Julia Chalaye1, Charlotte E Costentin2, Alain Luciani3, Giuliana Amaddeo4, Nathalie Ganne-Carrié5, Laurence Baranes3, Manon Allaire6, Julien Calderaro7, Daniel Azoulay8, Pierre Nahon5, Olivier Seror9, Ariane Mallat4, Michael Soussan10, Christophe Duvoux4, Emmanuel Itti1, Jean Charles Nault11. 1. Nuclear Medicine, Henri Mondor Hospital, Créteil APHP, France. 2. Liver Unit, Henri Mondor Hospital, Créteil APHP, France. Electronic address: charlotte.costentin.pro@gmail.com. 3. Radiology Department, Henri Mondor Hospital, Créteil, APHP, France. 4. Liver Unit, Henri Mondor Hospital, Créteil APHP, France. 5. Liver Unit, Hôpital Jean Verdier, Hôpitaux Universitaires Paris-Seine-Saint-Denis, APHP, Bondy, Unité de Formation et de Recherche Santé Médecine et Biologie humaine, Université Paris 13, Communauté d'Universités et Etablissements Sorbonne Paris Cité, Paris, France; Unité mixte de Recherche 1162, Génomique fonctionnelle des Tumeurs solides Institut National de la Santé et de la Recherche Médicale, Paris, France. 6. Department of Hepatogastroenterology, CHU Côte de Nacre, Caen, France. 7. Department of Pathology, Henri Mondor Hospital, Créteil, APHP, France. 8. Hepatobiliary Surgery and Liver Ttransplantation, Henri Mondor Hospital, Créteil, APHP, France. 9. Unité mixte de Recherche 1162, Génomique fonctionnelle des Tumeurs solides Institut National de la Santé et de la Recherche Médicale, Paris, France; Radiology Department, Jean Verdier Hospital, Bondy, Hôpitaux Universitaires Paris-Seine-Saint-Denis, APHP, Bondy, France. 10. Nuclear Medicine, Avicenne Hospital, APHP, Bobigny, France. 11. Liver Unit, Hôpital Jean Verdier, Hôpitaux Universitaires Paris-Seine-Saint-Denis, APHP, Bondy, Unité de Formation et de Recherche Santé Médecine et Biologie humaine, Université Paris 13, Communauté d'Universités et Etablissements Sorbonne Paris Cité, Paris, France; Unité mixte de Recherche 1162, Génomique fonctionnelle des Tumeurs solides Institut National de la Santé et de la Recherche Médicale, Paris, France. Electronic address: naultjc@gmail.com.
Abstract
BACKGROUND & AIMS: Hepatocellular carcinoma (HCC) staging according to the Barcelona Clinical Liver Cancer (BCLC) classification is based on conventional imaging. The aim of our study was to assess the impact of dual-tracer 18F-fluorocholine and 18F-fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) on tumor staging and treatment allocation. METHODS: A total of 192 dual-tracer PET/CT scans (18F-fluorocholine and 18F-fluorodeoxyglucose PET/CT) were performed in 177 patients with HCC. BCLC staging and treatment proposal were retrospectively collected based on conventional imaging, along with any new lesions detected, and changes in BCLC classification or treatment allocation based on dual-tracer PET/CT. RESULTS: Patients were primarily men (87.5%) with cirrhosis (71%) due to alcohol ± non-alcoholic steatohepatitis (26%), viral infection (62%) or unknown causes (12%). Among 122 patients with PET/CT performed for staging, BCLC stage based on conventional imaging was 0/A in 61 patients (50%), B in 32 patients (26%) and C in 29 patients (24%). Dual-tracer PET/CT detected new lesions in 26 patients (21%), upgraded BCLC staging in 14 (11%) and modified treatment strategy in 17 (14%). In addition, dual-tracer PET/CT modified the final treatment in 4/9 (44%) patients with unexplained elevation of alpha-fetoprotein (AFP), 10/25 patients (40%) with doubtful lesions on conventional imaging and 3/36 patients (8%) waiting for liver transplantation without active HCC after tumor response following bridging therapy. CONCLUSION: When used for HCC staging, dual-tracer PET/CT enabled BCLC upgrading and treatment modification in 11% and 14% of patients, respectively. Dual-tracer PET/CT might also be useful in specific situations (an unexplained rise in AFP, doubtful lesions or pre-transplant evaluation of patients without active HCC). LAY SUMMARY: Using a combination of tracers 18F-fluorocholine and 18F-fluorodeoxyglucose when performing positron emission tomography/computed tomography (PET/CT), often called a PET scan, helps to identify new tumor lesions in patients with hepatocellular carcinoma. This technique enabled staging modification of patients' tumors and led to changes in treatment allocation in certain patients.
BACKGROUND & AIMS:Hepatocellular carcinoma (HCC) staging according to the Barcelona Clinical Liver Cancer (BCLC) classification is based on conventional imaging. The aim of our study was to assess the impact of dual-tracer 18F-fluorocholine and 18F-fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) on tumor staging and treatment allocation. METHODS: A total of 192 dual-tracer PET/CT scans (18F-fluorocholine and 18F-fluorodeoxyglucose PET/CT) were performed in 177 patients with HCC. BCLC staging and treatment proposal were retrospectively collected based on conventional imaging, along with any new lesions detected, and changes in BCLC classification or treatment allocation based on dual-tracer PET/CT. RESULTS:Patients were primarily men (87.5%) with cirrhosis (71%) due to alcohol ± non-alcoholic steatohepatitis (26%), viral infection (62%) or unknown causes (12%). Among 122 patients with PET/CT performed for staging, BCLC stage based on conventional imaging was 0/A in 61 patients (50%), B in 32 patients (26%) and C in 29 patients (24%). Dual-tracer PET/CT detected new lesions in 26 patients (21%), upgraded BCLC staging in 14 (11%) and modified treatment strategy in 17 (14%). In addition, dual-tracer PET/CT modified the final treatment in 4/9 (44%) patients with unexplained elevation of alpha-fetoprotein (AFP), 10/25 patients (40%) with doubtful lesions on conventional imaging and 3/36 patients (8%) waiting for liver transplantation without active HCC after tumor response following bridging therapy. CONCLUSION: When used for HCC staging, dual-tracer PET/CT enabled BCLC upgrading and treatment modification in 11% and 14% of patients, respectively. Dual-tracer PET/CT might also be useful in specific situations (an unexplained rise in AFP, doubtful lesions or pre-transplant evaluation of patients without active HCC). LAY SUMMARY: Using a combination of tracers 18F-fluorocholine and 18F-fluorodeoxyglucose when performing positron emission tomography/computed tomography (PET/CT), often called a PET scan, helps to identify new tumor lesions in patients with hepatocellular carcinoma. This technique enabled staging modification of patients' tumors and led to changes in treatment allocation in certain patients.
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Authors: Hans-Christian Pommergaard; Andreas Arendtsen Rostved; René Adam; Allan Rasmussen; Mauro Salizzoni; Miguel Angel Gómez Bravo; Daniel Cherqui; Paolo De Simone; Pauline Houssel-Debry; Vincenzo Mazzaferro; Olivier Soubrane; Juan Carlos García-Valdecasas; Joan Fabregat Prous; Antonio D Pinna; John O'Grady; Vincent Karam; Christophe Duvoux; Lau Caspar Thygesen Journal: Liver Cancer Date: 2020-05-12 Impact factor: 11.740
Authors: Nader Hirmas; Catherine Leyh; Miriam Sraieb; Francesco Barbato; Benedikt M Schaarschmidt; Lale Umutlu; Michael Nader; Heiner Wedemeyer; Justin Ferdinandus; Christoph Rischpler; Ken Herrmann; Pedro Fragoso Costa; Christian M Lange; Manuel Weber; Wolfgang P Fendler Journal: J Nucl Med Date: 2021-01-28 Impact factor: 10.057