Department of Radiation Oncology, Xiamen Cancer Hospital, The First Affiliated Hospital of Xiamen University, Xiamen, China.
PET Center, Institute of Radiopharmaceutical Cancer Research, Helmholtz-Zentrum Dresden-Rossendorf, Dresden, Germany.
Eur J Nucl Med Mol Imaging. 2018 Sep;45(10):1752-1761. doi: 10.1007/s00259-018-3996-1. Epub 2018 Apr 21.
F-FDG uptake in irradiated non-tumour-affected oesophagus (NTO) on restaging PET is a potential surrogate for the measurement of radiation-induced inflammation. Radiation-induced inflammation itself has been shown to be of high prognostic relevance in patients undergoing preoperative radiochemotherapy (RCT) for locally advanced oesophageal cancer. We assessed the prognostic relevance of FDG uptake in the NTO in an independent cohort of patients treated with definitive RCT.
This retrospective evaluation included 72 patients with oesophageal squamous cell carcinoma treated with definitive RCT with curative intent. All patients underwent pretreatment and restaging FDG PET after receiving a radiation dose of 40-50 Gy. Standardized uptake values (SUV/SUV), metabolic tumour volume (MTV) and relative changes from pretreatment to restaging PET (∆SUV/∆SUV) were determined within the tumour and NTO. Univariate Cox regression with respect to overall survival (OS), local control (LC), distant metastases (DM) and treatment failure (TF) was performed. Independence of parameters was tested by multivariate Cox regression.
∆SUV NTO and MTV were prognostic factors for all investigated clinical endpoints (OS, LC, DM, TF). Inclusion of clinical and PET tumour parameters in multivariate analysis showed that ∆SUV NTO was an independent prognostic factor. Furthermore, multivariate analysis of ∆SUV NTO using previously published cut-off values from preoperatively treated patients revealed that ∆SUV NTO was independent prognostic factor for OS (HR = 1.88, p = 0.038), TF (HR = 2.11, p = 0.048) and DM (HR = 3.02, p = 0.047).
NTO-related tracer uptake during the course of treatment in patients with oesophageal carcinoma was shown to be of high prognostic relevance. Thus, metabolically activity of NTO measured in terms of ∆SUV NTO is a potential candidate for future treatment individualization (i.e. organ preservation).
在重新分期 PET 时，放射性非肿瘤累及食管（NTO）的 F-FDG 摄取是测量放射性炎症的潜在替代指标。已经证明，放射性炎症本身在接受局部晚期食管癌术前放化疗（RCT）的患者中具有很高的预后相关性。我们评估了在接受确定性 RCT 治疗的独立患者队列中 NTO 中 FDG 摄取的预后相关性。
本回顾性评估纳入了 72 例接受根治性 RCT 治疗的食管鳞状细胞癌患者。所有患者在接受 40-50 Gy 放射剂量后接受了预处理和重新分期 FDG PET。在肿瘤和 NTO 内确定标准化摄取值（SUV/SUV）、代谢肿瘤体积（MTV）和从预处理到重新分期 PET 的相对变化（∆SUV/∆SUV）。针对总生存期（OS）、局部控制（LC）、远处转移（DM）和治疗失败（TF）进行了单变量 Cox 回归分析。通过多变量 Cox 回归测试参数的独立性。
∆SUV NTO 和 MTV 是所有研究临床终点（OS、LC、DM、TF）的预后因素。将临床和 PET 肿瘤参数纳入多变量分析表明，∆SUV NTO 是一个独立的预后因素。此外，对使用来自先前接受治疗患者的已发表临界值的 ∆SUV NTO 进行的多变量分析显示，∆SUV NTO 是 OS（HR=1.88，p=0.038）、TF（HR=2.11，p=0.048）和 DM（HR=3.02，p=0.047）的独立预后因素。
在食管癌患者治疗过程中 NTO 相关示踪剂摄取被证明具有很高的预后相关性。因此，用 ∆SUV NTO 衡量的 NTO 代谢活性是未来个体化治疗（即器官保存）的潜在候选者。
