a considerable change of management.

Key Points

Yttrium-90 radioembolisation is a locoregional treatment for liver tumours

Detection of extrahepatic lesions, for which CT is widely used, is crucial

FDG-PET shows significantly more extrahepatic lesions compared to CT

FDG-PET findings led to a considerable change in treatment decisions

Keywords

Colorectal cancer Liver metastases Radioembolisation Diagnostic workup FDG-PET 

References

  1. 1.
    Coldwell D, Sangro B, Salem R, Wasan H, Kennedy A (2012) Radioembolization in the treatment of unresectable liver tumors: experience across a range of primary cancers. Am J Clin Oncol 35:167–177PubMedCrossRefGoogle Scholar
  2. 2.
    Kennedy AS, McNeillie P, Dezarn WA et al (2009) Treatment parameters and outcome in 680 treatments of internal radiation with resin 90Y-microspheres for unresectable hepatic tumors. Int J Radiat Oncol Biol Phys 74:1494–1500PubMedCrossRefGoogle Scholar
  3. 3.
    Murthy R, Brown DB, Salem R et al (2007) Gastrointestinal complications associated with hepatic arterial yttrium-90 microsphere therapy. J Vasc Interv Radiol 18:553–561, quiz 562PubMedCrossRefGoogle Scholar
  4. 4.
    Vente MA, Wondergem M, van der Tweel I et al (2009) Yttrium-90 microsphere radioembolization for the treatment of liver malignancies: a structured meta-analysis. Eur Radiol 19:951–959PubMedCrossRefGoogle Scholar
  5. 5.
    Dezarn WA, Cessna JT, DeWerd LA et al (2011) Recommendations of the American Association of Physicists in Medicine on dosimetry, imaging, and quality assurance procedures for 90Y microsphere brachytherapy in the treatment of hepatic malignancies. Med Phys 38:4824–4845PubMedCrossRefGoogle Scholar
  6. 6.
    Lewandowski RJ, Sato KT, Atassi B et al (2007) Radioembolization with 90Y microspheres: angiographic and technical considerations. Cardiovasc Intervent Radiol 30:571–592PubMedCrossRefGoogle Scholar
  7. 7.
    Hendlisz A, Eynde MVD, Peeters M et al (2010) Phase III trial comparing protracted intravenous fluorouracil infusion alone or with yttrium-90 resin microspheres radioembolization for liver-limited metastatic colorectal cancer refractory to standard chemotherapy. J Clin Oncol 28:3687–3694PubMedCrossRefGoogle Scholar
  8. 8.
    Kennedy A, Coldwell D, Nutting C et al (2006) Resin 90Y-microsphere brachytherapy for unresectable colorectal liver metastases: modern USA experience. Int J Radiat Oncol Biol Phys 65:412–425PubMedCrossRefGoogle Scholar
  9. 9.
    Stubbs RS, O’Brien I, Correia MM (2006) Selective internal radiation therapy with 90y microspheres for colorectal liver metastases: single-centre experience with 100 patients. ANZ J Surg 76:696–703PubMedCrossRefGoogle Scholar
  10. 10.
    Van Hazel G, Blackwell A, Anderson J et al (2004) Randomised phase 2 trial of SIR-Spheres® plus fluorouracil/leucovorin chemotherapy versus fluorouracil/leucovorin chemotherapy alone in advanced colorectal cancer. J Surg Oncol 88:78–85PubMedCrossRefGoogle Scholar
  11. 11.
    Gray B, Van Hazel GA, Hope M et al (2001) Randomised trial of SIR-Spheres® plus chemotherapy vs. chemotherapy alone for treating patients with liver metastases from primary large bowel cancer. Ann Oncol 12:1711–1720PubMedCrossRefGoogle Scholar
  12. 12.
    Chua TC, Bester L, Saxena A, Morris DL (2010) Radioembolization and systemic chemotherapy improves response and survival for unresectable colorectal liver metastases. J Cancer Res Clin Oncol 137:865–873PubMedCrossRefGoogle Scholar
  13. 13.
    Cosimelli M, Golfieri R, Cagol PP et al (2010) Multi-centre phase II clinical trial of yttrium-90 resin microspheres alone in unresectable, chemotherapy refractory colorectal liver metastases. Br J Cancer 103:324–331PubMedCrossRefGoogle Scholar
  14. 14.
    Coldwell D, Sangro B, Wasan H, Salem R, Kennedy A (2011) General selection criteria of patients for radioembolization of liver tumors: an international working group report. Am J Clin Oncol 34:337–341PubMedCrossRefGoogle Scholar
  15. 15.
    Kennedy A, Nag S, Salem R et al (2007) Recommendations for radioembolization of hepatic malignancies using yttrium-90 microsphere brachytherapy: a consensus panel report from the radioembolization brachytherapy oncology consortium. Int J Radiat Oncol Biol Phys 68:13–23PubMedCrossRefGoogle Scholar
  16. 16.
    Giammarile F, Bodei L, Chiesa C et al (2011) EANM procedure guideline for the treatment of liver cancer and liver metastases with intra-arterial radioactive compounds. Eur J Nucl Med Mol Imaging 38:1393–1406PubMedCrossRefGoogle Scholar
  17. 17.
    Denecke T, Rühl R, Hildebrandt B et al (2008) Planning transarterial radioembolization of colorectal liver metastases with yttrium 90 microspheres: evaluation of a sequential diagnostic approach using radiologic and nuclear medicine imaging techniques. Eur Radiol 18:892–902PubMedCrossRefGoogle Scholar
  18. 18.
    Kennedy A, Coldwell D, Sangro B, Wasan H, Salem R (2012) Radioembolization for the treatment of liver tumors general principles. Am J Clin Oncol 35:91–99PubMedCrossRefGoogle Scholar
  19. 19.
    Mulcahy MF, Lewandowski RJ, Ibrahim SM et al (2009) Radioembolization of colorectal hepatic metastases using yttrium-90 microspheres. Cancer 115:1849–1858PubMedCrossRefGoogle Scholar
  20. 20.
    Bester L, Meteling B, Pocock N et al (2012) Radioembolization versus standard care of hepatic metastases: comparative retrospective cohort study of survival outcomes and adverse events in salvage patients. J Vasc Interv Radiol 23:96–105PubMedCrossRefGoogle Scholar
  21. 21.
    Nace GW, Steel JL, Amesur N et al (2011) Yttrium-90 radioembolization for colorectal cancer liver metastases: a single institution experience. Int J Surg Oncol 2011:1–9. doi:10.1155/2011/571261 CrossRefGoogle Scholar
  22. 22.
    Povoski SP, Fong Y, Sgouros SC, Kemeny NE, Downey RJ, Blumgart LH (1998) Role of chest CT in patients with negative chest x-rays referred for hepatic colorectal metastases. Ann Surg Oncol 5:9–15PubMedCrossRefGoogle Scholar
  23. 23.
    Kronawitter U, Kemeny NE, Heelan R, Fata F, Fong Y (1999) Evaluation of chest computed tomography in the staging of patients with potentially resectable liver metastases from colorectal carcinoma. Cancer 86:229–235PubMedCrossRefGoogle Scholar
  24. 24.
    Strasberg SM, Dehdashti F (2010) Role of FDG-PET staging in selecting the optimum patient for hepatic resection of metastatic colorectal cancer. J Surg Oncol 102:955–959PubMedCrossRefGoogle Scholar
  25. 25.
    Huebner RH, Park KC, Shepherd JE et al (2000) A meta-analysis of the literature for whole-body FDG PET detection of recurrent colorectal cancer. J Nucl Med 41:1177–1189PubMedGoogle Scholar
  26. 26.
    Ruers TJM, Wiering B, van der Sijp JRM et al (2009) improved selection of patients for hepatic surgery of colorectal liver metastases with 18F-FDG PET: a randomized study. J Nucl Med 50:1036–1041PubMedCrossRefGoogle Scholar
  27. 27.
    Wiering B, Adang EMM, van der Sijp JRM et al (2010) Added value of positron emission tomography imaging in the surgical treatment of colorectal liver metastases. Nucl Med Commun 31:938–944PubMedCrossRefGoogle Scholar
  28. 28.
    Vach W, Hoilund-Carlsen PF, Gerke O, Weber WA (2011) Generating evidence for clinical benefit of PET/CT in diagnosing cancer patients. J Nucl Med 52:77S–85SPubMedCrossRefGoogle Scholar

Copyright information

© European Society of Radiology 2012

Authors and Affiliations

  • Charlotte E. N. M. Rosenbaum
    • 1
  • M. A. A. J. van den Bosch
    • 1
  • W. B. Veldhuis
    • 1
  • J. E. Huijbregts
    • 1
  • M. Koopman
    • 2
  • M. G. E. H. Lam
    • 1
  1. 1.Department of Radiology and Nuclear MedicineUniversity Medical Center UtrechtUtrechtThe Netherlands
  2. 2.Department of Medical OncologyUniversity Medical Center UtrechtUtrechtThe Netherlands

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