Avril Norbert, Sassen Stefanie, Schmalfeldt Barbara, Naehrig Joerg, Rutke Stephan, Weber Wolfgang A, Werner Martin, Graeff Henner, Schwaiger Markus, Kuhn Walther
University of Pittsburgh Medical Center, Division of Nuclear Medicine, 200 Lothrop St, Pittsburgh, PA, 15213, USA.
J Clin Oncol. 2005 Oct 20;23(30):7445-53. doi: 10.1200/JCO.2005.06.965. Epub 2005 Sep 12.
The aim of this study was to evaluate sequential F-18-fluorodeoxyglucose positron emission tomography (FDG-PET) to predict patient outcome after the first and third cycle of neoadjuvant chemotherapy in advanced-stage (International Federation of Gynecology and Obstetrics stages IIIC and IV) ovarian cancer.
Thirty-three patients received three cycles of carboplatin-based chemotherapy, followed by cytoreductive surgery. Quantitative FDG-PET of the abdomen and pelvis was acquired before treatment and after the first and third cycle of chemotherapy. Changes in tumoral FDG uptake, expressed as standardized uptake values (SUV), were compared with clinical and histopathologic response; overall survival served as a reference.
A significant correlation was observed between FDG-PET metabolic response after the first (P = .008) and third (P = .005) cycle of chemotherapy and overall survival. By using a threshold for decrease in SUV from baseline of 20% after the first cycle, median overall survival was 38.3 months in metabolic responders compared with 23.1 months in metabolic nonresponders. At a threshold of 55% decrease in SUV after the third cycle median overall survival was 38.9 months in metabolic responders compared with 19.7 months in nonresponders. There was no correlation between clinical response criteria (P = .7) or CA125 response criteria (P = .5) and overall survival. There was only a weak correlation (P = .09) between histopathologic response criteria and overall survival.
Sequential FDG-PET predicted patient outcome as early as after the first cycle of neoadjuvant chemotherapy and was more accurate than clinical or histopathologic response criteria including changes in tumor marker CA125. FDG-PET appears to be a promising tool for early prediction of response to chemotherapy.
本研究旨在评估序贯F-18-氟脱氧葡萄糖正电子发射断层扫描（FDG-PET）在晚期（国际妇产科联盟IIIC和IV期）卵巢癌新辅助化疗第一周期和第三周期后预测患者预后的情况。
33例患者接受了三个周期的以卡铂为基础的化疗，随后进行减瘤手术。在治疗前以及化疗第一周期和第三周期后获取腹部和盆腔的定量FDG-PET图像。将肿瘤FDG摄取的变化（以标准化摄取值（SUV）表示）与临床和组织病理学反应进行比较；总生存作为参考。
在化疗第一周期（P = 0.008）和第三周期（P = 0.005）后，FDG-PET代谢反应与总生存之间观察到显著相关性。以第一周期后SUV较基线下降20%为阈值，代谢反应者的中位总生存为38.3个月，而代谢无反应者为23.1个月。以第三周期后SUV下降55%为阈值，代谢反应者的中位总生存为38.9个月，无反应者为19.7个月。临床反应标准（P = 0.7）或CA125反应标准（P = 0.5）与总生存之间无相关性。组织病理学反应标准与总生存之间仅有微弱相关性（P = 0.09）。
序贯FDG-PET早在新辅助化疗第一周期后就能预测患者预后，并且比包括肿瘤标志物CA125变化在内的临床或组织病理学反应标准更准确。FDG-PET似乎是早期预测化疗反应的一个有前景的工具。
