Engenhart R, Kimmig B N, Strauss L G, Höver K H, Romahn J, Haberkorn U, van Kaick G, Wannenmacher M
University Clinic of Radiology, Department Radiotherapy, Heidelberg.
Strahlenther Onkol. 1992 Apr;168(4):203-12.
21 patients were followed by positron-emission-tomography (PET) FDG (18Flourdeoxyglucose) uptake, physical examination, CT and CEA levels after combined photon-neutron irradiation for inoperable recurrent rectal carcinoma. In order to evaluate the response to radiotherapy symptomatic relief, CEA levels, decrease of tumor volume measured by CT analysis were correlated with the FDG-uptake. The objective of this study was also to investigate if the level of FDG-uptake prior to radiotherapy or the early decrease after therapy can be used as a prognostic factor. Prior to radiotherapy sacral pain was the predominant symptom. All malignancies showed measurable tumor masses, evaluation of CEA levels and enhanced tracer accumulation of FDG in the PET cross section. The mean FDG-uptake before radiotherapy was 2.3 +/- 1.1 (range 1.1 to 5.0) in 21 patients in contrast to 1.9 +/- 0.7 (range 0.8 bis 4.0) three months after radiotherapy. In six patients FDG concentration values decreased to the range of normal soft tissue, moreover, two of them relapsed after six and 22 months. Elevated FDG-uptake of the sacral bone was noted in PET cross sections in two patients, while there was no evidence of osseous alterations in CT. Normal levels of CEA were achieved in 14 patients and complete or partial pain relief in 20 of 21 patients. A decrease of tumor volume of more than 50% was detected in the follow-up CT scans of three patients but no complete remission was found. The result suggests that enhanced glucose uptake is associated with recurrent rectal cancer. However, enhanced glycolytic activity is related not only to malignant cells but also to all proliferating cells. To distinguish between proliferation, repair, inflammation, and residual viable tumor cells is not possible and may be responsible for an unchanged or elevated FDG-uptake after radiotherapy.
对21例无法手术的复发性直肠癌患者进行光子-中子联合照射后，通过正电子发射断层扫描（PET）氟代脱氧葡萄糖（FDG）摄取、体格检查、CT及癌胚抗原（CEA）水平进行随访。为评估放疗反应、症状缓解情况，将CEA水平、CT分析测量的肿瘤体积减小与FDG摄取进行关联。本研究的目的还在于调查放疗前FDG摄取水平或治疗后早期下降是否可作为预后因素。放疗前骶骨疼痛是主要症状。所有恶性肿瘤均显示有可测量的肿瘤肿块，CEA水平评估及PET横断面中FDG示踪剂摄取增强。21例患者放疗前的平均FDG摄取为2.3±1.1（范围1.1至5.0），而放疗后3个月为1.9±0.7（范围0.8至4.0）。6例患者的FDG浓度值降至正常软组织范围，此外，其中2例分别在6个月和22个月后复发。2例患者的PET横断面显示骶骨FDG摄取升高，而CT未发现骨质改变迹象。14例患者CEA水平恢复正常，21例患者中有20例疼痛完全或部分缓解。3例患者的随访CT扫描显示肿瘤体积减小超过50%，但未发现完全缓解情况。结果表明，葡萄糖摄取增强与复发性直肠癌相关。然而，糖酵解活性增强不仅与恶性细胞有关，还与所有增殖细胞有关。区分增殖、修复、炎症和残留存活肿瘤细胞是不可能的，这可能是放疗后FDG摄取不变或升高的原因。
