Nuclear Medicine Department, Caen University Hospital, 14000, Caen, France.
Radiology Department, University Hospital, Caen, France.
Mol Imaging Biol. 2018 Jun;20(3):482-491. doi: 10.1007/s11307-017-1132-4.
The purpose of this study is to identify predictive factors on baseline [F]NaF positron emission tomography (PET)/computed tomography (CT) of early response to radium-223 dichloride after 3 cycles of treatment in metastatic castration-resistant prostate cancer patients.
Analysis of 152 metastases was performed in six consecutive patients who underwent [F]NaF PET/CT at baseline and for early monitoring after 3 cycles of radium-223 dichloride. All metastases depicted on whole-body [F]NaF PET/CT were contoured and CT (density in Hounsfield units, sclerotic, mixed, or lytic appearance) as well as [F]NaF [maximum standardized uptake value (SUV), SUV, and lesion volume (V)] patterns were recorded. Tumor response was defined as percentage change in SUV and SUV between baseline and post-treatment PET. Bone lesions were defined as stable, responsive, or progressive, according to thresholds derived from a recent multicentre test-retest study in [F]NaF PET/CT. Total [F]NaF uptake in metastases, defined as MATV × SUV, was correlated to uptake of radium-223 on biodistribution scintigraphy performed 7 days after the first cycle of treatment.
Among metastases, 116 involved the axial skeleton and 36 the appendicular skeleton. Lesions were sclerotic in 126 cases and mixed in 26 cases. No lytic lesion was depicted. ROC analysis showed that SUV and SUV were better predictors of lesion response than V and density on CT (P < 0.0001 and P = 0.001, respectively). SUV and SUV were predictors of individual tumor response in separate multivariate models (P = 0.01 and P = 0.02, respectively). CT pattern (mixed versus sclerotic) and lesion density were independent predictors only when assessing response with delta SUV (P = 0.002 and 0.007, respectively). A good correlation between total [F]NaF uptake within metastases and their relative radium-223 uptake assessed by two observers 7 days after treatment (r = 0.72 and 0.77, P < 0.0001) was found.
SUV and SUV on baseline [F]NaF PET/CT are independent predictors of bone lesions' response to 3 cycles of radium-223 dichloride, supporting the use of NaF to select patients more likely to respond to treatment.
本研究旨在确定镭-223 二氯化物治疗 3 周期后早期反应的基线 [F]NaF 正电子发射断层扫描（PET）/计算机断层扫描（CT）的预测因素，用于转移性去势抵抗性前列腺癌患者。
对连续 6 例接受基线 [F]NaF PET/CT 检查并在镭-223 二氯化物治疗 3 周期后进行早期监测的患者的 152 个转移灶进行分析。对全身 [F]NaF PET/CT 上显示的所有转移灶进行勾画，并记录 CT（密度单位为亨斯菲尔德单位、硬化、混合或溶骨性外观）以及 [F]NaF[最大标准化摄取值（SUV）、SUV 和病变体积（V）]模式。根据最近一项在 [F]NaF PET/CT 中进行的多中心测试-重测研究中得出的阈值，将肿瘤反应定义为 SUV 和 SUV 与基线和治疗后 PET 之间的百分比变化。根据 7 天内首次治疗后进行的生物分布闪烁扫描中镭-223 的摄取情况，将骨病变定义为稳定、有反应或进展。在转移灶中，定义为 MATV×SUV 的总 [F]NaF 摄取与治疗后第 1 周期 7 天后进行的生物分布闪烁扫描中镭-223 的摄取相关。
在转移灶中，116 个涉及轴向骨骼，36 个涉及附肢骨骼。126 例为硬化性病变，26 例为混合性病变。没有描绘出溶骨性病变。ROC 分析表明，SUV 和 SUV 比 CT 上的 SUV 和 SUV （P<0.0001 和 P=0.001）更好地预测病变反应。在单独的多变量模型中，SUV 和 SUV 是个体肿瘤反应的预测因素（P=0.01 和 P=0.02）。只有在评估 delta SUV 时，SUV 和 SUV （P=0.002 和 P=0.007）以及 CT 模式（混合性与硬化性）和病变密度才是独立的预测因素。治疗后 7 天，两位观察者评估的转移灶内总 [F]NaF 摄取与相对镭-223 摄取之间存在良好的相关性（r=0.72 和 r=0.77，P<0.0001）。
基线 [F]NaF PET/CT 上的 SUV 和 SUV 是镭-223 二氯化物治疗 3 周期后骨病变反应的独立预测因素，支持使用 NaF 来选择更有可能对治疗有反应的患者。
