用于Ⅲ期非小细胞肺癌患者预后评估及早期进展检测的放疗中期PET/CT
Mid-radiotherapy PET/CT for prognostication and detection of early progression in patients with stage III non-small cell lung cancer.
作者信息
Gensheimer Michael F, Hong Julian C, Chang-Halpenny Christine, Zhu Hui, Eclov Neville C W, To Jacqueline, Murphy James D, Wakelee Heather A, Neal Joel W, Le Quynh-Thu, Hara Wendy Y, Quon Andrew, Maxim Peter G, Graves Edward E, Olson Michael R, Diehn Maximilian, Loo Billy W
机构信息
Department of Radiation Oncology, Stanford University, USA; Stanford Cancer Institute, Stanford University School of Medicine, USA.
Department of Radiation Oncology, Stanford University, USA; Department of Radiation Oncology, Duke University, Durham, USA.
出版信息
Radiother Oncol. 2017 Nov;125(2):338-343. doi: 10.1016/j.radonc.2017.08.007. Epub 2017 Aug 19.
BACKGROUND AND PURPOSE
Pre- and mid-radiotherapy FDG-PET metrics have been proposed as biomarkers of recurrence and survival in patients treated for stage III non-small cell lung cancer. We evaluated these metrics in patients treated with definitive radiation therapy (RT). We also evaluated outcomes after progression on mid-radiotherapy PET/CT.
MATERIAL AND METHODS
Seventy-seven patients treated with RT with or without chemotherapy were included in this retrospective study. Primary tumor and involved nodes were delineated. PET metrics included metabolic tumor volume (MTV), total lesion glycolysis (TLG), and SUV. For mid-radiotherapy PET, both absolute value of these metrics and percentage decrease were analyzed. The influence of PET metrics on time to death, local recurrence, and regional/distant recurrence was assessed using Cox regression.
RESULTS
91% of patients had concurrent chemotherapy. Median follow-up was 14months. None of the PET metrics were associated with overall survival. Several were positively associated with local recurrence: pre-radiotherapy MTV, and mid-radiotherapy MTV and TLG (p=0.03-0.05). Ratio of mid- to pre-treatment SUV was associated with regional/distant recurrence (p=0.02). 5/77 mid-radiotherapy scans showed early out-of-field progression. All of these patients died.
CONCLUSIONS
Several PET metrics were associated with risk of recurrence. Progression on mid-radiotherapy PET/CT was a poor prognostic factor.
背景与目的
放疗前及放疗中期的氟代脱氧葡萄糖正电子发射断层扫描（FDG-PET）指标已被提议作为III期非小细胞肺癌患者复发和生存的生物标志物。我们对接受根治性放射治疗（RT）的患者的这些指标进行了评估。我们还评估了放疗中期PET/CT出现疾病进展后的结局。
材料与方法
本回顾性研究纳入了77例接受RT联合或不联合化疗的患者。勾画出原发肿瘤和受累淋巴结。PET指标包括代谢肿瘤体积（MTV）、总病变糖酵解（TLG）和标准化摄取值（SUV）。对于放疗中期PET，分析了这些指标的绝对值和下降百分比。使用Cox回归评估PET指标对死亡时间、局部复发和区域/远处复发的影响。
结果
91%的患者接受了同步化疗。中位随访时间为14个月。没有一个PET指标与总生存期相关。有几个指标与局部复发呈正相关：放疗前MTV、放疗中期MTV和TLG（p=0.03-0.05）。放疗中期与放疗前SUV的比值与区域/远处复发相关（p=0.02）。77例放疗中期扫描中有5例显示早期野外进展。所有这些患者均死亡。
结论
几个PET指标与复发风险相关。放疗中期PET/CT出现疾病进展是一个不良预后因素。
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