Division of Imaging and Intervention, Rikshospitalet, Oslo University Hospital, Oslo, Norway.
Clin Oncol (R Coll Radiol). 2011 Jun;23(5):339-43. doi: 10.1016/j.clon.2010.11.006. Epub 2010 Dec 4.
To assess the clinical benefit of combined functional imaging with [(18)F]2-fluoro-2-deoxy-d-glucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) in patients with metastatic renal cell carcinoma (mRCC) treated with the tyrosine kinase inhibitor sunitinib.
Fourteen patients with mRCC were prospectively enrolled in this study. All patients underwent PET/CT before receiving at least two cycles of sunitinib treatment. Three months after the onset of sunitinib treatment, a second PET/CT was carried out. The metabolic response evaluated from the PET (standard uptake value; SUV) was compared with the CT component of the PET/CT. The Response Evaluation Criteria in Solid Tumours criteria were used to assess the CT response and modified European Organization for Research and Treatment of Cancer criteria were used to assess the PET response.
Three main results were obtained: (1) Patients with relatively low 18F-FDG uptake before treatment (SUV<5) had a longer progression-free survival than those with a relatively high 18F-FDG uptake (P=0.006). (2) Patients with a partial metabolic response or stable metabolic disease after two courses of sunitinib had improved prognosis as compared with those with progressive metabolic disease (P=0.031). (3) There was a clear discrepancy between PET and CT as a tool for the evaluation of treatment response after two courses of sunitinib. PET indicated progressive disease in three patients, a partial response in six patients and stable disease in four patients. In contrast, CT concluded with progression in only one patient and stable disease in all other patients.
In patients with mRCC, a high baseline 18F-FDG uptake indicates aggressive disease, and the degree of reduction in 18F-FDG uptake after sunitinib treatment adds valuable prognostic information. Hence, the inclusion of PET results seems to improve the clinical counselling of patients with mRCC. Larger studies are needed to confirm these findings.
评估在接受酪氨酸激酶抑制剂舒尼替尼治疗的转移性肾细胞癌（mRCC）患者中，结合氟[18F]脱氧葡萄糖（18F-FDG）正电子发射断层扫描/计算机断层扫描（PET/CT）的功能成像的临床获益。
本研究前瞻性纳入 14 例 mRCC 患者。所有患者在接受至少两个周期舒尼替尼治疗前均进行了 PET/CT 检查。舒尼替尼治疗开始后 3 个月，进行了第二次 PET/CT 检查。从 PET 评估的代谢反应（标准摄取值；SUV）与 PET/CT 的 CT 成分进行了比较。使用实体瘤反应评价标准（RECIST）评估 CT 反应，使用欧洲癌症研究与治疗组织（EORTC）改良标准评估 PET 反应。
获得了三个主要结果：（1）治疗前 18F-FDG 摄取相对较低（SUV<5）的患者无进展生存期长于摄取相对较高的患者（P=0.006）。（2）接受两个疗程舒尼替尼治疗后出现部分代谢缓解或稳定代谢疾病的患者预后优于出现代谢进展的患者（P=0.031）。（3）在接受两个疗程舒尼替尼治疗后，PET 和 CT 作为评估治疗反应的工具之间存在明显差异。PET 显示三个患者为进展性疾病，六个患者为部分缓解，四个患者为稳定疾病。相比之下，CT 仅在一名患者中得出进展结论，而所有其他患者均为稳定疾病。
在 mRCC 患者中，基线时 18F-FDG 摄取较高提示疾病侵袭性强，舒尼替尼治疗后 18F-FDG 摄取减少程度可提供有价值的预后信息。因此，纳入 PET 结果似乎可以改善 mRCC 患者的临床咨询。需要更大的研究来证实这些发现。
