Importance of 18F-FDG PET/CT to select patients with nonresectable colorectal liver metastases for liver transplantation

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Abstract

Objective

The aim of this study was to evaluate fluorine-18-fluorodeoxyglucose (18F-FDG) PET/CT for the selection of patients with nonresectable colorectal liver metastases (NCLM) for liver transplantation (LT). In the secondary cancer study, we reported an improved 5-year overall survival in patients treated with LT for NCLM (56%) compared with chemotherapy (9%). However, many patients were rejected for LT owing to the detection of extrahepatic disease at preoperative imaging.

Patients and methods

18F-FDG PET/CT and contrast-enhanced computed tomography (ceCT) examinations before tentative LT for NCLM were assessed, and findings contraindicating LT were registered. Maximum, mean and peak standardized uptake values; tumor-to-background ratio; metabolic tumor volume; and total lesion glycolysis were measured and calculated for all liver metastases. Overall survival was calculated by the Kaplan–Meier method.

Results

Thirty-two patients excluded by 18F-FDG PET/CT and/or ceCT before tentative LT for NCLM were identified. 18F-FDG PET/CT from 20 of the 32 excluded patients revealed extrahepatic disease. Eight of the other 12 patients had a negative 18F-FDG PET/CT finding but were excluded by ceCT. Ten patients were excluded by 18F-FDG PET/CT only. Four patients were excluded owing to detected malignancy from frozen sections at the start of the intended transplant operation. Tumor-to-background ratio of the liver metastases was significantly higher in patients where 18F-FDG PET/CT detected extrahepatic disease (P=0.03). The median (range) survival after exclusion was 16 (0–52) months.

Conclusion

The ability of 18F-FDG PET/CT to detect extrahepatic disease before LT for NCLM is vital to establish LT as a treatment option.

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