de Geus-Oei Lioe-Fee, van der Heijden Henricus F M, Visser Eric P, Hermsen Rick, van Hoorn Bas A, Timmer-Bonte Johanna N H, Willemsen Antoon T, Pruim Jan, Corstens Frans H M, Krabbe Paul F M, Oyen Wim J G
Department of Nuclear Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
J Nucl Med. 2007 Oct;48(10):1592-8. doi: 10.2967/jnumed.107.043414. Epub 2007 Sep 14.
The aim of this prospective study was to evaluate the value of (18)F-FDG PET for the assessment of chemotherapy response in patients with non-small cell lung cancer. Furthermore, part of the objective of this study was to compare 2 methods to quantify changes in glucose metabolism.
In 51 patients, dynamic (18)F-FDG PET was performed before and at 5-8 wk into treatment. Simplified methods to measure glucose metabolism (standardized uptake value [SUV]) and quantitative measures (metabolic rate of glucose [MR(Glu)]), derived from Patlak analysis, were evaluated. The overall survival and progression-free survival with respect to MR(Glu) and SUV were calculated using Kaplan-Meier estimates. Fractional changes in tumor glucose use were stratified by the median value and also the predefined EORTC (European Organization for Research and Treatment of Cancer) metabolic response criteria, and criteria applying cutoff levels similar to those of RECIST (Response Evaluation Criteria in Solid Tumors) were evaluated.
When stratifying at the median value of DeltaMR(Glu) and DeltaSUV, the difference in overall survival (P = 0.017 for DeltaMR(Glu), P = 0.018 for DeltaSUV) and progression-free survival (P = 0.002 for DeltaMR(Glu), P = 0.0009 for DeltaSUV) was highly significant. When applying the predefined criteria for metabolic response, the cutoff levels as also used for size measurement (RECIST) showed significant differences for DeltaSUV between response categories in progression-free survival (P = 0.0003) as well as overall survival (P = 0.027).
The degree of chemotherapy-induced changes in tumor glucose metabolism as determined by (18)F-FDG PET is highly predictive for patient outcome, stratifying patients into groups with widely differing overall survival and progression-free survival probabilities. The use of (18)F-FDG PET for therapy monitoring seems clinically feasible, because simplified methods to measure tumor glucose use (SUV) are sufficiently reliable and can replace more complex, quantitative measures (MR(Glu)) in this patient population.
本前瞻性研究的目的是评估¹⁸F-FDG PET在评估非小细胞肺癌患者化疗反应中的价值。此外，本研究的部分目的是比较两种量化葡萄糖代谢变化的方法。
对51例患者在治疗前及治疗5 - 8周时进行动态¹⁸F-FDG PET检查。评估了测量葡萄糖代谢的简化方法（标准化摄取值[SUV]）和源自Patlak分析的定量测量方法（葡萄糖代谢率[MR(Glu)]）。使用Kaplan-Meier估计法计算了与MR(Glu)和SUV相关的总生存期和无进展生存期。肿瘤葡萄糖利用的分数变化按中位数以及预先定义的欧洲癌症研究与治疗组织（EORTC）代谢反应标准进行分层，并评估了应用与实体瘤疗效评价标准（RECIST）类似的截断水平的标准。
当按DeltaMR(Glu)和DeltaSUV的中位数进行分层时，总生存期（DeltaMR(Glu)为P = 0.017，DeltaSUV为P = 0.018）和无进展生存期（DeltaMR(Glu)为P = 0.002，DeltaSUV为P = 0.0009）的差异具有高度显著性。当应用预先定义的代谢反应标准时，用于大小测量（RECIST）的截断水平在无进展生存期（P = 0.0003）以及总生存期（P = 0.027）的反应类别之间显示出DeltaSUV的显著差异。
¹⁸F-FDG PET所确定的化疗诱导的肿瘤葡萄糖代谢变化程度对患者预后具有高度预测性，可将患者分为总生存期和无进展生存期概率差异很大的组。使用¹⁸F-FDG PET进行治疗监测在临床上似乎是可行的，因为测量肿瘤葡萄糖利用的简化方法（SUV）足够可靠，并且在该患者群体中可以替代更复杂的定量测量方法（MR(Glu)）。
