Trial Lecture – time and place
See Trial Lecture.
Adjudication committee
- First opponent: Associate Professor Rune Sundset, PET Imaging Center, University Hospital of North Norway
- Second opponent: Docent Per Lindnér, University of Gothenburg and Sahlgrenska University Hospital, Sweden
- Third member and chair of the evaluation committee: Associate Professor Anne Negård, Faculty of Medicine, University of Oslo
Chair of the Defence
Associate Professor Olav Engebråten, Faculty of Medicine, University of Oslo
Principal Supervisor
Senior Consultant Svein Dueland, Oslo University Hospital
Summary
In this thesis patients who underwent liver transplantation (LT) for unresectable colorectal liver metastases were studied (SECA study).
Lifelong immunosuppression following LT is necessary to prevent organ rejection and the general perception is that this treatment can increase growth of malignant tumors.
About 2/3 of the SECA patients developed pulmonary metastases and most metastases were available for surgical resection. Based on volume and diameter measurements from chest computed tomography (CT), tumor volume doubling time was calculated for all resected pulmonary metastases. The first paper shows that the growth of resected pulmonary metastases developed after LT was not accelerated despite the immunosuppression and survival following pulmonary resection was good.
Most malignant tumors use more glucose than normal tissue. In FDG PET/CT radioactive labeled glucose is utilized to make images of the glucose metabolism of the body. All patients considered for inclusion to the SECA study underwent an FDG PET/CT to exclude patients with extrahepatic metastases.
The second paper shows that low values of metabolic tumor volume and total lesion glycolysis of the liver metastases derived from the FDG PET/CT performed prior to LT, were significantly correlated to improved survival at 3- and 5-years and disease-free survival after LT and can potentially improve patient selection.
Many patients were excluded from the SECA study, mainly due to detected extrahepatic disease on the preoperative contrast enhanced computed tomography (ceCT) and/or FDG PET/CT. Results from the last paper show that FDG PET/CT revealed excluding findings in many patients not detected on the ceCT, underlining the importance of FDG PET/CT to detect extrahepatic disease to prevent patients with poor expected survival to undergo LT.
Additional information
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