PET/CT with18 F-choline or18 F-FDG in Hepatocellular Carcinoma Submitted to90 Y-TARE: A Real-World Study

Abstract

Our aim was to assess the role of positron emission computed tomography (PET/CT) with18 F-choline (18 F-FCH) or18 F-fluorodeoxyglucose (18 F-FDG) in hepatocellular carcinoma (HCC) submitted to90 Y-radioembolization (90 Y-TARE). We retrospectively analyzed clinical records of 21 HCC patients submitted to PET/CT with18 F-fluorocholine (18 F-FCH) or18 F-fluodeoxyglucose (18 F-FDG) before and 8 weeks after90 Y-TARE. On pre-treatment PET/CT, 13 subjects (61.9%) were18 F-FCH-positive, while 8 (38.1%) resulted18 F-FCH-negative and18 F-FDG-positive. At 8-weeks post90 Y-TARE PET/CT, 13 subjects showed partial metabolic response and 8 resulted non-responders, with a higher response rate among18 F-FCH-positive with respect to18 F-FDG-positive patients (i.e., 76.9% vs. 37.5%, p = 0.46). Post-treatment PET/CT influenced patients’ clinical management in 10 cases (47.6%); in 8 subjects it provided indication for a second90 Y-TARE targeting metabolically active HCC remnant, while in 2 patients it led to a PET-guided radiotherapy on metastatic nodes. By Kaplan–Meier analysis, patients’ age (≤69 y) and post90 Y-TARE PET/CT’s impact on clinical management significantly correlated with overall survival (OS). In Cox multivariate analysis, PET/CT’s impact on clinical management remained the only predictor of patients’ OS (p < 0.001). In our real-world study, PET/CT with18 F-FCH or18 F-FDG influenced clinical management and affected the final outcome for HCC patients treated with90 Y-TARE.