Ho Kung-Chu, Fang Yu-Hua Dean, Chung Hsiao-Wen, Liu Yuan-Chang, Chang John Wen-Cheng, Hou Ming-Mo, Yang Cheng-Ta, Cheng Nai-Ming, Su Tzu-Pei, Yen Tzu-Chen
Graduate Institute of Biomedical Electronics and Bioinformatics, National Taiwan University, Taipei, Taiwan.
Department of Nuclear Medicine and Center for Advanced Molecular Imaging and Translation, Chang Gung Memorial Hospital and Chang Gung University, 5 Fu-Shin Street, Kueishan, Taoyuan, 333, Taiwan.
Eur J Nucl Med Mol Imaging. 2016 Nov;43(12):2155-2165. doi: 10.1007/s00259-016-3433-2. Epub 2016 Jun 3.
In this retrospective review of prospectively collected data, we sought to investigate whether early FDG-PET assessment of treatment response based on total lesion glycolysis measured using a systemic approach (TLG-S) would be superior to either local assessment with EORTC (European Organization for Research and Treatment of Cancer) criteria or single-lesion assessment with PERCIST (PET Response Criteria in Solid Tumors) for predicting clinical outcomes in patients with metastatic lung adenocarcinoma treated with erlotinib. We also examined the effect of bone flares on tumor response evaluation by single-lesion assessment with PERCIST in patients with metastatic bone lesions.
We performed a retrospective review of prospectively collected data from 23 patients with metastatic lung adenocarcinoma treated with erlotinib. All participants underwent FDG-PET imaging at baseline and on days 14 and 56 after completion of erlotinib treatment. In addition, diagnostic CT scans were performed at baseline and on day 56. FDG-PET response was assessed with TLG-S, EORTC, and PERCIST criteria. Response assessment based on RECIST 1.1 (Response Evaluation Criteria in Solid Tumors) from diagnostic CT imaging was used as the reference standard. Two-year progression-free survival (PFS) and overall survival (OS) served as the main outcome measures.
We identified 13 patients with bone metastases. Of these, four (31 %) with persistent bone uptake due to bone flares on day 14 were erroneously classified as non-responders according to the PERCIST criteria, but they were correctly classified as responders according to both the EORTC and TLG-S criteria. Patients who were classified as responders on day 14 based on TLG-S criteria had higher rates of 2-year PFS (26.7 % vs. 0 %, P = 0.007) and OS (40.0 % vs. 7.7 %, P = 0.018). Similar rates were observed in patients who showed a response on day 56 based on CT imaging according to the RECIST criteria. Patients classified as responders on day 14 according to the EORTC criteria on FDG-PET imaging had better rates of 2-year OS than did non-responders (36.4 % vs. 8.3 %, P = 0.015).
TLG-S criteria may be of greater help in predicting survival outcomes than other forms of assessment. Bone flares, which can interfere with the interpretation of treatment response based on PERCIST criteria, are not uncommon in patients with metastatic lung adenocarcinoma treated with erlotinib.
在本次对前瞻性收集数据的回顾性研究中，我们旨在探究基于全身方法测量的总病灶糖酵解（TLG-S）进行的早期氟代脱氧葡萄糖正电子发射断层显像（FDG-PET）治疗反应评估，对于预测接受厄洛替尼治疗的转移性肺腺癌患者的临床结局，是否优于采用欧洲癌症研究与治疗组织（EORTC）标准的局部评估或实体瘤PET反应标准（PERCIST）的单病灶评估。我们还研究了骨闪烁对采用PERCIST单病灶评估的转移性骨病变患者肿瘤反应评估的影响。
我们对23例接受厄洛替尼治疗的转移性肺腺癌患者的前瞻性收集数据进行了回顾性研究。所有参与者在基线时以及厄洛替尼治疗完成后的第14天和第56天接受了FDG-PET成像检查。此外，在基线时和第56天进行了诊断性CT扫描。采用TLG-S、EORTC和PERCIST标准评估FDG-PET反应。基于诊断性CT成像的实体瘤疗效评价标准（RECIST）1.1进行的反应评估用作参考标准。两年无进展生存期（PFS）和总生存期（OS）作为主要结局指标。
我们确定了13例骨转移患者。其中，4例（31%）在第14天因骨闪烁而持续存在骨摄取，根据PERCIST标准被错误地分类为无反应者，但根据EORTC和TLG-S标准被正确地分类为反应者。根据TLG-S标准在第14天被分类为反应者的患者，其两年PFS率（26.7%对0%，P = 0.007）和OS率（40.0%对7.7%，P = 0.018）更高。根据RECIST标准在第56天基于CT成像显示有反应的患者也观察到了类似的比率。根据FDG-PET成像的EORTC标准在第14天被分类为反应者的患者，其两年OS率优于无反应者（36.4%对8.3%，P = 0.015）。
TLG-S标准在预测生存结局方面可能比其他评估形式更有帮助。骨闪烁会干扰基于PERCIST标准的治疗反应解读，在接受厄洛替尼治疗的转移性肺腺癌患者中并不少见。
