PET response criteria (PERCIST) predict progression-free survival and overall survival after radioembolization for liver metastases from pancreatic cancer

We evaluated the prognostic accuracy of established positron emission tomography (PET) response criteria in patients with liver metastases from pancreatic cancer (LMPAC) after treatment with ⁹⁰Y-Yttrium microspheres. Methods: 17 patients underwent ¹⁸F-2-fluoro-2-deoxy-D-glucose (¹⁸F-FDG) PET/CT before and three months after radioembolization for LMPAC. Overall survival (OS), progression-free survival (PFS), and time to intrahepatic progression (TTPliver) were among other factors correlated with metabolic response revealed by declining SUVpeak and total lesion glycolysis (TLG5), as defined by PET Response Criteria in Solid Tumors 1.0 (PERCIST). Results: Metabolic response by SUVpeak (n = 7/17) and TLG5 (n = 7/17) were predictors for OS (P = 0.039; HR 0.24, 95%CI 0.06-0.93), PFS (P = 0.016; HR 0.15, 95%CI 0.03-0.69) and TTPliver (P = 0.010; HR 0.16, 95%CI 0.04-0.65). A summed baseline CT diameter of the two largest liver metastases <8cm predicted TTPliver (P = 0.013; HR 0.21, 95%CI 0.06-0.72), but did not predict OS or PFS. Other parameters, including baseline SUVpeak, baseline TLG5, as well as baseline to follow-up change in the serum level of CEA or CA19-9, did not predict patient outcome (each p>0.05). Conclusion: Metabolic response by ¹⁸F-FDG PET/CT predicts overall survival, progression-free survival and time to intrahepatic progression after radioembolization for liver metastases from pancreatic cancer.

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