Division of Hematology-Oncology, Department of Medicine.
Department of Radiology; Department of Otolaryngology.
Ann Oncol. 2010 Nov;21(11):2278-2283. doi: 10.1093/annonc/mdq226. Epub 2010 Apr 29.
RECIST have limitations when applied to potentially curable locally advanced squamous cell carcinoma of the head and neck (SCCHN). [¹⁸F]fluorodeoxyglucose-positron emission tomography (PET) scan may be useful in assessing treatment response and predicting patient outcome.
We studied patients with previously untreated stages III-IVb SCCHN treated with primary concurrent chemoradiotherapy on five prospective clinical trials. Response was assessed by clinical exam, computed tomography (CT), and PET portions of combined PET-CT scan ∼8 weeks after completion of chemoradiotherapy.
Fifty-three patients were analyzed. Complete response (CR) was demonstrated in 42 patients (79%) by clinical exam, 15 (28%) by CT, and 27 (51%) by PET. CR as assessed by PET, but not as assessed by clinical exam or CT using RECIST, correlated significantly with progression-free status (PFS) (P < 0.0001). The 2-year PFS for patients with CR and without CR by PET was 93% and 48%, respectively (P = 0.0002).
A negative PET scan on combined PET-CT after chemoradiotherapy is a powerful predictor of outcome in patients receiving curative chemoradiotherapy for SCCHN. PET-CT is indicated for response evaluation in this setting to improve the accuracy of post-treatment assessment by CT.
当应用于潜在可治愈的局部晚期头颈部鳞状细胞癌（SCCHN）时，RECIST 存在局限性。氟脱氧葡萄糖正电子发射断层扫描（FDG-PET）扫描可能有助于评估治疗反应并预测患者预后。
我们研究了在五个前瞻性临床试验中接受原发性同期放化疗治疗的未经治疗的 III-IVb 期 SCCHN 患者。在放化疗完成后约 8 周，通过临床检查、计算机断层扫描（CT）和联合 PET-CT 扫描的 PET 部分评估反应。
分析了 53 名患者。42 名患者（79%）通过临床检查、15 名患者（28%）通过 CT 和 27 名患者（51%）通过 PET 显示完全缓解（CR）。通过 PET 评估的 CR，但不通过 RECIST 评估的临床检查或 CT 评估的 CR，与无进展状态（PFS）显著相关（P<0.0001）。通过 PET 评估为 CR 和无 CR 的患者的 2 年 PFS 分别为 93%和 48%（P=0.0002）。
放化疗后联合 PET-CT 的阴性 PET 扫描是接受 SCCHN 根治性放化疗患者预后的有力预测指标。在这种情况下，PET-CT 用于评估反应，以提高 CT 后治疗评估的准确性。
