Kolanjiyokarsinom Tanısı ile Karaciğer Metastazlarına Y-90 Mikroküre Tedavisi Verilmiş Hastalarda Hepatik Arter Perfüzyon Çalışması Görüntüleri ile Tedavi Öncesi – Tedavi Sonrası Bilgisayarlı Tomografi Ve Fdg Pet Bt Görüntüleri Arasındaki İlişkinin Araştırılması

Abstract

Mehmet Bozkurt, Evaluating the Association Between Pre- and Post- therapy Computerized Tomography/ Magnetic Resonance Imaging and F-18 FDG PET-CT Images and Hepatic Artery Perfusion Study in Liver Metastases of Cholangiocarcinoma Treated with Y-90 microspheres. Hacettepe University, Faculty of Medicine, Thesis in Department of Nuclear Medicine, Ankara 2017. Cholangiocellular carcinoma (CCA) is the second most common primary liver malignancy that has low survival rates and at the time of diagnosis, most of the patients are not eligible for surgical therapy. Unresectable or chemorefractory CCA patients may be treated by transarterial administration of Yttrium-90 (Y-90)- labeled microspheres. The aim of this study was patient and lesion based evaluation of hepatic artery perfusion scintigraphy(HAPS), pre- and post-treatment computerized tomography (CT), magnetic resonance imaging (MRI) and FDG PET-CT images in patients received Y90- radiomicrosphere therapies for primary or liver metastasis of CCA and their association between changes related to therapy. Data of 19 patients (n=6, extrahepatic CCA, and n=13, intrahepatic CCA), diagnosed with CCA, received total 24 sessions of Y90 microsphere therapies (n=13, glass; n=11, resin microspheres) between January 2008-November 2016, were retrospectively evaluated. Tumor load, tumor diameter, patient and lesion based treatment response evaluation by RECIST criteria were assessed from pre- and post-treatment conventional CT and MRI images; and tumor lesion glycolysis (TLG) metabolic tumor volume (MTV), SUVmax and treatment responses evaluated with PERCIST criteria were obtained from FDG PET-CT images; and their relations with treatment responses and follow-up period after treatment were sought. Maximum (HAPmax) and mean (HAPmean) values were measured by drawing region of interest in pretreatment HAPS planar images and VOImax and VOI mean were assessed by drawing volume of interest in SPECT or SPECT-CT images, and their correlation with tumor diameters, tumor loads, treatment responses and follow-up time after treatment were analyzed. The mean follow-up time of patients was 9,4 months± 7,8 and mean overall survival (OS) was 11,9 months±2,3. Thirteen therapies went through RECIST evaluation and revealed complete response(CR) in one, partial response (PR) in 2, stable disease (SD) in 4 and progressive disease(PD) in 6 of the therapies. Lesion-based evaluation of RECIST treatment response did not show a significant correlation with follow-up time (p=0,081). However, when patients were grouped CR and PR or SD and PD according to RECIST criteria of lesion based evaluation, the follow-up of patients with response group (PR/CR) was longer than non-response group (SD/PD) (p=0,034). In eight therapies, preand post-treatment FDG PET-CT images are obtained and showed CR in one (OS:15,3 months), PR in 6 (OS: 17,6 months±5,5) and SD in one ( OS: 18 months) of the treatments. Basal MTV, basal TLG, ΔTLG, ΔSUVmax and ΔSUVmean values of patients were not related with follow-up time after treatment. However, ΔMTV was positively correlated with follow-up time of the patients. HAPmax/mean and VOImax/mean values accepted as hepatic artery perfusion criteria were not associated with patient and lesion based RECIST or PERCIST treatment responses of treatments. In conclusion, in this study, we did not find any relation between HAPS findings and response to Y90 microsphere therapy. Changes in CT/MRI and FDG PET-CT parameters may be used to predict the therapy response of Y-90 microspheres in CCA.