Department of Radiation Oncology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Germany.
German Cancer Consortium (DKTK), Dresden, Germany.
Eur J Nucl Med Mol Imaging. 2017 Oct;44(11):1813-1822. doi: 10.1007/s00259-017-3742-0. Epub 2017 Jun 9.
Early side effects including oesophagitis are potential prognostic factors in patients undergoing radiochemotherapy (RCT) for locally advanced oesophageal cancer (LAEC). We assessed the prognostic value of F-fluorodeoxyglucose (FDG) uptake within irradiated non-tumour-affected oesophagus (NTO) during restaging positron emission tomography (PET) as a surrogate for inflammation/oesophagitis.
This retrospective evaluation included 64 patients with LAEC who had completed neoadjuvant RCT and had successful oncological resection. All patients underwent FDG PET/CT before and after RCT. In the restaging PET scan maximum and mean standardized uptake values (SUV, SUV) were determined in the tumour and NTO. Univariate Cox regression with respect to overall survival, local control, distant metastases and treatment failure was performed. Independence of clinically relevant parameters was tested in a multivariate Cox regression analysis.
Increased FDG uptake, measured in terms of SUV in NTO during restaging was significantly associated with complete pathological remission (p = 0.002) and did not show a high correlation with FDG response of the tumour (rho < 0.3). In the univariate analysis, increased SUV and SUV in NTO was associated with improved overall survival (p = 0.011, p = 0.004), better local control (p = 0.051, p = 0.044), a lower rate of treatment failure (p < 0.001 for both) and development of distant metastases (p = 0.012, p = 0.001). In the multivariate analysis, SUV and SUV in NTO remained a significant prognostic factor for treatment failure (p < 0.001, p = 0.004) and distant metastases (p = 0.040, p = 0.011).
FDG uptake in irradiated normal tissues measured on restaging PET has significant prognostic value in patients undergoing neoadjuvant RCT for LAEC. This effect may potentially be of use in treatment personalization.
在接受局部晚期食管癌（LAEC）放化疗（RCT）的患者中，早期副作用（包括食管炎）是潜在的预后因素。我们评估了再分期正电子发射断层扫描（PET）中照射非肿瘤受累食管（NTO）内 F-氟脱氧葡萄糖（FDG）摄取作为炎症/食管炎替代物的预后价值。
本回顾性评估纳入了 64 例接受新辅助 RCT 且成功进行了肿瘤切除的 LAEC 患者。所有患者在 RCT 前后均接受了 FDG PET/CT 检查。在再分期 PET 扫描中，在肿瘤和 NTO 中确定了最大和平均标准化摄取值（SUV，SUV）。进行了针对总生存期、局部控制、远处转移和治疗失败的单因素 Cox 回归。在多因素 Cox 回归分析中测试了临床相关参数的独立性。
再分期时 NTO 中 FDG 摄取（以 SUV 表示）的增加与完全病理缓解显著相关（p=0.002），且与肿瘤 FDG 反应相关性不高（rho<0.3）。在单因素分析中，NTO 中 SUV 和 SUV 的增加与总生存期的改善相关（p=0.011，p=0.004）、局部控制更好（p=0.051，p=0.044）、治疗失败率降低（p<0.001）和远处转移的发展（p=0.012，p=0.001）。在多因素分析中，NTO 中 SUV 和 SUV 仍然是治疗失败（p<0.001，p=0.004）和远处转移（p=0.040，p=0.011）的显著预后因素。
在接受新辅助 RCT 的 LAEC 患者中，再分期 PET 上测量的照射正常组织中 FDG 的摄取具有显著的预后价值。这种效应可能在治疗个体化中具有潜在的应用价值。
