Markovina Stephanie, Duan Fenghai, Snyder Bradley S, Siegel Barry A, Machtay Mitchell, Bradley Jeffrey D
Mallinckrodt Institute of Radiology and Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, Missouri.
Department of Biostatistics and Center for Statistical Sciences, Brown University School of Public Health, Providence, Rhode Island.
Int J Radiat Oncol Biol Phys. 2015 Nov 1;93(3):597-605. doi: 10.1016/j.ijrobp.2015.04.026.
The American College of Radiology Imaging Network (ACRIN) 6668/Radiation Therapy Oncology Group (RTOG) 0235 study demonstrated that standardized uptake values (SUV) on post-treatment [(18)F]fluorodeoxyglucose-positron emission tomography (FDG-PET) correlated with survival in locally advanced non-small cell lung cancer (NSCLC). This secondary analysis determined whether SUV of regional lymph nodes (RLNs) on post-treatment FDG-PET correlated with patient outcomes.
Included for analysis were patients treated with concurrent chemoradiation therapy, using radiation doses ≥60 Gy, with identifiable FDG-avid RLNs (distinct from primary tumor) on pretreatment FDG-PET, and post-treatment FDG-PET data. ACRIN core laboratory SUV measurements were used. Event time was calculated from the date of post-treatment FDG-PET. Local-regional failure was defined as failure within the treated RT volume and reported by the treating institution. Statistical analyses included Wilcoxon signed rank test, Kaplan-Meier curves (log rank test), and Cox proportional hazards regression modeling.
Of 234 trial-eligible patients, 139 (59%) had uptake in both primary tumor and RLNs on pretreatment FDG-PET and had SUV data from post-treatment FDG-PET. Maximum SUV was greater for primary tumor than for RLNs before treatment (P<.001) but not different post-treatment (P=.320). Post-treatment SUV of RLNs was not associated with overall survival. However, elevated post-treatment SUV of RLNs, both the absolute value and the percentage of residual activity compared to the pretreatment SUV were associated with inferior local-regional control (P<.001).
High residual metabolic activity in RLNs on post-treatment FDG-PET is associated with worse local-regional control. Based on these data, future trials evaluating a radiation therapy boost should consider inclusion of both primary tumor and FDG-avid RLNs in the boost volume to maximize local-regional control.
美国放射学会影像网络（ACRIN）6668/放射治疗肿瘤学组（RTOG）0235研究表明，治疗后[¹⁸F]氟脱氧葡萄糖正电子发射断层扫描（FDG-PET）的标准化摄取值（SUV）与局部晚期非小细胞肺癌（NSCLC）的生存率相关。这项二次分析确定了治疗后FDG-PET上区域淋巴结（RLN）的SUV是否与患者预后相关。
纳入分析的患者接受了同步放化疗，放疗剂量≥60 Gy，在治疗前FDG-PET上有可识别的FDG摄取阳性的RLN（与原发肿瘤不同），且有治疗后FDG-PET数据。使用ACRIN核心实验室的SUV测量值。事件时间从治疗后FDG-PET日期开始计算。局部区域失败定义为治疗的放疗体积内的失败，并由治疗机构报告。统计分析包括Wilcoxon符号秩检验、Kaplan-Meier曲线（对数秩检验）和Cox比例风险回归建模。
在234例符合试验条件的患者中，139例（59%）在治疗前FDG-PET上原发肿瘤和RLN均有摄取，并具有治疗后FDG-PET的SUV数据。治疗前原发肿瘤的最大SUV大于RLN（P<0.001），但治疗后无差异（P=0.320）。RLN的治疗后SUV与总生存率无关。然而，RLN治疗后SUV升高，无论是绝对值还是与治疗前SUV相比的残留活性百分比，均与较差的局部区域控制相关（P<0.001）。
治疗后FDG-PET上RLN的高残留代谢活性与较差的局部区域控制相关。基于这些数据，未来评估放疗加量的试验应考虑在加量体积中纳入原发肿瘤和FDG摄取阳性的RLN，以最大限度地提高局部区域控制。
