Schwarzenböck Sarah M, Eiber Matthias, Kundt Günther, Retz Margitta, Sakretz Monique, Kurth Jens, Treiber Uwe, Nawroth Roman, Rummeny Ernst J, Gschwend Jürgen E, Schwaiger Markus, Thalgott Mark, Krause Bernd J
Department of Nuclear Medicine, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany.
Department of Nuclear Medicine, Rostock University Medical Centre, Gertrudenplatz 1, 18057, Rostock, Germany.
Eur J Nucl Med Mol Imaging. 2016 Nov;43(12):2105-2113. doi: 10.1007/s00259-016-3439-9. Epub 2016 Jun 17.
The aim of this study was to prospectively evaluate the value of [C] Choline PET/CT in monitoring early and late response to a standardized first-line docetaxel chemotherapy in castration refractory prostate cancer (mCRPC) patients.
Thirty-two patients were referred for [C] Choline PET/CT before the start of docetaxel chemotherapy, after one and ten chemotherapy cycles (or - in case of discontinuation - after the last administered cycle) for therapy response assessment. [C] Choline uptake (SUV, SUV), CT derived Houndsfield units (HU, HU), and volume of bone, lung, and nodal metastases and local recurrence were measured semi-automatically at these timepoints. Change in SUV, SUV, HU, HU and volume was assessed between PET 2 and 1 (early response assessment, ERA) and PET 3 and 1 (late response assessment, LRA) on a patient and lesion basis. Results of PET/CT were compared to clinically used RECIST 1.1 and clinical criteria based therapy response assessment including PSA for defining progressive disease (PD) and non-progressive disease (nPD), respectively. Relationships between changes of SUV and SUV (early and late) and changes of PSA and PSA were evaluated. Prognostic value of initial SUV and SUV was assessed. Statistical analyses were performed using SPSS.
In the patient-based ERA and LRA there were no statistically significant differences in change of choline uptake, HU, and volume between PD and nPD applying RECIST or clinical response criteria. In the lesion-based ERA, decrease in choline uptake of bone metastases was even higher in PD (applying RECIST criteria), whereas in LRA the decrease was higher in nPD (applying clinical criteria). There were only significant correlations between change in choline uptake and PSA in ERA in PD, in LRA no significant correlations were discovered. Initial SUV and SUV were statistically significantly higher in nPD (applying clinical criteria).
There is no significant correlation between change in choline uptake in [C] Choline PET/CT and clinically routinely used objective response assessment during the early and late course of docetaxel chemotherapy. Therefore, [C] Choline PET/CT seems to be of limited use in therapy response assessment in standardized first-line chemotherapy in mCRPC patients.
本研究旨在前瞻性评估[C]胆碱PET/CT在监测去势抵抗性前列腺癌（mCRPC）患者标准化一线多西他赛化疗的早期和晚期反应中的价值。
32例患者在多西他赛化疗开始前、化疗1个周期和10个周期后（或 - 如果停药 - 在最后给药周期后）接受[C]胆碱PET/CT检查以评估治疗反应。在这些时间点半自动测量[C]胆碱摄取（SUV，SUV）、CT衍生的亨氏单位（HU，HU）以及骨、肺和淋巴结转移灶及局部复发的体积。在患者和病灶基础上评估PET 2和1之间（早期反应评估，ERA）以及PET 3和1之间（晚期反应评估，LRA）SUV、SUV、HU、HU和体积的变化。将PET/CT结果与临床使用的RECIST 1.1以及基于临床标准的治疗反应评估进行比较，后者分别包括用于定义疾病进展（PD）和非进展性疾病（nPD）的PSA。评估SUV和SUV（早期和晚期）变化与PSA和PSA变化之间的关系。评估初始SUV和SUV的预后价值。使用SPSS进行统计分析。
在基于患者的ERA和LRA中，应用RECIST或临床反应标准时，PD和nPD之间胆碱摄取、HU和体积的变化无统计学显著差异。在基于病灶的ERA中，PD（应用RECIST标准）中骨转移灶胆碱摄取的降低甚至更高，而在LRA中，nPD（应用临床标准）中的降低更高。在ERA中，仅PD患者的胆碱摄取变化与PSA之间存在显著相关性，在LRA中未发现显著相关性。nPD（应用临床标准）的初始SUV和SUV在统计学上显著更高。
在多西他赛化疗的早期和晚期过程中，[C]胆碱PET/CT中胆碱摄取的变化与临床常规使用的客观反应评估之间无显著相关性。因此，[C]胆碱PET/CT在mCRPC患者标准化一线化疗的治疗反应评估中似乎用途有限。
