Weber Wolfgang A, Petersen Volker, Schmidt Burkhard, Tyndale-Hines Leishia, Link Thomas, Peschel Christian, Schwaiger Markus
Nuklearmedizinische Klinik, Klinikum Rechts der Isar, Ismaning Strabetae 22, 81675 München, Germany.
J Clin Oncol. 2003 Jul 15;21(14):2651-7. doi: 10.1200/JCO.2003.12.004.
To prospectively evaluate the use of positron emission tomography with the glucose analog fluorodeoxyglucose (FDG-PET) to predict response to chemotherapy in patients with advanced non-small-cell lung cancer (NSCLC).
Patients with stage IIIB or IV NSCLC scheduled to undergo platinum-based chemotherapy were eligible for this study. Patients were studied by FDG-PET before and after the first cycle of therapy. Based on previous studies, a reduction of tumor FDG uptake by more than 20% as assessed by standardized uptake values (SUV) was used as a criterion for a metabolic response. Furthermore, changes in tumor SUVs were compared with changes in FDG net-influx constants (Ki) and tumor/muscle ratios (t/m).
Fifty-seven patients were included in the study. There was a close correlation between metabolic response and best response to therapy according to Response Evaluation Criteria in Solid Tumors (P <.0001; sensitivity and specificity for prediction of best response, 95% and 74%, respectively). Median time to progression and overall survival were significantly longer for metabolic responders than for metabolic nonresponders (163 v 54 days and 252 days v 151 days, respectively). Similar results were obtained when Ki was used to assess tumor glucose use, whereas changes in t/m showed considerable overlap between responding and nonresponding tumors.
In NSCLC, reduction of metabolic activity after one cycle of chemotherapy is closely correlated with final outcome of therapy. Using metabolic response as an end point may shorten the duration of phase II studies evaluating new cytotoxic drugs and may decrease the morbidity and costs of therapy in nonresponding patients.
前瞻性评估使用葡萄糖类似物氟脱氧葡萄糖正电子发射断层扫描（FDG-PET）预测晚期非小细胞肺癌（NSCLC）患者化疗反应的情况。
计划接受铂类化疗的IIIB期或IV期NSCLC患者符合本研究条件。患者在首个化疗周期前后接受FDG-PET检查。根据既往研究，将标准化摄取值（SUV）评估的肿瘤FDG摄取减少超过20%作为代谢反应的标准。此外，比较肿瘤SUV的变化与FDG净流入常数（Ki）和肿瘤/肌肉比值（t/m）的变化。
57例患者纳入研究。根据实体瘤疗效评价标准，代谢反应与最佳治疗反应之间存在密切相关性（P<.0001；预测最佳反应的敏感性和特异性分别为95%和74%）。代谢反应者的中位进展时间和总生存期显著长于代谢无反应者（分别为163天对54天和252天对151天）。当使用Ki评估肿瘤葡萄糖利用情况时，得到了类似结果，而t/m的变化显示反应性肿瘤和无反应性肿瘤之间有相当大的重叠。
在NSCLC中, 化疗一个周期后代谢活性的降低与治疗的最终结果密切相关。将代谢反应作为终点可能会缩短评估新细胞毒性药物的II期研究持续时间，并可能降低无反应患者的治疗发病率和成本。
