Ghrelin's second life - World Journal of Gastroenterology

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Online Submissions: http://www.wjgnet.com/1007-9327office wjg@wjgnet.com doi:10.3748/wjg.v18.i25.3215 Predictive value of 18 F-fluorodeoxyglucose PET/CT for transarterial chemolipiodolization of hepatocellular carcinoma Myeong Jun Song, Si Hyun Bae, Ie Ryung Yoo, Chung-Hwa Park, Jeong Won Jang, Ho Jong Chun, Byung Gil Choi, Hae Giu Lee, Jong Young Choi, Seung Kew Yoon Myeong Jun Song, Si Hyun Bae, Chung-Hwa Park, Jeong Won Jang, Jong Young Choi, Seung Kew Yoon, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul 137-040, South Korea Ie Ryung Yoo, Department of Nuclear, Medicine College of Medicine, The Catholic University of Korea, Seoul 137-040, South Korea Ho Jong Chun, Byung Gil Choi, Hae Giu Lee, Department of Radiology, College of Medicine, The Catholic University of Korea, Seoul 137-040, South Korea Author contributions: Song MJ, Bae SH, Choi JY and Yoon SK designed the study and performed the data analysis; Yoo IR collected the data; Park CH, Jang JW wrote the manuscript; and Chun HJ, Choi BG, Lee HG contributed the treatment response clinical data. Supported by National R and D Program grant for cancer control, Ministry of Health, Welfare and Family Affairs, South Korea, No. R0620390-1 Correspondence to: Si Hyun Bae, Professor, MD, PhD, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, No. 505 Banpodong, Seochogu, Seoul 137-040, South Korea. baesh@catholic.ac.kr Telephone: +82-2-22582073 Fax: +82-2-34814025 Received: November 26, 2011 Revised: April 27, 2012 Accepted: May 26, 2012 Published online: July 7, 2012 Abstract AIM: To investigate the correlation of 18 F-fluorodeoxyglucose ( 18 F-FDG) positron emission tomography (PET) with clinical features and the prediction of treatment response. METHODS: A total of 83 hepatocellular carcinoma (HCC) patients undergoing 18 F-FDG PET before transarterial chemolipiodolization with systemic chemo-infusion between October, 2006 and May, 2009 were retrospec- WJG|www.wjgnet.com World J Gastroenterol 2012 July 7; 18(25): 3215-3222 ISSN 1007-9327 (print) ISSN 2219-2840 (online) © 2012 Baishideng. All rights reserved. tively enrolled. The patients included 68 men and 15 women (mean age, 60 ± 10.7 years). The effect of 18 F- FDG-monitored PET uptake on clinical features and on the evaluated treatment response was ascertained with modified Response Evaluation Criteria in Solid Tumors. The PET parameters of maximal standardized uptake value of the tumor (Tsuvmax), the ratio of the tumor maximal standardized uptake value (SUV) to the liver maximal SUV (Tsuvmax/Lsuvmax) and the ratio of tumor maximal SUV to the liver mean SUV (Tsuvmax/Lsuvmean) were tested as predictive factors. RESULTS: Among the 3 SUV parameters, the Tsuvmax/Lsuvmean ratio (cutoff value of 1.90) was significantly associated with tumor burden including tumor size, tumor number, α-fetoprotein levels and tumor stage (P < 0.001, P = 0.008, P = 0.011, P < 0.001, respectively). The objective response rates in patients with a high SUV ratio (≥ 1.90) were significantly better than those with a low SUV ratio (< 1.90) (P = 0.020). The overall survival rates of patients exhibiting a low Tsuvmax/Lsuvmean ratio (< 1.90) and those with a high SUV ratio (≥ 1.90) was 38.2 and 10.3 mo, respectively (P < 0.01). However, the time to progression showed no significant difference between the groups (P = 0.15). CONCLUSION: 18 F-FDG PET can be an important predictor of HCC treatment. In particular, the Tsuvmax/ Lsuvmean ratio (cutoff value of 1.90) can provide useful information in treatment prognosis for HCC patients treated with locoregional therapy. © 2012 Baishideng. All rights reserved. ORIGINAL ARTICLE Key words: 18 F-fluorodeoxyglucose positron emission tomography; Transarterial chemolipiodolization with systemic chemo-infusion; Treatment response; Predictive factor; Overall survival 3215 July 7, 2012|Volume 18|Issue 25|
Song MJ et al . Usefulness of PET/CT Peer reviewers: Dr. Nagy Naguib Naeem Naguib, Institute for Diagnostic, Johann Wolfgang Goethe University Hospital, Theodor Stern Kai 7 Haus 23, 60590 Frankfurt, Germany; Dr. Avinash Kambadakone R, Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, White 270, Boston, MA 02114, United States Song MJ, Bae SH, Yoo IR, Park CH, Jang JW, Chun HJ, Choi BG, Lee HG, Choi JY, Yoon SK. Predictive value of 18 Ffluorodeoxyglucose PET/CT for transarterial chemolipiodolization of hepatocellular carcinoma. World J Gastroenterol 2012; 18(25): 3215-3222 Available from: URL: http://www.wjgnet. com/1007-9327/full/v18/i25/3215.htm DOI: http://dx.doi. org/10.3748/wjg.v18.i25.3215 INTRODUCTION Hepatocellular carcinoma (HCC) is the fifth most common malignancy, with an increasing incidence worldwide [1] , and the third most common cause of cancer related death [2] . Surveillance programs have been implemented for cirrhotic patients. However, curative therapies such as resection or transplantation can be applied to fewer than 30% of HCC patients [3] , because most are diagnosed at an intermediate-to-advanced stage of the disease. The prognosis of HCC patients remains poor, and life expectancy is difficult to predict because of variable factors that include tumor burden and liver reserve function [4] . Thus, it is important to assess the aggressive nature and metabolic change in HCC because this information is valuable in predicting the treatment response and in aiding in the selection of treatment modalities. One approach used to assess the biological activity of a tumor is positron emission tomography (PET). 18 F-fluorodeoxyglucose (FDG) PET is an imaging modality that can gauge the glucose metabolism of tumors, which has been established as a useful diagnostic tool for evaluating extrahepatic metastasis [5] . However, 18 F-FDG PET has limitations in its ability to detect primary HCC because of variable F-FDG uptake in HCC [6] . Nonetheless, PET monitored FDG uptake has the potential to be an additional tool for assessing biological behavior in HCC [7,8] . The difference in uptake between a tumor and the liver can be expressed as a standardized uptake value (SUV) ratio (T/Lsuv), which is associated with prognostic aspects of tumor aggressiveness such as differentiation grade, tumor size/number and tumor recurrence in liver transplantation [8] . It is feasible that FDG uptake, similar to tumor size/number and vascular invasion, may be of value in the prognosis of the treatment response in HCC [9,10] . However, the usefulness of 18 F-FDG PET has not been investigated in the prediction of treatment response for HCC by transarterial chemolipiodolization (TACL) with systemic chemo-infusion. The present study was undertaken to evaluate whether FDG uptake in HCC correlated with tumor characteristics and to determine, which PET/computed tomography (CT) parameter is especially important as a WJG|www.wjgnet.com predictor of treatment response. Finally, the probability of prognostic ability of 18 F-FDG PET for the prediction of treatment response in HCC was assessed. MATERIALS AND METHODS Patients A total of 83 HCC patients, who were aged > 18 years were retrospectively selected and analyzed. Patients included 68 men and 15 women (mean age, 60 ± 10.7 years). All patients had undergone 18 F-FDG PET within 3 d before treatment between October, 2006 and May, 2009. The median duration of follow-up was 10.3 mo (range, 1.8-35.7 mo). The eligibility criteria were as follows: no previous transarterial chemo embolization, chemotherapy or radiotherapy; a confirmed diagnosis of HCC according to the American Association for the Study of Liver Disease criteria; an Eastern Cooperative Oncology Group performance status of 0 or 1; and preserved liver function (Child-Pugh class A or B). Patients with potentially resectable or ablative lesions who were high risk for surgery and radiofrequency ablation were also enrolled. Exclusion criteria included any extrahepatic metastasis, another primary tumor, advanced liver disease (bilirubin levels > 3 mg/dL, and a level of aspartate aminotransferase (AST) or alanine transaminase (ALT) > 5 × the upper limit of normal). The study was approved by the institutional Ethics Review Board and was in compliance with the Declaration of Helsinki. Treatment methods The treatment regimen was a combination of intraarterial epirubicin (50 mg/m 2 ) and/or cisplatin (60 mg/ m 2 ) in a mixture of lipiodol (5-10 mL) without gelform embolization, and received an additional systemic infusion of 5-fluorouracil (200 mg/m 2 ) after completing the transarterial chemolipiodolization [11,12] . The dose or treatment interval was modified whenever any treatmentrelated toxicity was encountered. Based on our previous report, the following formula for dosage modification was derived: administration dosage = D × body surface area (BSA) × M where D is initial dosage of each agent, BSA is body surface area, and M is the modification rate = (white blood cell count/4000) × [1-(age-45)/100] × [1-(Child-Pugh score-5)/10]. According to this formula, the administration dosage of each chemotherapeutic agent was modified. Only the Child-Pugh score was calculated using this formula if the patient’s white blood cell count was > 4000/mm 3 or the patient’s age was < 45 years [13] . Follow-up imaging and laboratory tests including α-fetoprotein, albumin, bilirubin, AST, ALT and prothrombin time, were performed 4 wk after treatment. Repeat treatment was scheduled within 4 wk after followup imaging if there was residual viable tumor. All CTs were performed with a 64-slice multidetector CT (Siemen Somatom Sensation 64, Munich, Germany). CT examination was performed using a 4-phase protocol 3216 July 7, 2012|Volume 18|Issue 25|
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Page 3 and 4: Phillip S Oates, Perth Ross C Smith
Page 5 and 6: Deepak N Amarapurkar, Mumbai Abhiji
Page 7 and 8: Trine Olsen, Tromsø Eyvind J Pauls
Page 9 and 10: Conor P Delaney, Cleveland Sharon D
Page 11 and 12: S Contents EDITORIAL TOPIC HIGHLIGH
Page 13 and 14: Contents ACKNOWLEDGMENTS APPENDIX A
Page 15 and 16: Verhulst PJ et al . Ghrelin and glu
Page 27: Online Submissions: http://www.wjgn
Page 31: Ishikawa T. Zinc during interferon
Page 35 and 36: Sitarz R et al . Gastroenterostoma
Page 37 and 38: Sitarz R et al . Gastroenterostoma
Page 39 and 40: Morais TC et al . Gastrointestinal
Page 45: Morais TC et al . Gastrointestinal
Page 49 and 50: A Sensitivity B Sensitivity C Sensi
Page 51 and 52: Song MJ et al . Usefulness of PET/C
Page 53 and 54: Song MJ et al . Usefulness of PET/C
Page 55 and 56: Bae GS et al . Anti-inflammatory ef
Page 59 and 60: B Myeloperoxidase activity (U/mg pr
Page 61 and 62: A Time (h) - 1 3 6 NJ4 B Relative H
Page 63 and 64: A C Time (h) - 1 3 6 NJ4-2 B Relati
Page 70 and 71: A Collagen staining (fold change) C
Page 72 and 73: CCl4/YGJ CCl4-13 wk CCl4-7 wk Contr
Page 74 and 75: CCl4/YGJ CCl4-13 wk CCl4-7 wk Contr
Page 76 and 77: liver and have potent proliferative
Page 78 and 79: A 8 wk 9 wk 10 wk 13 wk CCl4/YGJ CC
Page 80 and 81: Cheng JC. A Chinese Herbal Decoctio
Page 82 and 83: Singh R, Neo EN, Nordeen N, Shanmug
Page 84 and 85: etter patient tolerance with regard
Page 86: Key words: Intestinal alkaline phos
Page 89 and 90: Molnár K et al . iAP in pediatric
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Chung WC et al . Ulcer after gastre
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Yang HY et al . Early resection of
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indicate a later timing for radical
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Zhao WC, Zhang HB, Yang N, Fu Y, Qi
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level, or rapid enlargement of lesi
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Table 3 Area under the receiver ope
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Zhao WC et al . Prognostic factors
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Online Submissions: http://www.wjgn
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mV 0 2 4 6 8 cpm FD patients are sh
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COMMENTS Background Gastric motilit
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thirds partial hepatectomy (PH) in
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A Serum ALT (U/L) C Serum alkaline
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REFERENCES 1 Schibler U. Circadian
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positive patients were found to hav
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21 Tosolini M, Kirilovsky A, Mlecni
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Diao TJ et al . NO and hepatopulmon
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Gallegos M et al . Lymphogranuloma
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Gallegos M et al . Lymphogranuloma
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A Hadžić N et al . Diagnosis in B
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Hadžić N et al . Diagnosis in BAA
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A B Chung HJ et al . Choledocholith
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Chung HJ et al . Choledocholithiasi
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Instructions to authors ISSN and EI
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Instructions to authors AIM (no mor
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Instructions to authors Guidelines
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