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Ingenerf, Maria; Kiesl, Sophia; Karim, Salma; Beyer, Leonie; Ilhan, Harun; Rübenthaler, Johannes; Seidensticker, Max; Ricke, Jens and Schmid-Tannwald, Christine (2021): Ga-68-DOTATATE PET/CT and MRI with Diffusion-Weighted Imaging (DWI) in Short- and Long-Term Assessment of Tumor Response of Neuroendocrine Liver Metastases (NELM) Following Transarterial Radioembolization (TARE). In: Cancers, Vol. 13, No. 17, 4321

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TARE with (90)Yttrium has become a valuable treatment option for patients with unresectable NELMs. However, early evaluation of therapy response remains challenging as size-based response assessments (such as RECIST) are known to be limited, especially in slow-growing tumors. Alternatives such as quantitative evaluation of SUV of Ga-68-DOTATATE PET/CT and ADC of DWI-MRI have not been compared so far. We found that early percentage changes in SUV tumor-to-organ ratios on first follow-up after TARE could predict longer HPFS in patients with NELM and were superior to Delta SUVmax/SUVmean alone or to Delta ADC. The aim of this study was to evaluate the role of SUV and ADC in assessing early response in patients with NELM following TARE. Thirty-two patients with pre- and postinterventional MRI with DWI and Ga-68-DOTATATE PET/CT were included. ADC and SUV of three target lesions and of tumor-free spleen and liver tissue were determined on baseline and first follow-up imaging, and tumor to spleen (T/S) and tumor to liver (T/L) ratios were calculated. Response was assessed by RECIST 1.1 and mRECIST on first follow-up, and long-term response was defined as hepatic progression-free survival (HPFS) over 6, 12, and <24 months. In responders, intralesional ADC values increased and SUV decreased significantly regardless of standard of reference for response assessment (mRECIST/RECIST/HPFS > 6/12/24 m). Using ROC analysis, Delta SUV T/S ratio (max/max) and Delta SUV T/L ratio (max/mean) were found to be the best and most robust metrics to correlate with longer HPFS and were superior to Delta ADC. Delta T/S ratio (max/max) < 23% was identified as an optimal cut-off to discriminate patients with longer HPFS (30.2 m vs. 13.4 m;p = 0.0002). In conclusion, early percentage changes in SUV tumor-to-organ ratios on first follow-up seem to represent a prognostic marker for longer HPFS and may help in assessing therapeutic strategies.

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