Kostakoglu Lale, Goldsmith Stanley J
Division of Nuclear Medicine, Department of Radiology, New York Presbyterian Hospital, Weill Medical College, Cornell University, New York, New York, USA.
J Nucl Med. 2004 Jan;45(1):56-68.
In patients with carcinoma of the head and neck and of the esophagus, metabolic and functional imaging by PET with (18)F-FDG has a pivotal role in the evaluation of tumor response to therapy, specifically, in the prediction of progression-free survival and overall survival. Metabolic imaging allows the detection of biochemical changes within tumor cells as opposed to identifiable morphologic changes. Anatomic imaging modalities do not reliably differentiate between responders and nonresponders early during the course of follow-up. The correlation between histopathologic tumor response after preoperative therapy and clinical prognosis is well established for many cancers. Squamous carcinoma of the head and neck and esophageal carcinoma demonstrate avid (18)F-FDG uptake. For these cancers, (18)F-FDG PET parallels histopathologic findings in its ability to detect residual viable tumor; therefore, it is a valuable tool for the noninvasive assessment of histopathologic tumor response in advanced-stage cases after neoadjuvant therapy before surgery. Early determination of nonresponders is of prime importance, as timely therapy modification can be accomplished for patients who do not demonstrate a response to therapy. This determination is exceptionally important for head and neck and esophageal malignancies, both of which are known for their unfavorable prognosis, as early modifications in therapy regimens for nonresponders may improve patient outcome. There is now evidence that (18)F-FDG PET is a sensitive and specific method for determining therapy response and for providing important prognostic information for these cancers. Therefore, (18)F-FDG PET may change patient management and lead to improved survival for a selected group of patients with carcinoma of the head and neck and of the esophagus.
对于头颈部癌和食管癌患者，采用（18）F-FDG的PET代谢和功能成像在评估肿瘤对治疗的反应中起着关键作用，特别是在预测无进展生存期和总生存期方面。代谢成像能够检测肿瘤细胞内的生化变化，这与可识别的形态学变化不同。在随访过程早期，解剖成像方式无法可靠地区分有反应者和无反应者。术前治疗后组织病理学肿瘤反应与临床预后之间的相关性在许多癌症中已得到充分证实。头颈部鳞状细胞癌和食管癌表现出对（18）F-FDG的高摄取。对于这些癌症，（18）F-FDG PET在检测残留存活肿瘤的能力方面与组织病理学结果相似；因此，它是术前新辅助治疗后晚期病例中对组织病理学肿瘤反应进行无创评估的有价值工具。早期确定无反应者至关重要，因为对于未显示出对治疗有反应的患者可以及时进行治疗调整。对于头颈部和食管恶性肿瘤来说，这种确定尤为重要，这两种癌症都以预后不良而闻名，因为对无反应者早期调整治疗方案可能改善患者预后。现在有证据表明，（18）F-FDG PET是确定治疗反应和为这些癌症提供重要预后信息的一种敏感且特异的方法。因此，（18）F-FDG PET可能会改变患者的治疗管理，并提高一部分头颈部癌和食管癌患者的生存率。
