[18F] - 氟米索硝唑正电子发射断层扫描/计算机断层扫描对活动期和骶尾椎脊索瘤患者肿瘤缺氧情况的可视化
[18F]-Fluoromisonidazole positron emission tomography/computed tomography visualization of tumor hypoxia in patients with chordoma of the mobile and sacrococcygeal spine.
作者信息
Cheney Matthew D, Chen Yen-Lin, Lim Ruth, Winrich Barbara K, Grosu Anca L, Trofimov Alexei V, Depauw Nicolas, Shih Helen A, Schwab Joseph H, Hornicek Francis J, DeLaney Thomas F
机构信息
Harvard Radiation Oncology Program, Boston, Massachusetts.
Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts.
出版信息
Int J Radiat Oncol Biol Phys. 2014 Dec 1;90(5):1030-6. doi: 10.1016/j.ijrobp.2014.08.016.
PURPOSE
To investigate [18F]-fluoromisonidazole positron emission tomography/computed tomography (FMISO-PET/CT) detection of targetable hypoxic subvolumes (HSVs) in chordoma of the mobile or sacrococcygeal spine.
METHODS AND MATERIALS
A prospective, pilot study of 20 patients with primary or locally recurrent chordoma of the mobile or sacrococcygeal spine treated with proton or combined proton/photon radiation therapy (RT) with or without surgery was completed. The FMISO-PET/CT was performed before RT and after 19.8-34.2 GyRBE (relative biologic effectiveness). Gross tumor volumes were delineated and HSVs defined including voxels with standardized uptake values ≥1.4 times the muscle mean. Clinical characteristics and treatments received were compared between patients with and without HSVs.
RESULTS
The FMISO-PET/CT detected HSVs in 12 of 20 patients (60%). Baseline and interval HSV spatial concordance varied (0%-94%). Eight HSVs were sufficiently large (≥5 cm(3)) to potentially allow an intensity modulated proton therapy boost. Patients with HSVs had significantly larger gross tumor volumes (median 410.0 cm(3) vs 63.4 cm(3); P=.02) and were significantly more likely to have stage T2 tumors (5 of 12 vs 0 of 8; P=.04). After a median follow-up of 1.8 years (range, 0.2-4.4 years), a local recurrence has yet to be observed. Three patients developed metastatic disease, 2 with HSVs.
CONCLUSIONS
Detection of targetable HSVs by FMISO-PET/CT within patients undergoing RT with or without surgery for treatment of chordoma of the mobile and sacrococcygeal spine is feasible. The study's inability to attribute interval HSV changes to treatment, rapidly changing hypoxic physiology, or imaging inconsistencies is a limitation. Further study of double-baseline FMISO-PET/CT and hypoxia-directed RT dose escalation, particularly in patients at high risk for local recurrence, is warranted.
目的
研究[18F] - 氟米索硝唑正电子发射断层扫描/计算机断层扫描（FMISO - PET/CT）检测活动脊柱或骶尾椎脊索瘤中可靶向的低氧亚体积（HSV）情况。
方法与材料
完成一项针对20例活动脊柱或骶尾椎原发性或局部复发性脊索瘤患者的前瞻性初步研究，这些患者接受了质子治疗或质子/光子联合放射治疗（RT），部分患者还接受了手术。在放疗前及19.8 - 34.2 GyRBE（相对生物效应）放疗后进行FMISO - PET/CT检查。勾勒出大体肿瘤体积并定义HSV，包括标准化摄取值≥肌肉平均值1.4倍的体素。比较有和没有HSV的患者的临床特征和接受的治疗情况。
结果
20例患者中有12例（60%）通过FMISO - PET/CT检测到HSV。基线和间隔期HSV的空间一致性各不相同（0% - 94%）。8个HSV足够大（≥5 cm³），有可能进行调强质子治疗增敏。有HSV的患者大体肿瘤体积明显更大（中位数410.0 cm³对63.4 cm³；P = 0.02），且更有可能患有T2期肿瘤（12例中有5例对8例中有0例；P = 0.04）。中位随访1.8年（范围0.2 - 4.4年）后，尚未观察到局部复发。3例患者发生转移，其中2例有HSV。
结论
对于接受或未接受手术治疗的活动脊柱和骶尾椎脊索瘤患者，通过FMISO - PET/CT检测可靶向的HSV是可行的。该研究无法将间隔期HSV变化归因于治疗、快速变化的低氧生理学或成像不一致是一个局限性。有必要进一步研究双基线FMISO - PET/CT和低氧导向放疗剂量递增，特别是在局部复发高危患者中。
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