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3. The criteria used for selecting patients eligible for curative treatment after tumor downstaging should be the same as before tumor downstaging.

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4. 18F-FDG PET/CT should be obtained prior to SIRT when available to determine baseline function.

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References: SIRT with resin microspheres in non-Asian regions



Key Points

Kucuk et al. Prognostic importance of 18F-FDG uptake pattern of hepatocellular cancer patients who received SIRT. Clin Nucl Med. 2013 Jul;38(7):e283-9. doi: 10.1097/RLU.0b013e3182867f17


  • Retrospective single-center cohort study conducted in Turkey using resin microspheres
  • Analysis of 19 patients who underwent 18F-FDG PET/CT before SIRT treatment
  • Etiology not specified
  • Patterns of FDG uptake were significantly correlated with progression-free survival (PFS). Median PFS for patients with hypoactive liver tumors was 5.25 ± 1.52 months, 12.3 ± 2.6 months for patients with nonhomogeneous FDG uptake, and 19.8 ± 5.0 months for patients with focal intense uptake (P=0.017)
  • HCC patients with higher SUVmax lesions showed better PFS following SIRT treatment than patients with lower SUVmax lesions

Filippi et al. Decrease in total lesion glycolysis and survival after yttrium-90-radioembolization in poorly differentiated hepatocellular carcinoma with portal vein tumour thrombosis. Nucl Med Commun. 2018 Sep;39(9):845-852. doi: 10.1097/MNM.0000000000000879


  • Retrospective single-center cohort study conducted in Italy using resin microspheres
  • Study aim was to evaluate the change in total lesion glycolysis (TLG) as a prognostic indicator for survival outcomes in HCC patients with PVTT after SIRT treatment
  • Retrospective analysis of 21 patients (33.3% HBV, 71.4% HCV, 9.5% HBV+HCV) with poorly differentiated HCC and PVTT who underwent SIRT. 18F-FDG PET-CT scans were taken at baseline and 1 month after SIRT treatment to assess decrease in total lesion glycolysis (ΔTLG) after SIRT.
  • Mean overall survival was significantly longer for patients with ΔTLG > 50% (n=9) compared to patients with ΔTLG <50% (n= 12): 16.8 (95% CI  14.2-19.5) months and 7.5 (95% CI 6.5-8.6) months, respectively; p<0.001 [Table 3]
  • ΔTLG as assessed by 18F-FDG PET-CT scans may be a useful indicator for treatment response and outcomes in HCC patients with PVTT who undergo SIRT

Blanc-Durand et al. Signature of survival: a 18F-FDG PET based whole-liver radiomic analysis predicts survival after 90Y-TARE for hepatocellular carcinoma. Oncotarget. 2017;9(4):4549-4558. doi: 10.18632/oncotarget.23423


  • Retrospective single-center case series conducted in Switzerland using resin and glass microspheres
  • Patient characteristics included unilobar (n=24) diffuse (n=18); PVI (n=21); serum AFP 17 kUI/L; BCLC A (n=3), B (N=18), C (n=26), Ascites (n=7); Child Pugh A (n=36), B (n=8); hepatitis B, C (n=17, 36.2%)
  • Administered activity 1.6 GBq
  • Average tumor volume was 170 cm3 and absorbed dose was 170 Gy
  • 30 patients recurred at median 6.9 months; 33 died of progression
  • Two difference methods were used to calculate risk related to PFS and OS and microsphere type did not affect survival using either calculation method

Pretreatment 18F-FDG PET independently predicts poor PFS and OS in patients undergoing SIRT for unresectable HCC