Weber W A, Ott K, Becker K, Dittler H J, Helmberger H, Avril N E, Meisetschläger G, Busch R, Siewert J R, Schwaiger M, Fink U
Departments of Nuclear Medicine, Surgery, Pathology, Radiology, and Medical Statistics, Technische Universität München, München, Germany.
J Clin Oncol. 2001 Jun 15;19(12):3058-65. doi: 10.1200/JCO.2001.19.12.3058.
Preoperative chemotherapy in patients with gastroesophageal cancer is hampered by the lack of reliable predictors of tumor response. This study evaluates whether positron emission tomography (PET) using fluorine-18 fluorodeoxyglucose (FDG) may predict response early in the course of therapy.
Forty consecutive patients with locally advanced adenocarcinomas of the esophagogastric junction were studied by FDG-PET at baseline and 14 days after initiation of cisplatin-based polychemotherapy. Clinical response (reduction of tumor length and wall thickness by > 50%) was evaluated after 3 months of therapy using endoscopy and standard imaging techniques. Patients with potentially resectable tumors underwent surgery, and tumor regression was assessed histopathologically.
The reduction of tumor FDG uptake (mean +/- 1 SD) after 14 days of therapy was significantly different between responding (-54% +/- 17%) and nonresponding tumors (-15% +/- 21%). Optimal differentiation was achieved by a cutoff value of 35% reduction of initial FDG uptake. Applying this cutoff value as a criterion for a metabolic response predicted clinical response with a sensitivity and specificity of 93% (14 of 15 patients) and 95% (21 of 22), respectively. Histopathologically complete or subtotal tumor regression was achieved in 53% (eight of 15) of the patients with a metabolic response but only in 5% (one of 22) of the patients without a metabolic response. Patients without a metabolic response were also characterized by significantly shorter time to progression/recurrence (P =.01) and shorter overall survival (P =.04).
PET imaging may differentiate responding and nonresponding tumors early in the course of therapy. By avoiding ineffective and potentially harmful treatment, this may markedly facilitate the use of preoperative therapy, especially in patients with potentially resectable tumors.
由于缺乏可靠的肿瘤反应预测指标，胃食管癌患者的术前化疗受到阻碍。本研究评估使用氟 - 18氟脱氧葡萄糖（FDG）的正电子发射断层扫描（PET）是否可在治疗过程早期预测反应。
连续40例食管胃交界部局部晚期腺癌患者在基线时以及基于顺铂的联合化疗开始14天后接受FDG - PET检查。治疗3个月后，使用内镜检查和标准成像技术评估临床反应（肿瘤长度和壁厚减少> 50%）。具有潜在可切除肿瘤的患者接受手术，并通过组织病理学评估肿瘤消退情况。
治疗14天后，反应性肿瘤（-54% ± 17%）与无反应性肿瘤（-15% ± 21%）的肿瘤FDG摄取减少情况有显著差异。初始FDG摄取减少35%的临界值可实现最佳区分。将此临界值作为代谢反应的标准预测临床反应，敏感性和特异性分别为93%（15例患者中的14例）和95%（22例患者中的21例）。有代谢反应的患者中53%（15例中的8例）实现了组织病理学完全或部分肿瘤消退，而无代谢反应的患者中只有5%（22例中的1例）。无代谢反应的患者还具有显著更短的进展/复发时间（P = 0.01）和更短的总生存期（P = 0.04）。
PET成像可在治疗过程早期区分反应性和无反应性肿瘤。通过避免无效和潜在有害的治疗，这可能显著促进术前治疗的应用，尤其是在具有潜在可切除肿瘤的患者中。
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