McGarry Ronald C, Feddock Jonathan, Sinha Partha, Conrad Gary, Shelton Brent J, Chen Li, Arnold Susanne M, Rinehart John
Department of Radiation Medicine, University of Kentucky, Lexington, Kentucky, USA.
Department of Radiology. University of Kentucky, Lexington, Kentucky, USA.
J Radiosurg SBRT. 2013;2(4):315-323.
Chemoradiation remains the standard of care for the nonsurgical treatment of advanced non-small cell lung cancer (NSCLC) but local recurrence rates of 30-40% are documented. We examined the early PET/CT responses of NSCLC treated with standard chemoradiation in a prospective single institutional trial of early F-2-deoxy-D-glucose-PET/CT scans to help define patients appropriate for dose escalation with SBRT. 48 patients with stage IIA, IIB or IIIA-B NSCLC with no or non-bulky (</= 3.0 cm) lymphadenopathy were included. Approximately one month following chemoradiation, PET-CT was performed to assess responses. Since many patients came from outside facilities, the ability to directly compare pre- and post therapy PET/CT SUV values is compromised. Thus, patients had their pre- and post-chemoradiation PET/CT SUV's assessed where possible, but also reviewed in a blinded manner by two experienced nuclear medicine physicians who scored the results on a subjective scale of FDG uptake to assess treatment responses. A high level of agreement was found between the reading nuclear medicine physicians: 0.76 (95% CI of 0.6 to 0.92). Disease progression occurred in 16% of scans including new metastatic or regional failures. 77% of patients had significant improvement in FDG uptake in the primary tumor but only 4.2% had complete resolution. Mediastinal adenopathy had resolved or significantly improved in 90%. This good, but not complete reduction of FDG uptake in the primary tumor suggests that it may be an appropriate target for local intensified radiation boost.
放化疗仍然是晚期非小细胞肺癌（NSCLC）非手术治疗的标准方案，但有文献记载其局部复发率为30%-40%。我们在一项关于早期F-2-脱氧-D-葡萄糖-PET/CT扫描的前瞻性单机构试验中，研究了接受标准放化疗的NSCLC患者的早期PET/CT反应，以帮助确定适合进行立体定向体部放疗（SBRT）剂量递增的患者。纳入了48例IIA期、IIB期或IIIA-B期NSCLC患者，这些患者无或有非肿大（≤3.0 cm）淋巴结病。放化疗后约1个月，进行PET-CT以评估反应。由于许多患者来自外部机构，直接比较治疗前和治疗后PET/CT的SUV值的能力受到影响。因此，尽可能评估患者放化疗前后的PET/CT SUV值，但也由两位经验丰富的核医学医师以盲法进行审查，他们根据FDG摄取的主观量表对结果进行评分以评估治疗反应。发现阅片的核医学医师之间的一致性水平较高：0.76（95%CI为0.6至0.92）。16%的扫描显示疾病进展，包括新的转移或区域失败。77%的患者原发肿瘤的FDG摄取有显著改善，但只有4.2%完全消退。纵隔淋巴结病已消退或显著改善的比例为90%。原发肿瘤中FDG摄取的这种良好但不完全降低表明它可能是局部强化放疗增敏的合适靶点。
