18F-FDG PET/CT引导的剂量引导放疗与基于CT的调强放疗在局部晚期鼻咽癌中的应用比较

PET/CT-guided dose-painting versus CT-based intensity modulated radiation therapy in locoregional advanced nasopharyngeal carcinoma.

作者信息

Liu Feng, Xi Xu-Ping, Wang Hui, Han Ya-Qian, Xiao Feng, Hu Ying, He Qian, Zhang Lin, Xiao Qin, Liu Lin, Luo Le, Li Yun, Mo Yi, Ma Hong-Zhi

机构信息

Department of Radiation Oncology, Hunan Cancer Hospital and The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan, China.

Key Laboratory of Translational Radiation Oncology, Hunan Province Department of Radiation Oncology, Hunan Cancer Hospital and The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan, China.

出版信息

Radiat Oncol. 2017 Jan 13;12(1):15. doi: 10.1186/s13014-016-0739-y.

DOI:10.1186/s13014-016-0739-y

PMID:28587681

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5461636/

Abstract

BACKGROUND

The effect of F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT)-guided dose-painting intensity-modulated radiation therapy (IMRT) in locoregionally advanced nasopharyngeal carcinoma (NPC) is unclear. This study aimed to assess the efficacy and toxicity of such combination.

METHODS

From 2012 to 2014, 213 patients with stage III-IVB NPC received chemoradiotherapy by PET/CT-guided DP-IMRT (group A, n = 101) or CT-based IMRT (group B, n = 112). In group A, subvolume GTVnx- (gross tumor volume of nasopharynx in PET images) was defined within GTVnx (gross tumor volume of nasopharynx) as the SUV50%max isocontour; the dose to GTVnx- was escalated to DT 75.2 Gy/32 and 77.55 Gy/33 Fx, respectively, for patients with T1-2 and T3-4 disease, respectively. In group B, PGTVnx was irradiated at DT 70.4-72.6 Gy/32-33 Fx in 2.2 Gy per fraction.

RESULTS

Complete response rates were 99.0% (100/101) and 92.9% (104/112) in groups A and B, respectively (P = 0.037). Compared with CT-based IMRT, FDG-PET/CT guided DP-IMRT significantly improved 3-year local failure-free survival (LFFS, 98.8% vs. 91.3%; P = 0.032), locoregional failure-free survival (LRFFS, 97.2 vs. 91.2%; P = 0.049), distant metastasis-free survival (DMFS, 92.9% vs. 87.4%; P = 0.041), disease free survival (DFS, 87.9% vs. 82.4%; P = 0.02), and overall survival (OS, 91.8% vs. 82.6%; P = 0.049). No statistically significant differences in acute and late toxic effects were observed. Multivariate analysis showed that dose painting (PET/CT-guided DP-IMRT vs CT-based IMRT without DP) was a significant independent prognostic factor for LFFS and DFS.

CONCLUSION

FDG-PET/CT guided DP-IMRT plus chemotherapy is associated with a considerable survival benefit, without increasing toxicity in patients with locoregional advanced NPC. Further randomized trials are needed to fully assess the role of PET/CT-guided DP-IMRT.

摘要

背景

氟脱氧葡萄糖正电子发射断层扫描/计算机断层扫描（FDG-PET/CT）引导下的剂量描绘调强放射治疗（IMRT）在局部晚期鼻咽癌（NPC）中的疗效尚不清楚。本研究旨在评估这种联合治疗的疗效和毒性。

方法

2012年至2014年，213例III-IVB期NPC患者接受了PET/CT引导下的剂量描绘调强放射治疗（A组，n = 101）或基于CT的调强放射治疗（B组，n = 112）。在A组中，在PET图像上的鼻咽部大体肿瘤体积（GTVnx）内，将SUV50%max等剂量线所包含的亚体积定义为GTVnx-；T1-2期和T3-4期患者的GTVnx-剂量分别递增至DT 75.2 Gy/32次和77.55 Gy/33次分割。在B组中，计划靶区（PGTVnx）接受DT 70.4-72.6 Gy/32-33次分割，每次分割2.2 Gy。

结果

A组和B组的完全缓解率分别为99.0%（100/101）和92.9%（104/112）（P = 0.037）。与基于CT的调强放射治疗相比，FDG-PET/CT引导下的剂量描绘调强放射治疗显著提高了3年局部无复发生存率（LFFS，98.8%对91.3%；P = 0.032）、区域无复发生存率（LRFFS，97.2%对91.2%；P = 0.049）、远处转移无复发生存率（DMFS，92.9%对87.4%；P = 0.041）、无病生存率（DFS，87.9%对82.4%；P = 0.02）和总生存率（OS，91.8%对82.6%；P = 0.049）。在急性和晚期毒性方面未观察到统计学显著差异。多因素分析表明，剂量描绘（PET/CT引导下的剂量描绘调强放射治疗与无剂量描绘的基于CT的调强放射治疗相比）是LFFS和DFS的显著独立预后因素。