Clinic and Polyclinic of Nuclear Medicine, Medical Faculty and University Hospital Carl Gustav Carus, Dresden University of Technology, Fetscherstraße 74, 01307 Dresden, Germany.
Eur J Nucl Med Mol Imaging. 2011 Jul;38(7):1203-11. doi: 10.1007/s00259-011-1759-3. Epub 2011 Feb 25.
Our study aimed to explore the optimal timing as well as the most appropriate prognostic parameter of (18)F-fluorodeoxyglucose positron emission tomography (FDG PET) during chemoradiotherapy (CRT) for an early prediction of outcome for patients with head and neck squamous cell carcinoma (HNSCC).
Serial PET data (before and three times during CRT) of 37 patients with advanced stage HNSCC, receiving combined CRT between 2005 and 2009, were evaluated. The maximum standardized uptake value (SUV(max)), the average SUV (SUV(mean)) and the gross tumour volume determined by FDG PET (GTV PET), based on a source to background algorithm, were analysed. Stratified actuarial analysis was performed for overall survival (OS), disease-free survival (DFS) and locoregional control (LRC). The median follow-up time was 26 months (range 8-50).
For all patients, OS was 51%, DFS 44% and LRC 55% after 2 years. The 2-year OS (88%) and 2-year LRC (88%) were higher for patients whose SUV(max) of the primary tumour decreased 50% or more from the beginning (0 Gy) to week 1 or 2 (10 or 20 Gy) of CRT (ΔSUV(max10/20) ≥ 50%) than for patients with ΔSUV(max20) < 50% (2-year OS = 38%; p = 0.02; 2-year LRC 40%; p = 0.06). A pretreatment GTV PET below the median of 10.2 ml predicted a better 2-year OS (34% for GTV PET ≥ 10.2 ml vs 83% for GTV PET < 10.2 ml; p = 0.02).
The decrease of SUV(max) from before (0 Gy) to week 1 or 2 (10 or 20 Gy) of CRT is a potential prognostic marker for patients with HNSCC. Because GTV PET depends on the applied method of analysis, we suggest the use of SUV(max), especially ΔSUV(max10/20), for an early estimation of therapy outcome. Confirmatory studies are warranted.
本研究旨在探讨在头颈部鳞状细胞癌（HNSCC）患者放化疗（CRT）期间进行（18）F-氟脱氧葡萄糖正电子发射断层扫描（FDG PET）的最佳时机和最合适的预后参数，以便早期预测治疗结果。
回顾性分析 2005 年至 2009 年间接受联合 CRT 的 37 例晚期 HNSCC 患者的连续 PET 数据（治疗前及 CRT 期间 3 次）。分析最大标准化摄取值（SUV(max)）、平均 SUV（SUV(mean)）和基于源到背景算法的 FDG PET 确定的肿瘤总体积（GTV PET）。采用分层生存分析评估总生存期（OS）、无病生存期（DFS）和局部区域控制率（LRC）。中位随访时间为 26 个月（8-50 个月）。
所有患者的 2 年 OS 为 51%，DFS 为 44%，LRC 为 55%。对于 SUV(max)从治疗开始（0 Gy）到第 1 或 2 周（10 或 20 Gy）下降 50%或更多的患者，其 2 年 OS（88%）和 2 年 LRC（88%）均高于 SUV(max20) < 50%的患者（2 年 OS = 38%；p = 0.02；2 年 LRC 40%；p = 0.06）。治疗前 GTV PET 低于中位数 10.2 ml 预示着更好的 2 年 OS（GTV PET ≥ 10.2 ml 为 34%，GTV PET < 10.2 ml 为 83%；p = 0.02）。
CRT 开始时（0 Gy）至第 1 或 2 周（10 或 20 Gy）SUV(max)的下降是 HNSCC 患者的一个潜在预后标志物。由于 GTV PET 取决于所应用的分析方法，我们建议使用 SUV(max)，特别是 SUV(max10/20)，来早期估计治疗结果。需要进一步的研究来证实这一结论。
