Use of PERCIST for prediction of progression-free and overall survival after radioembolization for liver metastases from pancreatic cancer

We evaluated the prognostic accuracy of established PET response criteria in patients with liver metastases from pancreatic cancer after treatment with ⁹⁰Y microspheres. Methods: Seventeen patients underwent ¹⁸F-FDG PET/CT before and 3 mo after radioembolization for liver metastases from pancreatic cancer. Overall survival, progression-free survival, and time to intrahepatic progression were among other factors correlated with metabolic response as revealed by PERCIST 1.0-defined declining SUV_peak and total-lesion glycolysis. Results: Metabolic response by change in SUV_peak (7/17) and change in total-lesion glycolysis (7/17) was a predictor for overall survival (P = 0.039; hazard ratio [HR], 0.24; 95% confidence interval [CI], 0.06-0.93), progression-free survival (P = 0.016; HR, 0.15; 95% CI, 0.03-0.69), and time to intrahepatic progression (P = 0.010; HR, 0.16; 95% CI, 0.04-0.65). A summed baseline CT diameter of less than 8 cm for the 2 largest liver metastases predicted time to intrahepatic progression (P = 0.013; HR, 0.21; 95% CI, 0.06-0.72) but did not predict overall or progression-free survival. Patient outcome was not predicted by other parameters, including baseline SUV_peak, baseline total-lesion glycolysis, or change in serum level of carcinoembryonic antigen or carbohydrate antigen 19-9 from baseline to followup (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.