应用 18F-氟代脱氧葡萄糖正电子发射断层扫描监测接受新辅助放化疗的局部进展期胰腺癌患者的临床转归。
Using 18F-fluorodeoxyglucose positron emission tomography to monitor clinical outcomes in patients treated with neoadjuvant chemo-radiotherapy for locally advanced pancreatic cancer.
机构信息
University of Mississippi, GV Montgomery VA Medical Center, Jackson, MS, USA.
出版信息
Am J Clin Oncol. 2010 Jun;33(3):257-61. doi: 10.1097/COC.0b013e3181a76a0b.
BACKGROUND
Pancreatic cancer ranks as the fourth leading cause of cancer death in the United States with 5-year survival ranging from 1% to 5%. Positron emission tomography (PET) is a metabolic imaging system that is widely used for the initial staging of cancer and detecting residual disease after treatment. There are limited data, however, on the use of this molecular imaging technique to assess early tumor response after treatment in pancreatic cancer.
METHODS
The objective of the study was to explore the relationship of early treatment response using the F-fluorodeoxyglucose (FDG) PET with surgical outcome and overall survival in patients with locally advanced pancreatic cancer. FDG-PET measurements of maximum standardized uptake value and kinetic parameters were compared with the clinical outcome.
RESULTS
Twenty patients were enrolled in the study evaluating neoadjuvant induction chemotherapy followed by concurrent chemoradiotherapy (chemo-RT) for locally advanced pancreatic cancer. All 20 patients had prestudy PET scans and a total of fifty PET scans were performed. Among patients who were PET responders (> or =50% decrease in standardized uptake value after cycle 1), 100% (2/2) had complete surgical resection. Only 6% (1/16) had surgical resection in the PET nonresponders (<50% decrease). Two patients did not have the second PET scan because of clinical progression or treatment toxicity. Mean survival was 23.2 months for PET responders and 11.3 months for nonresponders (P = 0.234). Similar differences in survival were also noted when response was measured using Patlak analysis.
CONCLUSIONS
FDG-PET can aid in monitoring the clinical outcome of patients with locally advanced pancreatic cancer treated with neoadjuvant chemo-RT. FDG-PET may be used to aid patients who could have complete surgical resection as well as prognosticate patients' survival.
背景
在美国，胰腺癌的死亡率位居癌症死因的第四位，5 年生存率在 1%至 5%之间。正电子发射断层扫描（PET）是一种代谢成像系统，广泛用于癌症的初始分期和治疗后残留疾病的检测。然而，关于使用这种分子成像技术来评估胰腺癌治疗后早期肿瘤反应的资料有限。
方法
本研究的目的是探讨氟-18-氟代脱氧葡萄糖（FDG）PET 早期治疗反应与局部晚期胰腺癌患者手术结果和总生存的关系。比较 FDG-PET 最大标准化摄取值和动力学参数测量值与临床结果。
结果
本研究共纳入 20 例接受新辅助诱导化疗后行同期放化疗（chemo-RT）的局部晚期胰腺癌患者。所有 20 例患者均行研究前 PET 扫描，共进行了 50 次 PET 扫描。在 PET 反应者（第 1 周期后标准化摄取值下降≥50%）中，100%（2/2）患者行完全手术切除。而在 PET 无反应者（标准化摄取值下降＜50%）中，仅 6%（1/16）患者行手术切除。由于临床进展或治疗毒性，有 2 例患者未进行第二次 PET 扫描。PET 反应者的平均生存时间为 23.2 个月，而 PET 无反应者的平均生存时间为 11.3 个月（P=0.234）。当使用 Patlak 分析测量反应时，也观察到生存差异相似。
结论
FDG-PET 可辅助监测接受新辅助 chemo-RT 治疗的局部晚期胰腺癌患者的临床结果。FDG-PET 可用于辅助可进行完全手术切除的患者，并预测患者的生存情况。
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