Shintani Stephanie A, Foote Robert L, Lowe Val J, Brown Paul D, Garces Yolanda I, Kasperbauer Jan L
Department of Otolaryngology-Head and Neck Surgery, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA.
Int J Radiat Oncol Biol Phys. 2008 Feb 1;70(2):322-9. doi: 10.1016/j.ijrobp.2007.06.038. Epub 2007 Sep 24.
To evaluate the utility of positron emission tomography (PET)/computed tomography (CT) early after surgical resection and before postoperative adjuvant radiation therapy.
We studied a prospective cohort of 91 consecutive patients referred for postoperative adjuvant radiation therapy after complete surgical resection. Tumor histologies included 62 squamous cell and 29 non-squamous cell cancers. Median time between surgery and postoperative PET/CT was 28 days (range, 13-75 days). Findings suspicious for persistent/recurrent cancer or distant metastasis were biopsied. Correlation was made with changes in patient care.
Based on PET/CT findings, 24 patients (26.4%) underwent biopsy of suspicious sites. Three patients with suspicious findings did not undergo biopsy because the abnormalities were not easily accessible. Eleven (45.8%) biopsies were positive for cancer. Treatment was changed for 14 (15.4%) patients (11 positive biopsy and 3 nonbiopsied patients) as a result. Treatment changes included abandonment of radiation therapy and switching to palliative chemotherapy or hospice care (4), increasing the radiation therapy dose (6), extending the radiation therapy treatment volume and increasing the dose (1), additional surgery (2), and adding palliative chemotherapy to palliative radiation therapy (1). Treatment for recurrent cancer and primary skin cancer were significant predictors of having a biopsy-proven, treatment-changing positive PET/CT (p < 0.03).
Even with an expectedly high rate of false positive PET/CT scans in this early postoperative period, PET/CT changed patient management in a relatively large proportion of patients. PET/CT can be recommended in the postoperative, preradiation therapy setting with the understanding that treatment-altering PET/CT findings should be biopsied for confirmation.
评估正电子发射断层扫描（PET）/计算机断层扫描（CT）在手术切除后及术后辅助放疗前早期的应用价值。
我们研究了一组连续的91例患者，这些患者在手术完全切除后接受术后辅助放疗。肿瘤组织学类型包括62例鳞状细胞癌和29例非鳞状细胞癌。手术与术后PET/CT检查的中位时间为28天（范围13 - 75天）。对怀疑有持续性/复发性癌症或远处转移的部位进行活检。并与患者治疗的变化进行相关性分析。
根据PET/CT检查结果，24例患者（26.4%）对可疑部位进行了活检。3例有可疑发现的患者未进行活检，因为异常部位不易取材。11例（45.8%）活检结果为癌症阳性。14例（15.4%）患者（11例活检阳性和3例未活检患者）因此改变了治疗方案。治疗方案的改变包括放弃放疗并改为姑息化疗或临终关怀（4例）、增加放疗剂量（6例）、扩大放疗范围并增加剂量（1例）、额外手术（2例）以及在姑息性放疗基础上加用姑息化疗（1例）。复发性癌症和原发性皮肤癌的治疗是PET/CT检查结果经活检证实且改变治疗方案为阳性的显著预测因素（p < 0.03）。
即使在术后早期PET/CT扫描假阳性率预计较高的情况下，PET/CT仍在相当一部分患者中改变了治疗管理。在术后放疗前的情况下可以推荐使用PET/CT，但应理解改变治疗的PET/CT检查结果应进行活检以确诊。
