Vercellino Laetitia, Bousquet Guilhem, Baillet Georges, Barré Emmanuelle, Mathieu Olivier, Just Pierre-Alexandre, Desgrandchamps François, Misset Jean-Louis, Hindié Elif, Moretti Jean-Luc
Nuclear Medicine Department, St. Louis Hospital, Paris, France.
Cancer Biother Radiopharm. 2009 Feb;24(1):137-44. doi: 10.1089/cbr.2008.0527.
Sunitinib is a new standard for the treatment of metastatic renal-cell carcinoma (RCC). We evaluated the accuracy of 18-fluorodeoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT) in assessing early response to this antiangiogenic drug, which cannot be obtained with conventional CT.
Patients had an FDG-PET/CT at baseline and another one for follow-up at the end of the first cycle (at day 42). For each examination, all lesions were registered and the maximum standardized uptake value (SUV(max)) was measured. The metabolic response on PET at day 42 was assessed, using European Organization for Research and Treatment of Cancer criteria. Morphologic response on CT at day 84 (after two cycles), using Response Evaluation Criteria in Solid Tumors criteria, was used as the reference standard. The long-term outcome was assessed by the progression-free survival.
Twelve (12) patients who completed at least two cycles of sunitinib were assessed. The SUV(max) for the lesions with the highest uptake ranged between 2.9 and 11.8 for the 12 patients (mean = 6.3). Early PET/CT findings, after one cycle of sunitinib, were consistent with later CT results in 9 patients of 11 assessable patients: 1 patient progressed on PET and CT, 7 patients had stable disease, and 1 had a partial response. The other 2 patients had a metabolic partial response on PET and stable disease on CT. However, 1 patient achieved a partial response later in follow-up, suggesting that metabolic early changes are an indication of sunitinib activity.
FDG-PET/CT seems to be an interesting tool for the early evaluation of response to sunitinib in metastatic RCC. Larger studies are needed to confirm these preliminary results and establish a prognostic value for PET/CT.
舒尼替尼是转移性肾细胞癌（RCC）治疗的新标准。我们评估了18-氟脱氧葡萄糖-正电子发射断层扫描/计算机断层扫描（FDG-PET/CT）在评估对这种抗血管生成药物的早期反应方面的准确性，这是传统CT无法获得的。
患者在基线时进行FDG-PET/CT检查，并在第一个周期结束时（第42天）进行另一次随访检查。每次检查时，记录所有病变并测量最大标准化摄取值（SUV(max)）。使用欧洲癌症研究与治疗组织标准评估第42天PET的代谢反应。使用实体瘤疗效评价标准评估第84天（两个周期后）CT的形态学反应，并将其作为参考标准。通过无进展生存期评估长期结局。
评估了完成至少两个周期舒尼替尼治疗的12例患者。12例患者中摄取最高的病变的SUV(max)在2.9至11.8之间（平均 = 6.3）。在11例可评估患者中，9例患者在接受一个周期舒尼替尼治疗后的早期PET/CT结果与后期CT结果一致：1例患者在PET和CT上均进展，7例患者病情稳定，1例患者部分缓解。另外2例患者在PET上有代谢部分缓解，在CT上病情稳定。然而，1例患者在后续随访中后来实现了部分缓解，这表明代谢早期变化是舒尼替尼活性的一个指标。
FDG-PET/CT似乎是早期评估转移性RCC对舒尼替尼反应的一个有价值的工具。需要更大规模的研究来证实这些初步结果并确定PET/CT的预后价值。
