Strobel Klaus, Dummer Reinhard, Steinert Hans C, Conzett Katrin Baumann, Schad Karin, Lago Marisol Pérez, Soyka Jan D, Veit-Haibach P, Seifert Burkhardt, Kalff V
Division of Nuclear Medicine, Department of Medical Radiology, University Hospital Zurich, Raemistr. 100, 8091, Zurich, Switzerland.
Eur J Nucl Med Mol Imaging. 2008 Oct;35(10):1786-95. doi: 10.1007/s00259-008-0806-1. Epub 2008 May 6.
This study aims to compare the use of 18F-FDG-PET/CT, CT, brain MRI, and tumormarker S-100B in chemotherapy response assessment of stage IV melanoma patients.
In 25 patients with stage IV melanoma, FDG-PET/CT and S-100B after 2-3 months (three cycles) of chemotherapy was compared with baseline PET/CT and baseline S-100B. Retrospectively, the response was correlated with the outcome. In patients with clinical suspicion for brain metastases, MRI or CCT was performed.
There was agreement between FDG-PET/CT and CT regarding response to chemotherapy in all patients. There was a clear trend to a longer OS of PET/CT responders (n=10) compared with PET/CT non-responders (n=15; p=0.072) with remarkably better 1-year OS of 80% compared to 40% (p=0.048). There was a significant longer PFS of PET/CT responders compared with PET/CT non-responders (p=0.002). S-100B was normal at baseline in eight of 22 patients where it was available. Chemotherapy response assessment with S-100B failed to show correlation with OS or PFS. Eleven patients developed brain metastases during treatment, first detected by PET/CT in two and by MRI or CCT in nine of 11 patients. Appearance of brain metastases was associated with a poor survival.
18F-FDG-PET/CT and CT alone are equally suitable for chemotherapy response assessment in melanoma patients and clearly superior to S-100B. PET/CT responders have better early survival, but this is shortlived due to late therapy failure--often with brain recurrence. Additional brain MRI for therapy response assessment in such high-risk patients is mandatory to detect brain metastases missed by PET/CT.
本研究旨在比较18F-FDG-PET/CT、CT、脑部MRI及肿瘤标志物S-100B在IV期黑色素瘤患者化疗反应评估中的应用。
对25例IV期黑色素瘤患者，将化疗2 - 3个月（三个周期）后的FDG-PET/CT及S-100B与基线PET/CT及基线S-100B进行比较。回顾性分析反应与预后的相关性。对临床怀疑有脑转移的患者进行MRI或CCT检查。
所有患者中，FDG-PET/CT与CT在化疗反应方面结果一致。PET/CT反应者（n = 10）与PET/CT无反应者（n = 15；p = 0.072）相比，有生存期明显更长的趋势，1年总生存期显著更好，分别为80%和40%（p = 0.048）。PET/CT反应者的无进展生存期显著长于PET/CT无反应者（p = 0.002）。在22例可检测S-100B的患者中，8例基线时S-100B正常。用S-100B进行化疗反应评估未显示与总生存期或无进展生存期相关。11例患者在治疗期间发生脑转移，11例中有2例首先通过PET/CT检测到，9例通过MRI或CCT检测到。脑转移的出现与生存不良相关。
单独使用18F-FDG-PET/CT和CT同样适用于黑色素瘤患者的化疗反应评估，且明显优于S-100B。PET/CT反应者早期生存率更高，但由于后期治疗失败（常伴有脑部复发）生存期较短。对于此类高危患者，为评估化疗反应进行额外的脑部MRI检查以检测PET/CT遗漏的脑转移是必要的。
