Roedl Johannes B, Halpern Elkan F, Colen Rivka R, Sahani Dushyant V, Fischman Alan J, Blake Michael A
Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, USA.
Mol Imaging Biol. 2009 Jan-Feb;11(1):54-60. doi: 10.1007/s11307-008-0169-9. Epub 2008 Sep 4.
We investigated the utility of metabolic tumor width parameters in predicting response to chemoradiotherapy and in predicting disease-free survival in patients with esophageal cancer. Furthermore, we evaluated the possible confounding effect of therapy-induced esophagitis on the evaluation of treatment response. Forty-nine patients with squamous cell carcinoma, who had undergone positron emission tomography/computed tomography (PET/CT) exams before and after neoadjuvant chemoradiotherapy, were included in the study. In the slice with the maximum 2-deoxy-2-[F-18]fluoro-D: -glucose (FDG) uptake of the tumor, the following metabolic tumor width parameters were measured: Area of the tumor, maximum diameter of the tumor, maximum and mean standardized uptake value (SUV). Furthermore, the "diameter-SUV index" was calculated by multiplying the tumor diameter by the mean SUV.
The decrease of the metabolic tumor diameter between pre- and post-treatment PET/CT scans was the single best predictor of treatment response and tumor-free survival. However, the accuracy of predicting response and survival was even higher when using the decrease of the "diameter-SUV index" as the metabolic criterion for treatment response. A decrease by more than 55% of the diameter-SUV index identified pathologic responders (n = 22) with a sensitivity of 91% and a specificity of 93%. Radiation esophagitis was found to have a significant impact on the assessment of treatment response when evaluating therapy response based on the maximum SUV, whereas no confounding effect of radiation esophagitis was seen when evaluating therapy response based on the tumor diameter or the diameter-SUV index.
The present study shows that tumor width parameters, especially the tumor diameter or the combination of diameter and SUV in the "diameter-SUV index", are valuable for predicting tumor-free survival and treatment response independent from the presence of radiation esophagitis.
我们研究了代谢肿瘤宽度参数在预测食管癌患者放化疗反应及无病生存期方面的效用。此外，我们评估了治疗引起的食管炎对治疗反应评估可能产生的混杂效应。本研究纳入了49例接受新辅助放化疗前后均进行过正电子发射断层扫描/计算机断层扫描（PET/CT）检查的鳞状细胞癌患者。在肿瘤2-脱氧-2-[F-18]氟-D-葡萄糖（FDG）摄取量最大的层面，测量以下代谢肿瘤宽度参数：肿瘤面积、肿瘤最大直径、最大及平均标准化摄取值（SUV）。此外，通过将肿瘤直径乘以平均SUV来计算“直径-SUV指数”。
治疗前后PET/CT扫描中代谢肿瘤直径的减小是治疗反应和无瘤生存期的最佳单一预测指标。然而，当使用“直径-SUV指数”的减小作为治疗反应的代谢标准时，预测反应和生存期的准确性更高。直径-SUV指数下降超过55%可识别出病理反应者（n = 22），敏感性为91%，特异性为93%。在基于最大SUV评估治疗反应时，放射性食管炎对治疗反应评估有显著影响，而在基于肿瘤直径或直径-SUV指数评估治疗反应时，未发现放射性食管炎的混杂效应。
本研究表明，肿瘤宽度参数，尤其是肿瘤直径或“直径-SUV指数”中直径与SUV的组合，对于预测无瘤生存期和治疗反应具有重要价值，且不受放射性食管炎的影响。
