Radiation Therapy, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia Department of Medical Imaging and Radiation Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia Sir Peter MacCallum Department of Oncology, University of Melbourne, Victoria, Australia
Sir Peter MacCallum Department of Oncology, University of Melbourne, Victoria, Australia Division of Radiation Oncology, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia.
J Nucl Med. 2014 Jul;55(7):1069-74. doi: 10.2967/jnumed.113.131631. Epub 2014 May 15.
We aimed to prospectively observe cellular metabolism and proliferation in patients with non-small-cell lung cancer (NSCLC) during radical chemoradiation therapy using serial PET/CT with (18)F-FDG and 3'-deoxy-3'-(18)F-fluorothymidine ((18)F-FLT).
Twenty patients with stage I-III NSCLC and candidates for radical chemoradiation therapy (60 Gy in 30 fractions over 6 wk) were recruited. (18)F-FDG and (18)F-FLT PET/CT were performed at baseline and during therapy (weeks 2 and 4). Tumor response was assessed semiquantitatively and using visual response criteria.
The median and range for primary tumor volume (cm(3)) at baseline on (18)F-FDG were 28 and 2-241, respectively, and on (18)F-FLT 31 and 2-184, respectively. At week 2, (18)F-FDG was 26 (range, 2-164), and (18)F-FLT was 11 (range, 0-111). At week 4, (18)F-FDG was 19 (1-147), and (18)F-FLT was 7 (0-48). The median and range of maximum standardized uptake value (SUVmax) at baseline on (18)F-FDG were 14 and 4-31, respectively, and on (18)F-FLT 6 and 2-12, respectively. Week 2 (18)F-FDG median SUVmax was 10 (2-31), and (18)F-FLT median SUVmax was 3 (1-15); week 4 (18)F-FDG median SUVmax was 10 (2-15), and (18)F-FLT median SUVmax was 2 (2-9). There was fair agreement between visual tumor response on (18)F-FDG and (18)F-FLT during therapy (Cohen's unweighted κ statistic, 0.27 at week 2 and 0.355 at week 4). Cerebral metastases were detected on 1 baseline (18)F-FLT scan, resulting in palliative management. Progressive disease was detected on week 2 scans in 3 patients, resulting in changes to radiation therapy (2 patients) and treatment intent (1 patient).
This study demonstrates that (18)F-FLT PET/CT is a more sensitive tracer of early treatment response than (18)F-FDG PET/CT. The ability of these tracers to detect distinct biologic processes may lead to their use as biomarkers for personalized radiation therapy and prognosis in the future.
使用（18）F-FDG 和 3'-去氧-3'-（18）F-氟胸苷（（18）F-FLT）的连续 PET/CT，前瞻性观察非小细胞肺癌（NSCLC）患者在根治性放化疗期间的细胞代谢和增殖情况。
招募 20 名 I-III 期 NSCLC 患者和根治性放化疗候选者（60 Gy 分 30 次，每周 5 次）。在基线和治疗期间（第 2 和第 4 周）进行（18）F-FDG 和（18）F-FLT PET/CT。半定量和使用视觉反应标准评估肿瘤反应。
原发性肿瘤体积（cm（3））在基线时的中位数和范围（18）F-FDG 分别为 28 和 2-241，（18）F-FLT 分别为 31 和 2-184。第 2 周时，（18）F-FDG 为 26（范围，2-164），（18）F-FLT 为 11（范围，0-111）。第 4 周时，（18）F-FDG 为 19（1-147），（18）F-FLT 为 7（0-48）。基线时（18）F-FDG 的最大标准化摄取值（SUVmax）中位数和范围分别为 14 和 4-31，（18）F-FLT 分别为 6 和 2-12。第 2 周（18）F-FDG 的 SUVmax 中位数为 10（2-31），（18）F-FLT 的 SUVmax 中位数为 3（1-15）；第 4 周（18）F-FDG 的 SUVmax 中位数为 10（2-15），（18）F-FLT 的 SUVmax 中位数为 2（2-9）。在治疗期间，（18）F-FDG 和（18）F-FLT 的肿瘤视觉反应之间存在适度的一致性（第 2 周和第 4 周的 Cohen 未加权κ统计量分别为 0.27 和 0.355）。在 1 次基线（18）F-FLT 扫描中检测到脑转移，导致姑息治疗。第 2 周扫描发现 3 例进行性疾病，导致放射治疗改变（2 例）和治疗意图改变（1 例）。
本研究表明，（18）F-FLT PET/CT 比（18）F-FDG PET/CT 更早地检测到治疗反应，这些示踪剂检测不同生物学过程的能力可能导致它们未来作为个性化放射治疗和预后的生物标志物。
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