Relationship of 99mtechnetium labelled macroaggregated albumin (99mTc-MAA) uptake by colorectal liver metastases to response following Selective Internal Radiation Therapy (SIRT)

Abstract

Background: SIRT is an emerging treatment for liver tumours which relies on the selective uptake by tumour of 90Y microspheres following hepatic arterial injection. Response rates of around 90% are reported. Hepatic arterial injection of MAA gives an indication of the expected distribution of 90Y microspheres within the liver. This study sought to determine if the MAA scan could be predictive of subsequent tumour response.

Methods: 58 patients with colorectal hepatic metastases received SIRT. All had pre-treatment MAA planar images and CT scans which were retrospectively reviewed. Tumours were qualitatively considered "cold", "equivocal" or "hot" based on MAA uptake and the ratio of uptake in tumour and normal liver tissue was calculated (TNR). Following SIRT (which included the administration of hepatic arterial Angiotensin 2) tumour response was assessed by CEA changes one to two months after treatment and by serial CT.

Results: Uptake was classified as "hot" in 37 patients (Group 1) and "equivocal" or "cold" in 21 (Group 2). CEA levels fell dramatically in over 90% of patients. The falls were not significantly different between the groups. There was no correlation between TNR and tumour response based on CEA changes (r2 = 0.004). CT responses after 3 months were not different in the 2 Groups.

Conclusion: The pattern of MAA uptake by colorectal liver tumours after arterial injection is not a predictor of tumour response after treatment by SIRT. The results suggest the doses of 90Y microspheres used may be greater than is necessary.

Figure 1

Example showing scans of a patient with MAA uptake described as "hot".

Figure 2

Example showing scans of a patient with MAA uptake described as "equivocal".

Figure 3

Example showing scans of a patient with MAA uptake described as "cold".

Figure 4

Linear regression line showing no correlation between TNR uptake of MAA and tumour response as assessed by the CEA change after one or two months (whichever is the greater) after SIRT.

Figure 5

Kaplan-Meier survival curves for Group 1 patients ("hot" lesions) and Group 2 patients ("equivocal" or "cold" lesions). There is no statistical difference in cumulative survival by logrank test.