Department of Nuclear Medicine, Medical University of Vienna/AKH Wien, Vienna, Austria.
Acta Oncol. 2010 Oct;49(7):941-7. doi: 10.3109/0284186X.2010.510145.
The aim of this pilot study was to assess tumour hypoxia in patients with cervical cancer before, during and after combined radio-chemotherapy and Magnetic Resonance Imaging (MRI) guided brachytherapy (BT) by use of the hypoxia Positron Emission Tomography (PET) tracer (18)F-fluoroazomycin-arabinoside ((18)FAZA ).
Fifteen consecutive patients with locally advanced cervical cancer referred for definitive radiotherapy (RT) were included in an approved clinical protocol. Stage distribution was 3 IB1, 1 IB2, 10 IIB, 1 IIIB, tumour volume was 55 cm(3) (+/- 67, SD). Dynamic and static (18)FAZA -PET scans were performed before, during and after external beam therapy (EBRT) and image guided BT +/- concomitant cisplatin. Dose was prescribed to the individual High Risk Clinical Target Volume (HR CTV) taking into account the dose volume constraints for adjacent organs at risk.
Five patients had visually identifiable tumours on (18)FAZA -PET scans performed prior to radio-chemotherapy and four patients before brachytherapy. One of five (18)FAZA PET positive patients had incomplete remission three months after RT, one had regional recurrence. Four of ten (18)FAZA-PET negative patients developed distant metastases. The one patient with incomplete remission received 69 Gy (D90) in the HR CTV, whereas all other patients received mean 99 Gy (+/-12, SD).
PET imaging with (18)FAZA is feasible in patients with cancer of the uterine cervix. However, its predictive and prognostic value remains to be clarified. This applies in particular for the additional value of (18)FAZA-PET compared to morphologic repetitive MRI within the setting of image guided high dose radiotherapy which may contribute to overcome hypoxia related radioresistance.
本研究旨在评估宫颈癌患者在接受放化疗联合磁共振成像（MRI）引导近距离放疗（BT）前后，通过使用乏氧正电子发射断层扫描（PET）示踪剂（18）F-氟代阿霉素-阿拉伯糖苷（（18）FAZA）评估肿瘤乏氧情况。
15 例局部晚期宫颈癌患者连续入组，行根治性放疗（RT），符合批准的临床研究方案。分期为 3 期 IB1 1 例、IB2 1 例、2B 期 10 例、3B 期 1 例，肿瘤体积为 55cm3（+/-67，SD）。在 EBRT 联合图像引导 BT +/-顺铂同期治疗前、期间和后进行动态和静态（18）FAZA-PET 扫描。根据危及器官剂量体积限制，为个体化高风险临床靶区（HR CTV）规定剂量。
5 例患者在放化疗前、4 例患者在 BT 前的（18）FAZA-PET 扫描中发现肉眼可见肿瘤。5 例（18）FAZA PET 阳性患者中，1 例患者在 RT 后 3 个月不完全缓解，1 例患者发生区域复发。10 例（18）FAZA-PET 阴性患者中，4 例患者发生远处转移。1 例不完全缓解患者的 HR CTV 接受 69Gy（D90），而其他所有患者接受的平均剂量为 99Gy（+/-12，SD）。
（18）FAZA 在宫颈癌患者中进行 PET 成像具有可行性。然而，其预测和预后价值仍有待阐明。这尤其适用于在图像引导高剂量放疗中，（18）FAZA-PET 与重复 MRI 形态学比较的附加价值，可能有助于克服与缺氧相关的放疗抵抗。
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