FDG PET as a prognostic tool for treatment response in cholangiocarcinoma

Objectives: Explore the clinical utility of quantitative FDG-PET in assessing treatment response in cholangiocarcinoma

Methods: Cholangiocarcinoma is the most common biliary malignancy, affecting elderly adults with peak incidence in the 7th decade, and according to its location it is divided into intrahepatic and extrahepatic cholangiocarcinoma. The only treatment for CC is surgical resection, so early detection and diagnosis is crucial to ensure better prognosis and survival of patients. 18-F-FDG PET Imaging has been frequently used in diagnosis, follow-up and monitoring therapy of various malignancies owing to its functional capabilities in detecting the activity of tumors, lymph node involvement as well as distant metastasis, and anatomical capabilities of the hybrid PET/CT systems. We aim to evaluate the role of FDG PET as a prognostic tool for clinical outcomes for cholangiocarcinoma patients undergoing systemic or liver-directed therapy.

Results: Hybrid Imaging with PET/CT using FDG as the radioactive tracer provides important information about tumor metabolic activity, lymph node involvement and distant metastasis, so helping with proper staging of and better selection of patients for therapy types. Quantitative PET analysis is a technique that can aid in the selection, evaluation, and continued management of cholangiocarcinoma patients. We demonstrate a quantitative method for assessment of the global disease burden that incorporates all the malignant lesions using the adaptive thresholding algorithm of ROVER software (ABX GmbH, Radeberg, Germany).

Conclusions: Global assessment of disease burden using quantitative FDG-PET/CT is a promising imaging tool in cholangiocarcinoma patients with regards to treatment response. More studies need to confirm and validate such role.