同期放化疗治疗宫颈癌时，通过连续 18F-氟代脱氧葡萄糖正电子发射断层扫描/计算机断层扫描评估肿瘤反应的预后意义。
Prognostic significance of tumor response as assessed by sequential 18F-fluorodeoxyglucose-positron emission tomography/computed tomography during concurrent chemoradiation therapy for cervical cancer.
机构信息
Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
出版信息
Int J Radiat Oncol Biol Phys. 2013 Nov 1;87(3):549-54. doi: 10.1016/j.ijrobp.2013.07.009.
PURPOSE
To investigate the prognostic role of metabolic response by the use of serial sets of positron emission tomography/computed tomography (PET/CT) in patients with cervical cancer who were treated with concurrent chemoradiation therapy (CCRT).
METHODS AND MATERIALS
A total of 60 patients who were treated with CCRT between February 2009 and December 2010 were analyzed. Three sequential PET/CT images were acquired for each patient: pre-CCRT, during-CCRT at 4 weeks of CCRT, and 1 month post-CCRT PET/CT. Metabolic responses were assessed qualitatively. The percentage changes in the maximum values of standardized uptake value (ΔSUV(max)%) from the PET/CT images acquired pre-CCRT and during-CCRT were calculated. Receiver operating characteristic (ROC) curve analysis was performed to evaluate whether ΔSUV(max)% could predict complete response (CR) on the post-CCRT PET/CT and to identify the best cutoff value. Prognostic factors of progression-free survival (PFS) were analyzed.
RESULTS
During-CCRT PET/CT showed that 8 patients (13%) had CR, and the other 52 patients (87%) had partial response (PR). On the post-CCRT PET/CT, 43 patients (73%) had CR, 12 patients (20%) had PR, and 4 patients (7%) had progressive disease. The average SUV(max) in primary tumors was 16.3 (range, 6.4-53.0) on the pre-CCRT PET/CT images and 5.3 (range, 0-19.4) on the during-CCRT PET/CT images. According to ROC curve analysis, ΔSUV(max)% could predict CR response on post-CCRT PET/CT (P<.001, cutoff value of 59.7%). In all patients, the PFS rate was 71.9% at 2 years. Multivariate analysis showed that ΔSUV(max)% ≥60% (P=.045) and CR response on the post-CCRT PET/CT (P=.012) were statistically significant predictors of PFS.
CONCLUSION
Metabolic responses on the during-CCRT images at 4 weeks of treatment and 1-month post-CCRT PET/CT images may predict treatment outcomes in patients with cervical cancer. ΔSUV(max)% ≥60% at 4 weeks of CCRT may predict CR response on 1-month post-CCRT PET/CT and also PFS.
目的
通过使用一系列正电子发射断层扫描/计算机断层扫描（PET/CT）来研究接受同期放化疗（CCRT）治疗的宫颈癌患者代谢反应的预后作用。
方法和材料
对 2009 年 2 月至 2010 年 12 月期间接受 CCRT 治疗的 60 例患者进行了分析。每位患者采集了三组连续的 PET/CT 图像：CCRT 前、CCRT 期间的第 4 周以及 CCRT 后 1 个月的 PET/CT。对代谢反应进行定性评估。从 CCRT 前和 CCRT 期间采集的 PET/CT 图像中计算最大标准摄取值（SUV(max)）的百分比变化（ΔSUV(max)％）。进行受试者工作特征（ROC）曲线分析，以评估 ΔSUV(max)％是否可以预测 CCRT 后 PET/CT 的完全缓解（CR），并确定最佳截断值。分析无进展生存期（PFS）的预后因素。
结果
CCRT 期间的 PET/CT 显示，8 例患者（13％）有 CR，其余 52 例患者（87％）有部分缓解（PR）。在 CCRT 后 PET/CT 上，43 例患者（73％）有 CR，12 例患者（20％）有 PR，4 例患者（7％）有疾病进展。原发肿瘤的平均 SUV(max)在 CCRT 前的 PET/CT 图像上为 16.3（范围，6.4-53.0），在 CCRT 期间的 PET/CT 图像上为 5.3（范围，0-19.4）。根据 ROC 曲线分析，ΔSUV(max)％可以预测 CCRT 后 PET/CT 的 CR 反应（P<.001，截断值为 59.7％）。在所有患者中，2 年的 PFS 率为 71.9％。多变量分析显示，ΔSUV(max)％≥60％（P=.045）和 CCRT 后 PET/CT 的 CR 反应（P=.012）是 PFS 的统计学显著预测因素。
结论
治疗 4 周时 CCRT 期间的代谢反应和 CCRT 后 1 个月的 PET/CT 图像可以预测宫颈癌患者的治疗结果。CCRT 治疗 4 周时的ΔSUV(max)％≥60％可能预测 CCRT 后 1 个月的 PET/CT 上的 CR 反应和 PFS。
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