Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Int J Radiat Oncol Biol Phys. 2011 Sep 1;81(1):118-25. doi: 10.1016/j.ijrobp.2010.04.034. Epub 2010 Aug 2.
Induction chemotherapy (ICT) has been used to select patients for organ preservation and determine subsequent treatments in patients with locally advanced squamous cell carcinoma of the head and neck (LASCCHN). Still, the clinical outcomes of LASCCHN patients who showed response to ICT are heterogeneous. We evaluated the efficacy of interim 18-fluoro-2-deoxy-glucose positron emission tomography (FDG-PET) after ICT in this specific subgroup of LASCCHN patients who achieved partial response (PR) after ICT to predict clinical outcomes after concurrent chemoradiotherapy (CCRT).
Twenty-one patients with LASCCHN who showed PR to ICT by Response Evaluation Criteria In Solid Tumors before definitive CCRT were chosen in this retrospective analysis. FDG-PET was performed before and 2-4 weeks after ICT to assess the extent of disease at baseline and the metabolic response to ICT, respectively. We examined the correlation of the metabolic response by the percentage decrease of maximum standardized uptake value (SUVmax) on the primary tumor or lymph node after ICT or a specific threshold of SUVmax on interim FDG-PET with clinical outcomes including complete response (CR) rate to CCRT, progression-free survival (PFS), and overall survival (OS).
A SUVmax of 4.8 on interim FDG-PET could predict clinical CR after CCRT (100% vs. 20%, p=0.001), PFS (median, not reached vs. 8.5 mo, p<0.001), and OS (median, not reached vs. 12.0 months, p=0.001) with a median follow-up of 20.3 months in surviving patients. A 65% decrease in SUVmax after ICT from baseline also could predict clinical CR after CCRT (100% vs. 33.3%, p=0.003), PFS (median, not reached vs. 8.9 months, p<0.001) and OS (median, not reached vs. 24.4 months, p=0.001) of the patients.
These data suggest that interim FDG-PET after ICT might be a useful determinant to predict clinical outcomes in patients with LASCCHN receiving sequential ICT followed by CCRT.
诱导化疗（ICT）已被用于选择接受器官保留治疗的患者，并确定局部晚期头颈部鳞状细胞癌（LASCCHN）患者的后续治疗方案。然而，对 ICT 有反应的 LASCCHN 患者的临床结局存在异质性。我们评估了 ICT 后中期 18-氟-2-脱氧葡萄糖正电子发射断层扫描（FDG-PET）在 ICT 后达到部分缓解（PR）的 LASCCHN 患者这一特定亚组中的疗效，以预测同步放化疗（CCRT）后的临床结局。
在这项回顾性分析中，我们选择了 21 例在接受确定性 CCRT 前通过实体瘤反应评估标准（RECIST）对 ICT 有 PR 的 LASCCHN 患者。FDG-PET 在 ICT 前和 ICT 后 2-4 周进行，以分别评估基线时疾病的范围和 ICT 对代谢的反应。我们检查了 ICT 后最大标准化摄取值（SUVmax）的百分比下降或中期 FDG-PET 上 SUVmax 的特定阈值与包括 CCRT 后完全缓解（CR）率、无进展生存期（PFS）和总生存期（OS）在内的临床结局之间的相关性。
中期 FDG-PET 上的 SUVmax 为 4.8 可预测 CCRT 后的临床 CR（100% vs. 20%，p=0.001）、PFS（中位数，未达到 vs. 8.5 个月，p<0.001）和 OS（中位数，未达到 vs. 12.0 个月，p=0.001），在有生存患者的中位随访 20.3 个月时。ICT 后 SUVmax 基线值下降 65%也可预测 CCRT 后的临床 CR（100% vs. 33.3%，p=0.003）、PFS（中位数，未达到 vs. 8.9 个月，p<0.001）和 OS（中位数，未达到 vs. 24.4 个月，p=0.001）。
这些数据表明，ICT 后中期 FDG-PET 可能是预测接受 ICT 序贯治疗后再接受 CCRT 的 LASCCHN 患者临床结局的有用指标。
