18氟脱氧葡萄糖正电子发射断层扫描（18F-FDG-PET）在识别局部晚期食管癌放化疗反应者中的预测价值。
Predictive value of 18-fluoro-deoxy-glucose-positron emission tomography (18F-FDG-PET) in the identification of responders to chemoradiation therapy for the treatment of locally advanced esophageal cancer.
作者信息
Levine Edward A, Farmer Michael R, Clark Paige, Mishra Girish, Ho Coty, Geisinger Kim R, Melin Susan A, Lovato James, Oaks Tim, Blackstock A William
机构信息
Surgical Oncology Service and the Department of General Surgery, Comprehensive Cancer Center of Wake Forest University, Winston-Salem, NC 27157, USA.
出版信息
Ann Surg. 2006 Apr;243(4):472-8. doi: 10.1097/01.sla.0000208430.07050.61.
OBJECTIVE
To evaluate the utility of F-FDG-PET in predicting response to concomitant chemoradiation in locally-advanced esophageal cancer.
SUMMARY BACKGROUND DATA
Approximately 25% of esophageal cancer patients experience a pathologic complete response (pCR) to preoperative chemoradiation therapy. Computed tomography, endoscopy, and endoscopic ultrasound are unable to identify patients experiencing a pCR. Growing evidence supports the use of F-FDG-PET in the staging of esophageal cancer in its ability to detect occult metastatic and lymph nodal disease. The identification of patients with a pCR to chemoradiation could potentially spare those patients the morbidity associated with a resection.
METHODS
Eligibility criteria included T3-T4N0M0 or T1-T4N1M0 esophageal cancer. Patients underwent an initial F-FDG-PET before treatment and then repeated 4 to 6 weeks after chemoradiation, prior to the esophagectomy. Chemoradiation consisted of: cisplatinum, 5-fluorouracil, and radiation to a median dose of 50.4 Gy. Pathologic response was determined from a systematic review of the esophagectomy specimens.
RESULTS
Sixty-four patients have completed therapy to date. Response was as follows: pCR 27%, pathologic residual microscopic (pCRmicro) 14.5%, partial response 19%, and stable or progressive disease 39.5%. A pretreatment standardized uptake value (SUVmax1hour) > or = 15 was associated with an observed 77.8% significant response (pCR + pCRmicro) compared with 24.2% for patients with a pretreatment SUVmax1hour < 15 (P = 0.005). Significant response was observed in 71.4% of patients with a decrease in SUVmax1hour > or = 10 compared with 33.3% when the SUVmax1hour decreased <10 (P = 0.004).
CONCLUSIONS
Pretreatment and posttreatment F-FDG-PET can be useful for predicting significant response to chemoradiation in esophageal cancer. These data should be considered in evaluation of patients for esophagectomy after chemoradiation.
目的
评估F-FDG-PET在预测局部晚期食管癌同步放化疗疗效方面的作用。
总结背景数据
约25%的食管癌患者对术前放化疗有病理完全缓解（pCR）。计算机断层扫描、内镜检查和内镜超声无法识别出有pCR的患者。越来越多的证据支持使用F-FDG-PET进行食管癌分期，因为它能够检测隐匿性转移和淋巴结疾病。识别出对放化疗有pCR的患者可能会使这些患者避免与手术切除相关的并发症。
方法
纳入标准包括T3-T4N0M0或T1-T4N1M0食管癌患者。患者在治疗前接受首次F-FDG-PET检查，然后在放化疗后4至6周、食管切除术前行重复检查。放化疗方案包括：顺铂、5-氟尿嘧啶，中位放疗剂量为50.4 Gy。通过对食管切除标本的系统检查确定病理反应。
结果
迄今为止，64例患者已完成治疗。反应情况如下：pCR 27%，病理残留微小（pCRmicro）14.5%，部分缓解19%，疾病稳定或进展39.5%。治疗前标准化摄取值（SUVmax1小时）≥15与观察到的77.8%显著反应（pCR + pCRmicro）相关，而治疗前SUVmax1小时<15的患者为24.2%（P =
0.005）。SUVmax1小时下降≥10的患者中71.4%观察到显著反应，而SUVmax1小时下降<10时为33.3%（P = 0.004）。
结论
治疗前和治疗后F-FDG-PET可用于预测食管癌放化疗的显著反应。在评估放化疗后行食管切除术的患者时应考虑这些数据。
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