Le Quynh-Thu, Koong Albert, Lieskovsky Yee Yie, Narasimhan Balasubramanian, Graves Edward, Pinto Harlan, Brown J Martin, Spielman Daniel
Department of Radiation Oncology, Stanford University Medical Center, Stanford, CA 94305-5847, USA.
Int J Radiat Oncol Biol Phys. 2008 Jul 15;71(4):1151-7. doi: 10.1016/j.ijrobp.2007.11.030. Epub 2008 Feb 6.
To investigate in vivo(1)H magnetic resonance spectroscopy imaging of lactate for assessing tumor hypoxia in head and neck cancers and to determine its utility in predicting the response and outcomes.
Volume-localized lactate-edited (1)H magnetic resonance spectroscopy at 1.5 T was performed in vivo on involved neck nodes and control subcutaneous tissues in 36 patients with Stage IV head and neck cancer. The signal intensities (SIs) of lactate, choline, and creatine and the choline/creatine ratio were measured. The tumor partial pressure of oxygen (pO(2)) was obtained in the same lymph node before MRS. Patients were treated with either two cycles of induction chemotherapy (tirapazamine, cisplatin, 5-fluorouracil) followed by simultaneous chemoradiotherapy or the same regimen without tirapazamine. The lactate SI and the choline/creatine ratio correlated with the tumor pO(2), nodal response, and locoregional control.
The lactate SI was greater for the involved nodes (median, 0.25) than for the subcutaneous tissue (median, 0.04; p = 0.07). No significant correlation was found between the lactate SI and tumor pO(2) (mean, 0.46 +/- 0.10 for hypoxic nodes [pO(2) < or =10 mm Hg, n = 15] vs. 0.36 +/- 0.07 for nonhypoxic nodes [pO(2) >10 mm Hg, n = 21], p = 0.44). A significant correlation was found between the choline/creatine ratios and tumor pO(2) (mean, 2.74 +/- 0.34 for hypoxic nodes vs. 1.78 +/- 0.31 for nonhypoxic nodes, p = 0.02). No correlation was found between the lactate SI and the complete nodal response (p = 0.52) or locoregional control rates.
The lactate SI did not correlate with tumor pO(2), treatment response, or locoregional control. Additional research is needed to refine this technique.
研究利用体内氢磁共振波谱成像检测乳酸以评估头颈癌肿瘤缺氧情况，并确定其在预测治疗反应和预后方面的效用。
对36例IV期头颈癌患者的受累颈部淋巴结及对照皮下组织进行1.5T的容积定位乳酸编辑氢磁共振波谱检查。测量乳酸、胆碱和肌酸的信号强度（SI）以及胆碱/肌酸比值。在进行磁共振波谱检查前，在同一淋巴结获取肿瘤氧分压（pO₂）。患者接受两个周期的诱导化疗（替拉扎明、顺铂、5-氟尿嘧啶），随后进行同步放化疗，或接受不含替拉扎明的相同方案治疗。乳酸SI及胆碱/肌酸比值与肿瘤pO₂、淋巴结反应及局部区域控制相关。
受累淋巴结的乳酸SI（中位数为0.25）高于皮下组织（中位数为0.04；p = 0.07）。乳酸SI与肿瘤pO₂之间未发现显著相关性（缺氧淋巴结平均为0.46±0.10 [pO₂≤10 mmHg，n = 15]，非缺氧淋巴结平均为0.36±0.07 [pO₂>10 mmHg，n = 21]，p = 0.44）。胆碱/肌酸比值与肿瘤pO₂之间存在显著相关性（缺氧淋巴结平均为2.74±0.34，非缺氧淋巴结平均为1.78±0.31，p = 0.02）。乳酸SI与完全淋巴结反应（p = 0.52）或局部区域控制率之间未发现相关性。
乳酸SI与肿瘤pO₂、治疗反应或局部区域控制无关。需要进一步研究以完善该技术。
