Nishimura Junichi, Hasegawa Junichi, Ogawa Yoji, Miwa Hideaki, Uemura Mamoru, Haraguchi Naotsugu, Hata Taishi, Yamamoto Hirofumi, Takemasa Ichiro, Mizushima Tsunekazu, Nezu Riichiro, Doki Yuichiro, Mori Masaki
Department of Gastroenterological Surgery, Osaka University, Graduate School of Medicine, Suita, Osaka, Japan.
Department of Surgery, Osaka Rosai Hospital, Sakai, Osaka, Japan.
Surg Today. 2016 Oct;46(10):1152-8. doi: 10.1007/s00595-015-1297-x. Epub 2015 Dec 28.
Early detection of a response to neoadjuvant chemotherapy for locally advanced rectal cancer may spare patients from additional toxic but ineffective chemotherapy. Using (18)F-fluorodeoxyglucose positron emission tomography ((18)F-FDG PET), we evaluated tumor response prospectively in the early course of preoperative chemotherapy.
The subjects were 15 patients who received neoadjuvant chemotherapy (XELOX or XELOX plus bevacizumab) for locally advanced rectal cancer. Patients underwent (18)F-FDG PET before chemotherapy, at the end of the first cycle of chemotherapy, and before surgical resection. Magnetic resonance imaging (MRI) was performed before chemotherapy, after the second cycle of chemotherapy, and before resection. After resection, the SUVmax and diameter were compared and graded according to the tumor regression grade (TRG).
The TRG was assessed as TRG1 in one patient, TRG2 in five patients, and TRG3 in nine patients. We divided the patients into two groups: non-responders (NR) included the TRG1 and TRG2 patients, and responders (R) included the TRG3 patients. The tumor size before surgery was significantly smaller in the R group than in the NR group. The SUVmax at the end of the first cycle of chemotherapy and before surgical resection was significantly lower in the R group than in the NR group.
Performing (18)F-FDG PET at the end of the first cycle of chemotherapy allowed us to predict the pathological response of locally advanced rectal cancer.
早期检测局部晚期直肠癌新辅助化疗的反应，可能使患者避免接受额外的毒性但无效的化疗。我们使用（18）F-氟脱氧葡萄糖正电子发射断层扫描（（18）F-FDG PET），在术前化疗的早期过程中对肿瘤反应进行前瞻性评估。
研究对象为15例接受新辅助化疗（XELOX或XELOX加贝伐单抗）治疗局部晚期直肠癌的患者。患者在化疗前、化疗第一周期结束时以及手术切除前接受（18）F-FDG PET检查。在化疗前、化疗第二周期后以及切除前进行磁共振成像（MRI）检查。切除后，根据肿瘤退缩分级（TRG）比较SUVmax和直径并进行分级。
TRG评估为1级的患者1例，2级的患者5例，3级的患者9例。我们将患者分为两组：无反应者（NR）包括TRG1和TRG2患者，反应者（R）包括TRG3患者。R组手术前的肿瘤大小明显小于NR组。R组化疗第一周期结束时和手术切除前的SUVmax明显低于NR组。
在化疗第一周期结束时进行（18）F-FDG PET检查，使我们能够预测局部晚期直肠癌的病理反应。
