Department of Radiation Oncology, Radiation Therapy Services, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia.
Cancer. 2010 Nov 1;116(21):5030-7. doi: 10.1002/cncr.25392.
The authors studied growth and progression of untreated nonsmall cell lung cancer (NSCLC) by comparing diagnostic and radiotherapy (RT) planning fluorodeoxyglucose (FDG)-positron emission tomography (PET)/computed tomography (CT) scans before proposed radical chemo-RT.
Patients enrolled on a prospective clinical trial were eligible for this analysis if they underwent 2 pretreatment whole body FDG-PET/CT scans, >7 days apart. Scan 1 was performed for diagnosis/disease staging and scan 2 for RT planning. Interscan comparisons included disease stage, metabolic characteristics, tumor doubling times, and change in treatment intent.
Eighty-two patients underwent planning PET/CT scans between October 2004 and February 2007. Of these, 28 patients (61% stage III, 18% stage II) had undergone prior staging PET/CT scans. The median interscan period was 24 days (range, 8-176 days). Interscan disease progression (TNM stage) was detected in 11 (39%) patients. The probability of upstaging within 24 days was calculated to be 32% (95% confidence interval [CI], 18%-49%). Treatment intent changed from curative to palliative in 8 (29%) cases, in 7 because of PET. For 17 patients who underwent serial PET/CT scans under standardized conditions, there was a mean relative interscan increase of 19% in tumor maximum standardized uptake value (SUV) (P=.022), 16% in average SUV (P=.004), and 116% in percentage injected dose (P=.002). Estimated doubling time of FDG avid tumor was 66 days (95% CI, 51-95 days).
Rapid tumor progression was detected in patients with untreated, predominantly stage III, NSCLC on serial FDG-PET/CT imaging, highlighting the need for prompt diagnosis, staging, and initiation of therapy in patients who are candidates for potentially curative therapy.
作者通过比较拟行根治性放化疗前诊断和放疗计划氟脱氧葡萄糖（FDG）正电子发射断层扫描（PET）/计算机断层扫描（CT），研究未经治疗的非小细胞肺癌（NSCLC）的生长和进展。
如果患者接受了 2 次预处理全身 FDG-PET/CT 扫描，且间隔时间＞7 天，则符合本前瞻性临床试验的分析条件。扫描 1 用于诊断/疾病分期，扫描 2 用于 RT 计划。扫描间比较包括疾病分期、代谢特征、肿瘤倍增时间和治疗意向的变化。
2004 年 10 月至 2007 年 2 月期间，82 例患者接受了计划 PET/CT 扫描。其中，28 例（61%为 III 期，18%为 II 期）患者在之前的分期 PET/CT 扫描中发现疾病进展。两次扫描的中位间隔时间为 24 天（范围为 8-176 天）。11 例（39%）患者在 24 天内出现疾病进展（TNM 分期）。计算得出 24 天内分期升高的概率为 32%（95%置信区间 [CI]，18%-49%）。8 例（29%）患者因 PET 结果改变治疗意向，从根治性治疗改为姑息性治疗。17 例患者在标准化条件下进行了连续 PET/CT 扫描，肿瘤最大标准化摄取值（SUV）的平均相对扫描间增加了 19%（P=.022），平均 SUV 增加了 16%（P=.004），注射剂量百分比增加了 116%（P=.002）。FDG 摄取肿瘤的倍增时间估计为 66 天（95%CI，51-95 天）。
在未经治疗的、以 III 期为主的 NSCLC 患者中，通过连续 FDG-PET/CT 成像发现了快速肿瘤进展，这凸显了对可能接受根治性治疗的患者进行及时诊断、分期和启动治疗的必要性。
