La Trang H, Filion Edith J, Turnbull Brit B, Chu Jackie N, Lee Percy, Nguyen Khoa, Maxim Peter, Quon Andy, Graves Edward E, Loo Billy W, Le Quynh-Thu
Department of Radiation Oncology, Stanford University, Stanford, CA 94305, USA.
Int J Radiat Oncol Biol Phys. 2009 Aug 1;74(5):1335-41. doi: 10.1016/j.ijrobp.2008.10.060. Epub 2009 Mar 14.
To evaluate the prognostic value of metabolic tumor volume measured on 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) imaging and other clinical factors in patients treated for locally advanced head-and-neck cancer (HNC) at a single institution.
Between March 2003 and August 2007, 85 patients received positron emission tomography (PET)/computed tomography-guided chemoradiotherapy for HNC. Metabolically active tumor regions were delineated on pretreatment PET scans semiautomatically using custom software. We evaluated the relationship of (18)F-fluorodeoxyglucose-PET maximum standardized uptake value (SUV) and total metabolic tumor volume (MTV) with disease-free survival (DFS) and overall survival (OS).
Mean follow-up for surviving patients was 20.4 months. The estimated 2-year locoregional control, DFS, and OS for the group were 88.0%, 69.5%, and 78.4%, respectively. The median time to first failure was 9.8 months among the 16 patients with relapse. An increase in MTV of 17.4 mL (difference between the 75th and 25th percentiles) was significantly associated with an increased hazard of first event (recurrence or death) (1.9-fold, p < 0.001), even after controlling for Karnofsky performance status (KPS) (1.8-fold, p = 0.001), and of death (2.1-fold, p < 0.001). We did not find a significant relationship of maximum SUV, stage, or other clinical factors with DFS or OS.
Metabolic tumor volume is an adverse prognostic factor for disease recurrence and death in HNC. MTV retained significance after controlling for KPS, the only other significant adverse prognostic factor found in this cohort. MTV is a direct measure of tumor burden and is a potentially valuable tool for risk stratification and guiding treatment in future studies.
评估在单一机构接受局部晚期头颈癌（HNC）治疗的患者中，通过18F-氟脱氧葡萄糖正电子发射断层扫描（FDG-PET）成像测量的代谢肿瘤体积及其他临床因素的预后价值。
2003年3月至2007年8月期间，85例患者接受了PET/计算机断层扫描引导下的头颈癌放化疗。使用定制软件在治疗前的PET扫描上半自动勾勒出代谢活跃的肿瘤区域。我们评估了18F-氟脱氧葡萄糖-PET最大标准化摄取值（SUV）和总代谢肿瘤体积（MTV）与无病生存期（DFS）和总生存期（OS）的关系。
存活患者的平均随访时间为20.4个月。该组患者估计的2年局部区域控制率、DFS和OS分别为88.0%、69.5%和78.4%。16例复发患者首次出现失败的中位时间为9.8个月。MTV增加17.4 mL（第75百分位数与第25百分位数之间的差异）与首次事件（复发或死亡）风险增加显著相关（1.9倍，p<0.001），即使在控制卡氏功能状态（KPS）后也是如此（1.8倍，p = 0.001），与死亡风险增加相关（2.1倍，p<0.001）。我们未发现最大SUV、分期或其他临床因素与DFS或OS之间存在显著关系。
代谢肿瘤体积是头颈癌疾病复发和死亡的不良预后因素。在控制KPS后，MTV仍具有显著意义，KPS是该队列中发现的唯一其他显著不良预后因素。MTV是肿瘤负荷的直接测量指标，在未来研究中是进行风险分层和指导治疗的潜在有价值工具。
