Nahmias Claude, Hanna Wahid T, Wahl Lindi M, Long Misty J, Hubner Karl F, Townsend David W
Department of Medicine, University of Tennessee, Knoxville, TN 37920-6999, USA.
J Nucl Med. 2007 May;48(5):744-51. doi: 10.2967/jnumed.106.038513.
PET and (18)F-FDG have the potential to follow the early metabolic response to chemotherapy in patients with non-small cell lung cancer and to predict success or failure of the therapy.
We studied 16 patients with non-small cell lung cancer as they followed 2 courses of docetaxel and carboplatin. Each patient was studied weekly for 7 wk, and tissue activity was assessed by the amount of radioactivity retained 90 min after the intravenous injection of (18)F-FDG. In a prospective analysis, the linear least-squares method was used to evaluate the time course of metabolic activity in tumor and liver, bone marrow, and unaffected lung tissues; a metabolic response was defined as a response in which the slope of the regression was negative and significantly different from zero. Our hypothesis was that patients who exhibited a tumor metabolic response would survive longer than those who did not. In a retrospective examination of our data, we grouped our patients into those who survived <6 mo and those who survived longer and calculated the difference in the standardized uptake value (SUV) between day 7 and subsequent time points to determine the most appropriate timing of 2 PET studies in predicting response to therapy.
Fifteen of 16 patients completed the study. In the prospective study, 8 patients were classified as nonresponders as the slope of the regression of tumor SUV versus time was not different from zero; they all died within 35 wk of the end of their study. Seven patients were classified as responders; 5 survived and 2 died, one at 25 wk and the other at 76 wk. In the retrospective study, a decrease of 0.5 SUV between studies performed at 1 and 3 wk after the initiation of chemotherapy was predictive of those patients who survived >6 mo and in whom chemotherapy was presumably successful.
Patients with non-small cell lung cancer who had a positive outcome, as exhibited by prolonged survival, were those who showed a tumor metabolic response assessed using weekly (18)F-FDG PET studies. (18)F-FDG PET studies performed at 1 and 3 wk after the initiation of chemotherapy allowed prediction of the response to therapy.
正电子发射断层扫描（PET）及（18）F - 氟代脱氧葡萄糖（（18）F - FDG）有潜力追踪非小细胞肺癌患者对化疗的早期代谢反应，并预测治疗的成败。
我们研究了16例接受多西他赛和卡铂两个疗程治疗的非小细胞肺癌患者。每位患者每周接受研究，为期7周，通过静脉注射（18）F - FDG后90分钟保留的放射性量评估组织活性。在前瞻性分析中，采用线性最小二乘法评估肿瘤、肝脏、骨髓及未受影响肺组织中代谢活性的时间进程；代谢反应定义为回归斜率为负且显著异于零的反应。我们的假设是，表现出肿瘤代谢反应的患者比未表现出的患者存活时间更长。在对我们的数据进行回顾性检查时，我们将患者分为存活时间小于6个月的患者和存活时间更长的患者，并计算第7天与后续时间点之间标准化摄取值（SUV）的差异，以确定两次PET研究在预测治疗反应方面最合适的时间。
16例患者中有15例完成了研究。在前瞻性研究中，8例患者被归类为无反应者，因为肿瘤SUV与时间的回归斜率无异于零；他们均在研究结束后的35周内死亡。7例患者被归类为反应者；5例存活，2例死亡，1例在25周时死亡，另1例在76周时死亡。在回顾性研究中，化疗开始后第1周和第3周进行的研究之间SUV下降0.5可预测那些存活时间超过6个月且化疗可能成功的患者。
通过延长生存期表现出良好预后的非小细胞肺癌患者，是那些通过每周（18）F - FDG PET研究显示出肿瘤代谢反应的患者。化疗开始后第1周和第3周进行的（18）F - FDG PET研究可预测治疗反应。
