Brücher B L, Weber W, Bauer M, Fink U, Avril N, Stein H J, Werner M, Zimmerman F, Siewert J R, Schwaiger M
Chirurgische Klinik und Poliklinik, Klinikum rechts der Isar der Technischen Universität, Munich, Germany.
Ann Surg. 2001 Mar;233(3):300-9. doi: 10.1097/00000658-200103000-00002.
To evaluate the use of positron emission tomography using [(18)F]-fluorodeoxyglucose (FDG-PET) to assess the response to neoadjuvant radiotherapy and chemotherapy in patients with locally advanced esophageal cancer.
Imaging modalities, including endoscopy, endoscopic ultrasound, computed tomography, and magnetic resonance imaging, currently used to evaluate response to neoadjuvant treatment in esophageal cancer do not reliably differentiate between responders and nonresponders.
Twenty-seven patients with histopathologically proven squamous cell carcinoma of the esophagus, located at or above the tracheal bifurcation, underwent neoadjuvant therapy consisting of external-beam radiotherapy and 5-fluorouracil as a continuous infusion. FDG-PET was performed before and 3 weeks after the end of radiotherapy and chemotherapy (before surgery). Quantitative measurements of tumor FDG uptake were correlated with histopathologic response and patient survival.
After neoadjuvant therapy, 24 patients underwent surgery. Histopathologic evaluation revealed less than 10% viable tumor cells in 13 patients (responders) and more than 10% viable tumor cells in 11 patients (nonresponders). In responders, FDG uptake decreased by 72% +/- 11%; in nonresponders, it decreased by only 42% +/- 22%. At a threshold of 52% decrease of FDG uptake compared with baseline, sensitivity to detect response was 100%, with a corresponding specificity of 55%. The positive and negative predictive values were 72% and 100%. Nonresponders to PET scanning had a significantly worse survival after resection than responders.
FDG-PET is a valuable tool for the noninvasive assessment of histopathologic tumor response after neoadjuvant radiotherapy and chemotherapy.
评估使用[（18）F] - 氟脱氧葡萄糖正电子发射断层扫描（FDG - PET）来评估局部晚期食管癌患者对新辅助放疗和化疗的反应。
目前用于评估食管癌新辅助治疗反应的成像方式，包括内镜检查、内镜超声、计算机断层扫描和磁共振成像，不能可靠地区分反应者和无反应者。
27例经组织病理学证实为食管鳞状细胞癌且位于气管分叉或其上方的患者接受了新辅助治疗，包括外照射放疗和持续输注5 - 氟尿嘧啶。在放疗和化疗结束前（手术前）及结束后3周进行FDG - PET检查。对肿瘤FDG摄取的定量测量与组织病理学反应和患者生存率相关。
新辅助治疗后，24例患者接受了手术。组织病理学评估显示，13例患者（反应者）存活肿瘤细胞少于10%，11例患者（无反应者）存活肿瘤细胞多于10%。反应者中，FDG摄取下降了72%±11%；无反应者中，仅下降了42%±22%。与基线相比，FDG摄取下降阈值为52%时，检测反应的敏感性为100%，相应的特异性为55%。阳性和阴性预测值分别为72%和100%。PET扫描无反应者切除术后的生存率明显低于反应者。
FDG - PET是一种用于无创评估新辅助放疗和化疗后肿瘤组织病理学反应的有价值工具。
