Lee Jeongshim, Lee Minkyung, Koom Woong Sub, Kim Hun Jung, Kim Woo Chul
Department of Radiation Oncology, Inha University Hospital, Inha University School of Medicine, Incheon.
Department of Radiation Oncology, Yonsei University College of Medicine, Seoul.
Jpn J Clin Oncol. 2018 Oct 1;48(10):920-926. doi: 10.1093/jjco/hyy115.
The prognostic value of metabolic parameters using 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) has not been established for early non-small cell lung cancer (NSCLC). Accordingly, the authors investigated the prognostic value of metabolic parameters in terms of failure patterns in patients with early NSCLC who underwent stereotactic body radiation therapy (SBRT).
Data from 35 patients with Stage I NSCLC who underwent SBRT using CyberKnife and received pretreatment FDG PET/CT between 2008 and 2016 were retrospectively reviewed. Maximum standardized uptake value (SUVmax), metabolic tumor volume, and total lesion glycolysis were measured. The significance of these parameters with regard to failure patterns was assessed.
The median follow-up was 23 months for all patients and 34 months for living patients. Ten patients experienced recurrence: three local failures, five regional failures (RF), and eight distant failures (DF). Three-year local, regional and distant control rates were 96.7%, 86.4% and 71.1%, respectively. High SUVmax (<9 vs. ≥9) was an independent predictive factor associated with increased RF (P = 0.027) and DF (P = 0.008). Furthermore, SUVmax was indicative of both progression-free (P = 0.015) and overall (P = 0.034) survival.
High SUVmax was a significant metabolic parameter associated with increased RF and DF in patients with early NSCLC who received SBRT, having a high propensity for dissemination. These results suggest that adjuvant treatment in conjunction with SBRT may be considered in patients with early NSCLC and high SUVmax.
18F-氟脱氧葡萄糖正电子发射断层扫描/计算机断层扫描（FDG PET/CT）代谢参数对早期非小细胞肺癌（NSCLC）的预后价值尚未明确。因此，作者研究了接受立体定向体部放射治疗（SBRT）的早期NSCLC患者代谢参数在失败模式方面的预后价值。
回顾性分析2008年至2016年间35例接受射波刀SBRT且治疗前接受FDG PET/CT检查的I期NSCLC患者的数据。测量最大标准化摄取值（SUVmax）、代谢肿瘤体积和总病变糖酵解。评估这些参数在失败模式方面的意义。
所有患者的中位随访时间为23个月，存活患者为34个月。10例患者出现复发：3例局部失败，5例区域失败（RF），8例远处失败（DF）。三年局部、区域和远处控制率分别为96.7%、86.4%和71.1%。高SUVmax（<9 vs.≥9）是与RF增加（P = 0.027）和DF增加（P = 0.008）相关的独立预测因素。此外，SUVmax可预示无进展生存期（P = 0.015）和总生存期（P = 0.034）。
高SUVmax是接受SBRT的早期NSCLC患者中与RF和DF增加相关的重要代谢参数，具有较高的播散倾向。这些结果表明，对于早期NSCLC且SUVmax高的患者，可考虑联合SBRT进行辅助治疗。
