PET/CT with (18)F-choline or (18)F-FDG in Hepatocellular Carcinoma Submitted to (90)Y-TARE: A Real-World Study

Our aim was to assess the role of positron emission computed tomography (PET/CT) with (18)F-choline ((18)F-FCH) or (18)F-fluorodeoxyglucose ((18)F-FDG) in hepatocellular carcinoma (HCC) submitted to (90)Y-radioembolization ((90)Y-TARE). We retrospectively analyzed clinical records of 21 HCC patients submitted to PET/CT with (18)F-fluorocholine ((18)F-FCH) or (18)F-fluodeoxyglucose ((18)F-FDG) before and 8 weeks after (90)Y-TARE. On pre-treatment PET/CT, 13 subjects (61.9%) were (18)F-FCH-positive, while 8 (38.1%) resulted (18)F-FCH-negative and (18)F-FDG-positive. At 8-weeks post (90)Y-TARE PET/CT, 13 subjects showed partial metabolic response and 8 resulted non-responders, with a higher response rate among (18)F-FCH-positive with respect to (18)F-FDG-positive patients (i.e., 76.9% vs. 37.5%, p = 0.46). Post-treatment PET/CT influenced patients’ clinical management in 10 cases (47.6%); in 8 subjects it provided indication for a second (90)Y-TARE targeting metabolically active HCC remnant, while in 2 patients it led to a PET-guided radiotherapy on metastatic nodes. By Kaplan–Meier analysis, patients’ age (≤69 y) and post (90)Y-TARE PET/CT’s impact on clinical management significantly correlated with overall survival (OS). In Cox multivariate analysis, PET/CT’s impact on clinical management remained the only predictor of patients’ OS (p < 0.001). In our real-world study, PET/CT with (18)F-FCH or (18)F-FDG influenced clinical management and affected the final outcome for HCC patients treated with (90)Y-TARE.