PET/CT with F-18-choline or F-18-FDG in Hepatocellular Carcinoma Submitted to Y-90-TARE: A Real-World Study

Our aim was to assess the role of positron emission computed tomography (PET/CT) with F-18-choline (F-18-FCH) or F-18-fluorodeoxyglucose (F-18-FDG) in hepatocellular carcinoma (HCC) submitted to Y-90-radioembolization (Y-90-TARE). We retrospectively analyzed clinical records of 21 HCC patients submitted to PET/CT with F-18-fluorocholine (F-18-FCH) or F-18-fluodeoxyglucose (F-18-FDG) before and 8 weeks after Y-90-TARE. On pre-treatment PET/CT, 13 subjects (61.9%) were F-18-FCH-positive, while 8 (38.1%) resulted F-18-FCH-negative and F-18-FDG-positive. At 8-weeks post Y-90-TARE PET/CT, 13 subjects showed partial metabolic response and 8 resulted non-responders, with a higher response rate among F-18-FCH-positive with respect to F-18-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 second Y-90-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 post Y-90-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 with F-18-FCH or F-18-FDG influenced clinical management and affected the final outcome for HCC patients treated with Y-90-TARE.