LiverCandidateValue of 18-FDG-Positron Emission Tomography/Computed Tomography Before and After Transarterial Chemoembolization in Patients With Hepatocellular Carcinoma Undergoing Liver Transplantation: Initial Results
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Patients and Methods
From January 2007 through December 2009, 39 patients with HCC and liver cirrhosis were included in our liver transplantation program. All patients who were enrolled for OLT met the Milan criteria, namely, a single tumor ≤5 cm or no more than 3 nodules with the greatest not exceeding 3 cm. Before OLT TACE was used to treat HCC in 21 candidates. TACE procedures were performed with tumor embolization using drug-eluting beads containing adriamycin after arteriography identified the major arterial
Results
Six patients who underwent an 18-FDG PET/CT before and after TACE included 3 with hepatitis C virus (HCV)-related cirrhosis, one of them with HCV and alcohol 2 with alcoholic cirrhosis, 1 with hepatitis B virus (HBV)-related cirrhosis. The median patient age was 64 years (range, 34–72), with a median time on the waiting list for OLT of 113 days (range, 60–123). All patients underwent a single TACE procedure with drug-eluting beads (adiramycin). The PET data reporting percentage of tumor
Discussion
HCC is now the leading cause of death among patients with liver cirrhosis. The diagnosis should be established in the early stages of the disease, while curative therapies are still possible. Programs for early detection of HCC among cirrhotic patients include alpha-fetoprotein (AFP) levels and regular monitoring of ultrasounds. Currently the best therapeutic option for cirrhotic patients is OLT. However, the increase in patients on the waiting list has led to strategies to minimize the impact
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2019, PET ClinicsCitation Excerpt :Regarding quantitative analysis, an SUV reduction after TACE (SUV <3 or <3.5) compared with untreated tumors was shown to correlate with greater than 70%–80% tumor necrosis, indicating a positive clinical outcome.57 In addition, decreased FDG uptake after TACE was an independent predictor of long-term survival after liver transplantation in patients with HCC.58,59 Among others, Song and colleagues evaluated 18F-FDG PET/CT as a prognostic marker before TACE and for early response prediction after treatment.
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