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OtherTheranostics

[68Ga]Ga-PSMA-11 PET/CT improves tumor detection and impacts management in patients with hepatocellular carcinoma (HCC)

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 and Wolfgang P. Fendler
Journal of Nuclear Medicine January 2021, jnumed.120.257915; DOI: https://doi.org/10.2967/jnumed.120.257915
Nader Hirmas
1 Department of Nuclear Medicine, University of Duisburg-Essen and German Cancer Consortium (DKTK)-University Hospital Essen, Germany;
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Catherine Leyh
2 Department of Gastroenterology and Hepatology, University Hospital Essen, University Duisburg-Essen, Germany;
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Miriam Sraieb
1 Department of Nuclear Medicine, University of Duisburg-Essen and German Cancer Consortium (DKTK)-University Hospital Essen, Germany;
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Francesco Barbato
1 Department of Nuclear Medicine, University of Duisburg-Essen and German Cancer Consortium (DKTK)-University Hospital Essen, Germany;
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Benedikt M. Schaarschmidt
3 Institute of Diagnostic and Interventional Radiology and Neuroradiology; University Hospital Essen, University Duisburg-Essen, Germany
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Lale Umutlu
1 Department of Nuclear Medicine, University of Duisburg-Essen and German Cancer Consortium (DKTK)-University Hospital Essen, Germany;
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Michael Nader
1 Department of Nuclear Medicine, University of Duisburg-Essen and German Cancer Consortium (DKTK)-University Hospital Essen, Germany;
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Heiner Wedemeyer
2 Department of Gastroenterology and Hepatology, University Hospital Essen, University Duisburg-Essen, Germany;
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Justin Ferdinandus
1 Department of Nuclear Medicine, University of Duisburg-Essen and German Cancer Consortium (DKTK)-University Hospital Essen, Germany;
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Christoph Rischpler
1 Department of Nuclear Medicine, University of Duisburg-Essen and German Cancer Consortium (DKTK)-University Hospital Essen, Germany;
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Ken Herrmann
1 Department of Nuclear Medicine, University of Duisburg-Essen and German Cancer Consortium (DKTK)-University Hospital Essen, Germany;
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Pedro Fragoso Costa
1 Department of Nuclear Medicine, University of Duisburg-Essen and German Cancer Consortium (DKTK)-University Hospital Essen, Germany;
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Christian M. Lange
2 Department of Gastroenterology and Hepatology, University Hospital Essen, University Duisburg-Essen, Germany;
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Manuel Weber
1 Department of Nuclear Medicine, University of Duisburg-Essen and German Cancer Consortium (DKTK)-University Hospital Essen, Germany;
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Wolfgang P. Fendler
1 Department of Nuclear Medicine, University of Duisburg-Essen and German Cancer Consortium (DKTK)-University Hospital Essen, Germany;
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Abstract

Rationale: Hepatocellular carcinoma (HCC) is the sixth most prevalent cancer and the third most frequent cause of cancer-related death. A growing number of local and systemic therapies are available, and accurate staging is critical for management decisions. We assessed the impact of neovasculature imaging by 68Ga-Ga-PSMA-11 PET/CT on disease staging, prognostic groups and management of patients with HCC compared to staging with computed tomography (CT). Methods: Forty patients who received imaging with 68Ga-Ga-PSMA-11 PET/CT for HCC staging between September 2018 and September 2019 were retrospectively included. Management pre- and post-PET scan was assessed by standardized surveys. Presence of HCC was evaluated by three blinded readers on a per-patient and per-region basis for PET/CT (PET criteria) and multi-phase contrast-enhanced CT (CT criteria) in separate sessions. Lesions were validated by follow-up imaging or histopathology, and progression-free survival (PFS) was recorded. Endpoints were detection rate and positive predictive value (PPV) for 68Ga-Ga-PSMA-11 PET vs. CT, inter-reader reproducibility, and changes in stage, prognostic groups and management plans. Results: Median age was 65 years (range, 37-81), median Child-Pugh score was 5 (range, 5-9). Most patients were treatment naïve (27 of 40, 67.5%). The sensitivity of PET vs. CT to identify liver lesions for patients with lesion validation was 31/32 (97%) for both modalities, while it was 6/6 (100%) vs. 4/6 (67%) for extra-hepatic lesions. PET and CT each had a PPV of 100% at the liver level. PET vs. CT stage was congruent in 30/40 (75%) patients; upstaging was seen in 8/40 patients (20%), while 2/40 (5%) had downstaging by PET. Intended management changed in 19/40 patients (47.5%); 9/19 of these patients were found to have detectable distant metastases (47.4%) and assigned stage 4 disease, the majority of whom were shifted to systemic therapy (8 of 9, 89%). Two patients underwent 177Lu-Lu-PSMA-617 radioligand therapy. Median PFS was 5.2 months for the entire cohort; 5.3 months for PET M0, and 4.7 months for PET M1 patients, respectively. Conclusion: 68Ga-Ga-PSMA-11 PET demonstrated higher accuracy than CT in the detection of HCC metastases and was associated with management change in about half of the patient cohort.

  • Gastrointestinal
  • Hepatology
  • Oncology: Liver
  • PET/CT
  • Hepatocellular carcinoma
  • PET
  • PSMA
  • Staging
  • Theranostic
  • Copyright © 2021 by the Society of Nuclear Medicine and Molecular Imaging, Inc.

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Journal of Nuclear Medicine: 62 (3)
Journal of Nuclear Medicine
Vol. 62, Issue 3
March 1, 2021
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[68Ga]Ga-PSMA-11 PET/CT improves tumor detection and impacts management in patients with hepatocellular carcinoma (HCC)
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 of Nuclear Medicine Jan 2021, jnumed.120.257915; DOI: 10.2967/jnumed.120.257915

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[68Ga]Ga-PSMA-11 PET/CT improves tumor detection and impacts management in patients with hepatocellular carcinoma (HCC)
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 of Nuclear Medicine Jan 2021, jnumed.120.257915; DOI: 10.2967/jnumed.120.257915
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Keywords

  • Gastrointestinal
  • Hepatology
  • Oncology: Liver
  • PET/CT
  • Hepatocellular carcinoma
  • PET
  • PSMA
  • staging
  • Theranostic
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