[ 68 Ga]Ga-Prostate-Specific Membrane Antigen PET/CT: a novel method for imaging patients with hepatocellular carcinoma
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ORIGINAL ARTICLE
[68 Ga]Ga-Prostate-Specific Membrane Antigen PET/CT: a novel method for imaging patients with hepatocellular carcinoma Jolanta Kunikowska 1 & Bartosz Cieślak 2 & Beata Gierej 3 & Waldemar Patkowski 4 & Leszek Kraj 5,6 & Marcin Kotulski 4 & Krzysztof Zieniewicz 4 & Leszek Królicki 1 Received: 17 May 2020 / Accepted: 27 August 2020 # The Author(s) 2020
Abstract Purpose Prostate-specific membrane antigen (PSMA) is not only highly expressed on the surface prostate cancer cells but is also elevated during angiogenesis in other cancer cell types, including hepatocellular carcinoma (HCC). This study aimed to evaluate the feasibility of using PET/CT imaging with [68Ga]Ga-PSMA-11 in HCC and its impact on patient management. Methods Fifteen patients (13 men and two women; aged 55.6 ± 18.2 years) with HCC were enrolled in this prospective, singleinstitution study. All patients underwent contrast-enhanced MRI/CT, [68Ga]Ga-PSMA-11 PET/CT, and histopathological verification of lesions. Results No radiopharmaceutical-related adverse events were noted. Visual interpretation showed increased accumulation of [68Ga]Ga-PSMA-11 in all HCC patients. The tumor-to-liver ratio (TLR) was 3.6 ± 2.1, and the maximal standardized uptake value (SUVmax) was 13.5 ± 7.1. There were no significant differences in the SUVs or TLR between newly diagnosed and recurrent patients. No statistically significant relationship was found between serum concentration of tumor markers (i.e., AFP, CA 19-9, CEA) and PET parameters. Results of the [68Ga]Ga-PSMA-11 PET/CT changed the treatment strategy in five (33%) patients. PSMA staining showed visible heterogeneity in terms of intensity and distribution: the reaction was weak and only observed in a few vessels in pseudoglandular patterns of HCC, while it was homogeneously strong, with some hot spots, in trabecular patterns of HCC. Conclusion [68Ga]Ga-PSMA-11 PET/CT can detect PSMA expression in vivo in patients with HCC and is useful for guiding treatment strategies. Further investigation of the clinical utility of this method in HCC is warranted. Keywords PSMA . HCC . [68Ga]Ga-PSMA-11 . Hepatocellular carcinoma
This article is part of the Topical Collection on Oncology - Digestive tract * Jolanta Kunikowska [email protected] 1
Nuclear Medicine Department, Medical University of Warsaw, ul. Banacha 1 a, 02-097 Warsaw, Poland
2
Department of General Surgery, John Paul II Specialist Hospital, Nowy Targ, Poland
3
Department of Pathology, Medical University of Warsaw, Warsaw, Poland
4
Department of General, Transplant, and Liver Surgery, Medical University of Warsaw, Warsaw, Poland
5
Department of Haematology, Oncology and Internal Medicine, Medical University of Warsaw, Warsaw, Poland
6
Laboratory of Neurogenomics, Institute of Genetics and Animal Breeding, Polish Academy of Sciences, Jastrzebiec, Poland
Introduction Hepatocellular carcinoma (HCC) is the most common type of primary liver malignancy, and the fourth leading cause of cancer-related deaths worldwide [1]. The dia
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