Grootjans Willem, Usmanij Edwin A, Oyen Wim J G, van der Heijden Erik H F M, Visser Eric P, Visvikis Dimitris, Hatt Mathieu, Bussink Johan, de Geus-Oei Lioe-Fee
Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands; Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands.
Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands.
Radiother Oncol. 2016 Jun;119(3):473-9. doi: 10.1016/j.radonc.2016.04.039. Epub 2016 May 10.
This study evaluated the use of total lesion glycolysis (TLG) determined by different automatic segmentation algorithms, for early response monitoring in non-small cell lung cancer (NSCLC) patients during concomitant chemoradiotherapy.
Twenty-seven patients with locally advanced NSCLC treated with concomitant chemoradiotherapy underwent (18)F-fluorodeoxyglucose (FDG) PET/CT imaging before and in the second week of treatment. Segmentation of the primary tumours and lymph nodes was performed using fixed threshold segmentation at (i) 40% SUVmax (T40), (ii) 50% SUVmax (T50), (iii) relative-threshold-level (RTL), (iv) signal-to-background ratio (SBR), and (v) fuzzy locally adaptive Bayesian (FLAB) segmentation. Association of primary tumour TLG (TLGT), lymph node TLG (TLGLN), summed TLG (TLGS=TLGT+TLGLN), and relative TLG decrease (ΔTLG) with overall-survival (OS) and progression-free survival (PFS) was determined using univariate Cox regression models.
Pretreatment TLGT was predictive for PFS and OS, irrespective of the segmentation method used. Inclusion of TLGLN improved disease and early response assessment, with pretreatment TLGS more strongly associated with PFS and OS than TLGT for all segmentation algorithms. This was also the case for ΔTLGS, which was significantly associated with PFS and OS, with the exception of RTL and T40.
ΔTLGS was significantly associated with PFS and OS, except for RTL and T40. Inclusion of TLGLN improves early treatment response monitoring during concomitant chemoradiotherapy with FDG-PET.
本研究评估了通过不同自动分割算法确定的总病灶糖酵解（TLG）在非小细胞肺癌（NSCLC）患者同步放化疗期间早期反应监测中的应用。
27例接受同步放化疗的局部晚期NSCLC患者在治疗前及治疗第二周接受了（18）F-氟脱氧葡萄糖（FDG）PET/CT成像。使用以下方法对原发肿瘤和淋巴结进行分割：（i）40%SUVmax的固定阈值分割（T40），（ii）50%SUVmax的固定阈值分割（T50），（iii）相对阈值水平（RTL），（iv）信号与背景比值（SBR），以及（v）模糊局部自适应贝叶斯（FLAB）分割。使用单变量Cox回归模型确定原发肿瘤TLG（TLGT）、淋巴结TLG（TLGLN）、总TLG（TLGS = TLGT + TLGLN）和相对TLG降低（ΔTLG）与总生存期（OS）和无进展生存期（PFS）的相关性。
无论使用何种分割方法，治疗前的TLGT均对PFS和OS具有预测性。纳入TLGLN可改善疾病和早期反应评估，对于所有分割算法，治疗前的TLGS与PFS和OS的相关性均比TLGT更强。ΔTLGS也是如此，除RTL和T40外，其与PFS和OS显著相关。
除RTL和T40外，ΔTLGS与PFS和OS显著相关。纳入TLGLN可改善FDG-PET同步放化疗期间的早期治疗反应监测。
