使用氟代阿霉素阿拉伯糖苷正电子发射断层扫描测量局部晚期宫颈癌患者的肿瘤缺氧。

Measurement of Tumor Hypoxia in Patients With Locally Advanced Cervical Cancer Using Positron Emission Tomography with F-Fluoroazomyin Arabinoside.

机构信息

Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada.

Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Quantitative Imaging for Personalized Cancer Medicine, Techna Institute, University Health Network, Toronto, Ontario, Canada.

出版信息

Int J Radiat Oncol Biol Phys. 2018 Nov 15;102(4):1202-1209. doi: 10.1016/j.ijrobp.2018.02.030. Epub 2018 Mar 2.

DOI:10.1016/j.ijrobp.2018.02.030

PMID:29680257

Abstract

PURPOSE

To assess cervical tumor hypoxia using the hypoxia tracer F-fluoroazomycin arabinoside (F-FAZA) and compare different reference tissues and thresholds for quantifying tumor hypoxia.

METHODS AND MATERIALS

Twenty-seven patients with cervical cancer were studied prospectively by positron emission tomography (PET) imaging with F-FAZA before starting standard chemoradiation. The hypoxic volume was defined as all voxels within a tumor (T) with standardized uptake values (SUVs) greater than 3 standard deviations from the mean gluteus maximus muscle SUV value (M) or SUVs greater than 1 to 1.4 times the mean SUV value of the left ventricle, a blood (B) surrogate. The hypoxic fraction was defined as the ratio of the number of hypoxic voxels to the total number of tumor voxels.

RESULTS

A F-FAZA-PET hypoxic volume could be identified in the majority of cervical tumors (89% when using T/M or T/B > 1.2 as threshold) on the 2-hour static scan. The hypoxic fraction ranged from 0% to 99% (median 31%) when defined using the T/M threshold and from 0% to 78% (median 32%) with the T/B > 1.2 threshold. Hypoxic volumes derived from the different thresholds were highly correlated (Spearman's correlation coefficient ρ between T/M and T/B > 1-1.4 were 0.82-0.91), as were hypoxic fractions (0.75-0.85). Compartmental analysis of the dynamic scans showed k, the FAZA accumulation constant, to be strongly correlated with hypoxic fraction defined using the T/M (Spearman's ρ=0.72) and T/B > 1.2 thresholds (0.76).

CONCLUSIONS

Hypoxia was detected in the majority of cervical tumors on F-FAZA-PET imaging. The extent of hypoxia varied markedly between tumors but not significantly with different reference tissues/thresholds.

摘要

目的

使用缺氧示踪剂 F-氟代阿霉素阿拉伯糖苷（F-FAZA）评估宫颈肿瘤的缺氧情况，并比较不同的参考组织和量化肿瘤缺氧的阈值。

方法和材料

27 例宫颈癌患者在开始标准放化疗前前瞻性地进行 F-FAZA 正电子发射断层扫描（PET）成像。缺氧体积定义为所有肿瘤（T）内的体素，其标准化摄取值（SUVs）大于平均臀大肌 SUV 值（M）的 3 个标准差，或 SUVs 大于 1 至 1.4 倍的左心室平均 SUV 值，作为血液（B）替代物。缺氧分数定义为缺氧体素数与肿瘤体素总数的比值。

结果

在大多数宫颈肿瘤（89%，当使用 T/M 或 T/B>1.2 作为阈值时）的 2 小时静态扫描中，可以识别出 F-FAZA-PET 缺氧体积。当使用 T/M 阈值定义时，缺氧分数范围从 0%到 99%（中位数为 31%），当使用 T/B>1.2 阈值时，缺氧分数范围从 0%到 78%（中位数为 32%）。不同阈值衍生的缺氧体积高度相关（T/M 和 T/B>1-1.4 之间的 Spearman 相关系数ρ为 0.82-0.91），缺氧分数也高度相关（0.75-0.85）。动态扫描的房室分析显示，FAZA 积累常数 k 与使用 T/M（Spearman 的ρ=0.72）和 T/B>1.2 阈值（0.76）定义的缺氧分数强烈相关。