Department of Thoracic Surgery, Boston Medical Center and Boston University School of Medicine, Boston, MA 02118, USA.
J Thorac Cardiovasc Surg. 2013 Mar;145(3):709-15. doi: 10.1016/j.jtcvs.2012.12.024. Epub 2013 Jan 12.
OBJECTIVE(S): Recommendations for surveillance after stereotactic body radiation therapy (SBRT) for early stage non-small cell lung cancer (NSCLC) are not well defined. Prospective studies evaluating the efficacy of SBRT have used interval posttreatment imaging with computed tomography (CT). We set out to determine whether positron emission tomography (PET) combined with diagnostic chest CT (PET/d-chest) can enhance detection of potentially salvageable recurrence after SBRT.
We performed a retrospective analysis of posttreatment imaging for 35 patients consecutively treated with SBRT for biopsy-proven early-stage NSCLC. PET/d-chest was generally performed every 3 months after treatment. A board-certified radiologist who did not have access to the PET results retrospectively interpreted the CT scans. CT results were reported according to response criteria used in Radiation Therapy Oncology Group 0236 and compared with PET/d-chest readings. Local and regional recurrence-free survival was compared using the Mantle-Cox (log-rank) test.
Median follow-up was 12.8 months. Twenty-four patients had stage IA, 7 stage IB, 3 stage IIA, and 1 stage IIB biopsy-proven NSCLC. Two-year overall survival was 62%. CT scans indicated no regional recurrences. PET/d-chest indicated 10 regional recurrences. The 1-year rate of regional recurrence-free survival as evaluated by CT and PET/d-chest was 100% and 69.4%, respectively (P = .0045). Four of 10 patients with a diagnosis of regional recurrence underwent salvage treatment with definitive chemoradiotherapy.
PET/d-chest enhances the detection of regional progression of NSCLC after SBRT over currently recommended practices. In patients who are fit for salvage treatment, where early detection of recurrence can increase the likelihood of successful treatment, PET/d-chest appears critical for follow-up.
立体定向体部放射治疗（SBRT）治疗早期非小细胞肺癌（NSCLC）后的监测建议尚不清楚。评估 SBRT 疗效的前瞻性研究使用了治疗后计算机断层扫描（CT）的间隔影像学检查。我们旨在确定正电子发射断层扫描（PET）与诊断性胸部 CT（PET/d-chest）联合应用是否可以提高 SBRT 后潜在可挽救性复发的检测率。
我们对 35 例连续接受 SBRT 治疗活检证实的早期 NSCLC 患者的治疗后影像学进行了回顾性分析。一般在治疗后每 3 个月进行一次 PET/d-chest。一位具有放射学委员会认证的放射科医生对 CT 扫描进行了回顾性解读，该医生不知道 PET 的结果。根据放射治疗肿瘤学组 0236 中使用的反应标准报告 CT 结果，并与 PET/d-chest 读数进行比较。采用 Mantel-Cox（对数秩）检验比较局部和区域无复发生存率。
中位随访时间为 12.8 个月。24 例患者为 IA 期，7 例为 IB 期，3 例为 IIA 期，1 例为 IIB 期。2 年总生存率为 62%。CT 扫描未显示区域性复发。PET/d-chest 显示有 10 例区域性复发。CT 和 PET/d-chest 评估的 1 年区域无复发生存率分别为 100%和 69.4%（P =.0045）。10 例区域复发患者中有 4 例接受了确定性放化疗的挽救性治疗。
与目前推荐的实践相比，PET/d-chest 可增强 SBRT 后 NSCLC 区域性进展的检测。在适合挽救性治疗的患者中，早期发现复发可增加成功治疗的可能性，因此 PET/d-chest 对随访至关重要。
