Interventional locoregional treatment and metabolic response: advantages of using PET/CT in the evaluation of response to treatment

Abstract

Introduction: Interventional oncology locoregional therapies are validated treatment modalities for primary and secondary tumors in liver, lung, kidney and bone. At this time, there is no accordance in the choice of imaging modality to assess treatment response. Morphological imaging and RECIST 1.1 criteria based on size variation are limited by several critical points. On the other hand the role of functional imaging, in particular by [18F]-fluorodeoxyglucose ([18F]-FDG) positron emission tomography (PET), in both staging and response evaluation of locoregional treatments remains unclear because of the heterogeneous nature of available data. The aim of this paper was to summarize the available literature illustrating the state of art of metabolic evaluation of response after locoregional therapies in the three major organs of interest: liver, lung and bone.

Evidence acquisition: Medline database was searched for relevant original paper evaluating the role of [18F]-FDG PET in interventional oncology treatment published up to June 2017 excluding case reports.

Evidence synthesis: Finally 41 studies papers evaluating the role of [18F]-FDG PET in both staging and in response evaluation of locoregional treatments focused on liver tumoral lesions (N.=29), on lung lesions (N.=10) and on bone lesions (N.=2) were considered for this review.

Conclusions: PET/CT appears to perform well in the assessment of response to interventional therapies compared to conventional imaging, not only in terms of response evaluation but also as a possible prognostic tool. Nevertheless further prospective, homogenous studies are required to confirm these data, in particular for lung and bone lesions.