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Thématique :
- Foie
Originalité :
Intermédiaire
Solidité :
Intermédiaire
Doit faire évoluer notre pratique :
Dans certains cas
 
 
Nom du veilleur :
Docteur Jean-Louis PAYEN
Coup de coeur :
 
 
Journal of Hepatology
  2018/08  
 
  2018 Aug;69(2):336-344.  
  doi: 10.1016/j.jhep.2018.02.018.  
 
  Positron emission tomography/computed tomography with 18F-fluorocholine improve tumor staging and treatment allocation in patients with hepatocellular carcinoma  
 
  Chalaye J, Costentin CE, Luciani A, Amaddeo G, Ganne-Carrié N, Baranes L, Allaire M, Calderaro J, Azoulay D, Nahon P, Seror O, Mallat A, Soussan M, Duvoux C, Itti E, Nault JC  
  https://www.ncbi.nlm.nih.gov/pubmed/29518452  
 
 

Abstract
 

BACKGROUND & AIMS:

Hepatocellular carcinoma (HCC) staging according to the Barcelona Clinical Liver Cancer (BCLC) classification is based on conventional imaging. The aim of our study was to assess the impact of dual-tracer 18F-fluorocholine and 18F-fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) on tumor staging and treatment allocation.

METHODS:

A total of 192 dual-tracer PET/CT scans (18F-fluorocholine and 18F-fluorodeoxyglucose PET/CT) were performed in 177 patients with HCC. BCLC staging and treatment proposal were retrospectively collected based on conventional imaging, along with any new lesions detected, and changes in BCLC classification or treatment allocation based on dual-tracer PET/CT.

RESULTS:

Patients were primarily men (87.5%) with cirrhosis (71%) due to alcohol ± non-alcoholic steatohepatitis (26%), viral infection (62%) or unknown causes (12%). Among 122 patients with PET/CT performed for staging, BCLC stage based on conventional imaging was 0/A in 61 patients (50%), B in 32 patients (26%) and C in 29 patients (24%). Dual-tracer PET/CT detected new lesions in 26 patients (21%), upgraded BCLC staging in 14 (11%) and modified treatment strategy in 17 (14%). In addition, dual-tracer PET/CT modified the final treatment in 4/9 (44%) patients with unexplained elevation of alpha-fetoprotein (AFP), 10/25 patients (40%) with doubtful lesions on conventional imaging and 3/36 patients (8%) waiting for liver transplantation without active HCC after tumor response following bridging therapy.

CONCLUSION:

When used for HCC staging, dual-tracer PET/CT enabled BCLC upgrading and treatment modification in 11% and 14% of patients, respectively. Dual-tracer PET/CT might also be useful in specific situations (an unexplained rise in AFP, doubtful lesions or pre-transplant evaluation of patients without active HCC).

LAY SUMMARY:

Using a combination of tracers 18F-fluorocholine and 18F-fluorodeoxyglucose when performing positron emission tomography/computed tomography (PET/CT), often called a PET scan, helps to identify new tumor lesions in patients with hepatocellular carcinoma. This technique enabled staging modification of patients' tumors and led to changes in treatment allocation in certain patients.

 
Question posée
 
La tomographie par émission de positrons associée à la tomodensitométrie au 18F-fluorocholine (TEP/TDM) améliore la classification des tumeurs et modifie le choix du traitement chez les patients atteints d'un carcinome hépatocellulaire.
 
Question posée
 
La TEP/TDM a détecté de nouvelles lésions chez 26 patients (21%), amélioré la classification de Barcelone chez 14 patients (11%) et modifié la stratégie de traitement chez 17 patients (14%), a modifié le traitement final chez 4 patients sur 9 (44%) présentant une élévation inexpliquée de l’alpha-foetoprotéine (AFP), 10/25 patients (40%) présentant des lésions douteuses sur l’imagerie conventionnelle et 3 / 36 patients (8%) attente d’ une transplantation hépatique sans CHC actif après une réponse tumorale après un traitement de transition.
 
Commentaires

Cette technique d’imagérie semble séduisante, mais à confirmer par des études de confirmation.

 
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