• Colorectal
• Fluorodeoxyglucose
• Focal
• Hypermetabolism
• Incidental
• Positron emission tomography

• Fluorodeoxyglucose
• Focal
• Hypermetabolism
• Incidental
• Incidentaloma
• Positron emission tomography

• Yttrium-90 radioembolization
• colorectal cancer
• imaging
• interventional oncology
• liver metastases
• locoregional therapy
• margin
• stereotactic body radiation therapy
• thermal ablation

• P30 CA008748 NCI NIH HHS

• 18F-FLT PET/CT
• TACE
• TARE
• chemoembolization
• early response
• liver tumors
• metastatic
• primary
• radioembolization

• ACR–ABS–ACNM–ASTRO–SIR–SNMMI
• Radioembolization
• SIRT
• TARE
• Yttrium-90

Interventional radiology plays an important and increasing role in cancer treatment. Follow-up is important to be able to assess treatment success and detect locoregional and distant recurrence and recommendations for follow-up are needed. At ECIO 2018, a joint ECIO-ESOI session was organized to establish follow-up recommendations for oncologic intervention in liver, renal, and lung cancer. Treatments included thermal ablation, TACE, and TARE. In total five topics were evaluated: ablation in colorectal liver metastases (CRLM), TARE in CRLM, TACE and TARE in HCC, ablation in renal cancer, and ablation in lung cancer. Evaluated modalities were FDG-PET-CT, CT, MRI, and (contrast-enhanced) ultrasound. Prior to the session, five experts were selected and performed a systematic review and presented statements, which were voted on in a telephone conference prior to the meeting by all panelists. These statements were presented and discussed at the ECIO-ESOI session at ECIO 2018. This paper presents the recommendations that followed from these initiatives. Based on expert opinions and the available evidence, follow-up schedules were proposed for liver cancer, renal cancer, and lung cancer. FDG-PET-CT, CT, and MRI are the recommended modalities, but one should beware of false-positive signs of residual tumor or recurrence due to inflammation early after the intervention. There is a need for prospective preferably multicenter studies to validate new techniques and new response criteria. This paper presents recommendations that can be used in clinical practice to perform the follow-up of patients with liver, lung, and renal cancer who were treated with interventional locoregional therapies.

• Interventional radiology
• Liver
• Lung cancer
• Oncology
• Recommendations

To identify an imaging predictor for the assessment of early treatment response to yttrium-90 transarterial radioembolization (TARE) in patients with hepatocellular carcinoma (HCC), using a quantitative assessment of dynamic computed tomography (CT) images.

Dynamic contrast-enhanced CT was obtained pre- and 4 weeks post-TARE in 44 patients (34 men, 10 women; mean age, 60 years) with HCC. Computer software was developed for measuring the percentage increase in the combined delayed-enhancing area and necrotic area (pD + N) and the percentage increase in the necrotic area (pNI) in the tumor-containing segments pre- and post-TARE. Local progression-free survival (PFS) was compared between patient groups using Cox regression and Kaplan-Meier analyses.

Post-TARE HCC with pD + N ≥ 35.5% showed significantly longer PFS than those with pD + N < 35.5% (p = 0.001). The local tumor progression hazard ratio was 17.3 (p = 0.009) for pD + N < 35.5% versus pD + N ≥ 35.5% groups. HCCs with a high pNI tended to have longer PFS, although this difference did not reach statistical significance.

HCCs with a larger pD + N are less likely to develop local progression after TARE.

• Computed tomography
• Hepatocellular carcinoma
• Quantitative analysis
• Response
• Treatment outcome
• Yttrium radioisotopes

• Y90
• biomarkers
• colorectal cancer
• liver cancer
• radioembolization

• Colorectal Neoplasms/complications
• Colorectal Neoplasms/mortality
• Colorectal Neoplasms/pathology
• Embolization, Therapeutic/methods
• Humans
• Liver Neoplasms/mortality
• Liver Neoplasms/radiotherapy
• Liver Neoplasms/secondary
• Neoplasm Metastasis
• Prognosis
• Prospective Studies
• Radioimmunotherapy/methods
• Retrospective Studies
• Survival Analysis
• Treatment Outcome

• UL1 TR001863 NCATS NIH HHS

This prospective study was to investigate the value of [¹¹C]-acetate PET and [¹⁸F]-FDG PET in the evaluation of hepatocellular carcinoma (HCC) before and after treatment with transarterial chemoembolization (TACE) and vascular endothelial growth factor (VEGF) antibody (bevacizumab).

Twenty-two patients (three women, 19 men; 62 ± 8 years) with HCC verified by histopathology were treated with TACE and bevacizumab (n = 11) or placebo (n = 11). [¹¹C]-acetate PET and [¹⁸F]-FDG PET were performed before and after TACE with bevacizumab or placebo. Comparisons between groups were performed with t-tests and Chi-squared tests, where appropriate. Overall survival (OS) was defined as the time from start of bevacizumab or placebo until the date of death/last follow-up, respectively.

The patient-related sensitivity of [¹¹C]-acetate PET, [¹⁸F]-FDG PET, and combined [¹¹C]-acetate and [¹⁸F]-FDG PET was 68%, 45%, and 73%, respectively. There was a significantly higher rate of conversion from [¹¹C]-acetate positive lesions to negative lesions in patients treated with TACE and bevacizumab as compared with that in patients with TACE and placebo (p < 0.05). In patients with negative acetate PET, the mean OS in patients treated with TACE and bevacizumab was 259 ± 118 days and was markedly shorter as compared with that (668 ± 217 days) in patients treated with TACE and placebo (p < 0.05). In patients treated with TACE and placebo, there was significant difference in mean OS in patients with positive FDG PET as compared with that in patients with negative FDG PET (p < 0.05). The HCC lesions had different tracer avidities showing the heterogeneity of HCC.

Our study suggests that combining [¹⁸F]-FDG with [¹¹C]-acetate PET could be useful for the management of HCC patients and might also provide relevant prognostic and molecular heterogeneity information.

• Acetate
• Bevacizumab
• FDG
• Hepatocellular carcinoma
• Pet
• Transarterial chemoembolization

• FDG PET/CT
• Hepatocellular carcinoma
• Imaging
• Survival
• TARE

• Choi criteria
• colorectal liver metastases
• radioembolization
• tumor attenuation

• Colorectal liver metastases
• Overall survival
• PET/CT
• RECIST 1.0
• Radioembolization

• 90Y-radioembolization
• FDG-PET
• breast cancer
• liver metastases
• total lesion glycolysis

• Arterially directed therapies
• Hepatic malignancy
• SIRT
• Selective internal radiation therapy
• Yttrium-90

• HCC
• liver
• metastasis
• neoplasm
• radioembolization

The higher tolerated mean absorbed dose for selective internal radiation therapy (SIRT) with intra-arterially infused ⁹⁰Y microspheres compared to external beam therapy is speculated to be caused by absorbed dose inhomogeneity, which allows for liver regeneration. However, the complex liver microanatomy and rheology makes modelling less valuable if the tolerance doses are not based on the actual microsphere distribution. The present study demonstrates the sphere distribution and small-scale absorbed dose inhomogeneity and its correlation with the mean absorbed dose in liver tissue resected after SIRT.

A patient with marginally resectable cholangiocarcinoma underwent SIRT 9 days prior to resection including adjacent normal liver tissue. The resected specimen was formalin-fixed and sliced into 1 to 2-mm sections. Forty-one normal liver biopsies 6-8 mm in diameter were punched from these sections and the radioactivity measured. Sixteen biopsies were further processed for detailed analyses by consecutive serial sectioning of 15 30-μm sections per biopsy, mounted and stained with haematoxylin-eosin. All sections were scrutinised for isolated or conglomerate spheres. Small-scale dose distributions were obtained by applying a ⁹⁰Y-dose point kernel to the microsphere distributions.

A total of 3888 spheres were found in the 240 sections. Clusters were frequently found as strings in the arterioles and as conglomerates in small arteries, with the largest cluster comprising 453 spheres. An increased mean absorbed dose in the punch biopsies correlated with large clusters and a greater coefficient of variation. In simulations the absorbed dose was 5–1240 Gy; 90% were 10-97 Gy and 45% were <30 Gy, the assumed tolerance in external beam therapy.

Sphere clusters were located in both arterioles and small arteries and increased in size with increasing sphere concentration, resulting in increased absorbed dose inhomogeneity, which contradicts earlier modelling studies.

• Dosimetry
• Liver
• Microspheres
• Radioembolisation
• SIRT
• Y-90

• PET/CT
• anal cancer
• colorectal cancer
• radiation therapy planning
• therapy assessment

• 18F-FDG PET
• HCC
• SIRT
• radioembolization

• (90)Y radioembolization
• Intrahepatic cholangiocarcinoma
• Total lesion glycolysis
• [(18)F] FDG PET

Treatment of oncologic disease has improved significantly in the last decades and in the future a vast majority of cancer types will continue to increase worldwide. As a result, many patients are confronted with primary liver cancers or metastatic liver disease. Surgery in liver malignancies has steeply improved and curative resections are applicable in wider settings, leading to a prolonged survival. Simultaneously, radiofrequency ablation (RFA) and liver transplantation (LTx) have been applied more commonly in oncologic settings with improving results. To minimize adverse events in treatments of liver malignancies, locoregional minimal invasive treatments have made their appearance in this field, in which radioembolization (RE) has shown promising results in recent years with few adverse events and high response rates. We discuss several other applications of RE for oncologic patients, other than its use in the palliative setting, whether or not combined with other treatments. This review is focused on the role of RE in acquiring patient eligibility for radical treatments, like surgery, RFA, and LTx. Inducing significant tumor reduction can downstage patients for resection or, through attaining stable disease, patients can stay on the LTx waiting list. Hereby, RE could make a difference between curative of palliative intent in oncologic patient management. Prior to surgery, the future remnant liver volume might be inadequate in some patients. In these patients, forming an adequate liver reserve through RE leads to prolonged survival without risking post-operative liver failure and minimizing tumor progression while inducing hypertrophy. In order to optimize results, developments in procedures surrounding RE are equally important. Predicting the remaining liver function after radical treatment and finding the right balance between maximum tumor irradiation and minimizing the chance of inducing radiation-related complications are still challenges.

• bridge to transplantation
• dosimetry
• downstaging
• future liver remnant
• hepatobiliary scintigraphy
• liver malignancies
• radioembolization
• transplantation

Transarterial radioembolization (TARE) with yttrium 90 microspheres is an increasingly popular therapy for both primary and secondary liver malignancies. TARE entails delivery of β-particle brachytherapy and embolization of the tumor vasculature. The consequent biological sequelae are distinct from those of other transarterial therapies for liver tumors, as reflected in the often baffling post-treatment imaging features. As the clinical use of TARE is increasing, more diverse post-treatment radiological findings are encountered with variable overlap among treatment response, residual disease, reactionary changes and complications. Thus, post-TARE image interpretation is challenging. This review provides a comprehensive description of the different findings seen in post-treatment scans, with the aim of facilitating appropriate radiological interpretation of post-TARE pathologic changes, notwithstanding their existing limitations.

• Carcinoembryonic Antigen/blood
• Colonography, Computed Tomographic
• Colorectal Neoplasms/diagnostic imaging
• Colorectal Neoplasms/pathology
• Colorectal Neoplasms/surgery
• Cost-Benefit Analysis
• Fluorodeoxyglucose F18
• Humans
• Liver Neoplasms/secondary
• Multimodal Imaging/economics
• Neoplasm Invasiveness
• Neoplasm Recurrence, Local/diagnosis
• Neoplasm Staging
• Positron-Emission Tomography
• Radiopharmaceuticals
• Sensitivity and Specificity
• Tomography, X-Ray Computed

• Ablation Techniques/methods
• Carcinoma, Hepatocellular/mortality
• Carcinoma, Hepatocellular/pathology
• Carcinoma, Hepatocellular/therapy
• Colorectal Neoplasms/mortality
• Colorectal Neoplasms/secondary
• Colorectal Neoplasms/therapy
• Contraindications
• Electroporation/methods
• Embolization, Therapeutic/methods
• Hepatectomy/methods
• Humans
• Laparoscopy/methods
• Liver Neoplasms/mortality
• Liver Neoplasms/pathology
• Liver Neoplasms/therapy
• Postoperative Complications
• Robotics
• Treatment Outcome

To describe post-CyberKnife® imaging characteristics of liver metastases as an aid in assessing response to treatment, and a novel set of combined criteria (CC) as an alternative to response according to change in size (RECIST).

Imaging data and medical records of 28 patients with 40 liver metastases treated with stereotactic body radiotherapy (SBRT) were reviewed. Tumor size, CT attenuation coefficient, and contrast enhancement of lesions were evaluated up to 2 years post SBRT. Rates of local control, progression-free survival, time to progression, and overall survival according to RECIST and CC were estimated.

Complete response (CR) was 3.6% (95% CI: 0.1–18%) and 18% (95% CI: 6–37%) according to RECIST and combined criteria, respectively. Two progressive diseases and two partial responses according to RECIST were classified as CR by the combined criteria and one stable response according to RECIST was classified as progressive by CC (Stuart-Maxwell test, p = 0.012). The disease control rate was 60.7% (95% CI: 41–78%) by RECIST and 64% (95% CI: 44%–81%) by CC.

Use of response criteria based on change in size alone in the interpretation of liver response to SBRT may be inadequate. We propose a simple algorithm with a combination of criteria to better assess tumor response. Further studies are needed to confirm their validity.