Department of Radiation Oncology, Seidman Cancer Center, Case Western Reserve University School of Medicine, University Hospitals Cleveland Medical Center, United States; Department of Radiation Oncology, University of Michigan, Ann Arbor, United States.
Department of Radiation Oncology, University of Michigan, Ann Arbor, United States; Department of Radiation Oncology, Cancer Hospital, Fudan University, Shanghai, China.
Radiother Oncol. 2019 Mar;132:241-249. doi: 10.1016/j.radonc.2018.10.006. Epub 2018 Oct 30.
This study tested the hypotheses that 1) changes in mid-treatment fluorodeoxyglucose (FDG)-positron emission tomography (PET) parameters are predictive of overall survival (OS) and 2) mid-treatment FDG-PET-adapted treatment has the potential to improve survival in patients with non-small cell lung cancer (NSCLC).
Patients with stage I-III NSCLC requiring daily fractionated radiation were eligible. FDG-PET-CT scans were obtained prior to and mid-treatment with radiotherapy at 40-50 Gy. The normalized maximum standardized uptake value (NSUVmax), normalized mean SUV (NSUVmean), PET-metabolic tumor volume (MTV), total lesion glycolysis (TLG), and computed tomography-based gross tumor volume (CT-GTV) were consistently measured for all patients. The primary study endpoint was OS.
The study is comprised of 102 patients who received 3-dimensional conformal radiotherapy, among whom 30 patients who received mid-treatment PET-adapted dose escalation radiotherapy. All PET-CT parameters decreased significantly (P < 0.001) mid-treatment, with greater reductions in FDG-volumetric parameters compared to FDG-activity factors. Mid-treatment changes in MTV (P = 0.053) and TLG (P = 0.021) were associated with OS, while changes in NSUVmax, NSUVmean, and CT-GTV were not (all Ps>0.1). Patients receiving conventional radiation (60-70 Gy) with MTV reductions greater than the mean had a median survival of 14 months, compared to those with MTV reductions less than the mean who had a median survival of 22 months. By contrast, patients receiving mid-treatment PET-adapted radiation with MTV reductions greater than the mean had a median survival of 33 months, compared to those with MTV reductions less than the mean who had a median survival of 19 months. Overall, PET-adapted treatment resulted in a 19% better 5-year survival than conventional radiation.
Changes in mid-treatment PET-volumetric parameters were significantly associated with survival in NSCLC. A greater reduction in the mid-treatment MTV was associated with worse survival in patients treated with standard radiation, but with better survival in patients who received mid-treatment PET-adapted treatment.
本研究旨在验证以下两个假设：1）治疗中期氟脱氧葡萄糖（FDG）-正电子发射断层扫描（PET）参数的变化是否可预测总生存期（OS）；2）治疗中期 FDG-PET 调整的治疗是否有可能改善非小细胞肺癌（NSCLC）患者的生存。
需要每日分割放射治疗的 I-III 期 NSCLC 患者符合入组条件。在接受 40-50Gy 放射治疗前和治疗中期进行 FDG-PET-CT 扫描。对所有患者均连续测量标准化最大摄取值（NSUVmax）、标准化平均摄取值（NSUVmean）、PET 代谢肿瘤体积（MTV）、总病变糖酵解（TLG）和基于计算机断层扫描的大体肿瘤体积（CT-GTV）。主要研究终点为 OS。
本研究共纳入 102 例接受三维适形放疗的患者，其中 30 例患者接受了治疗中期的 PET 调整剂量递增放疗。所有 PET-CT 参数在治疗中期均显著降低（P<0.001），FDG 体积参数的降低幅度明显大于 FDG 活性因子。治疗中期 MTV（P=0.053）和 TLG（P=0.021）的变化与 OS 相关，而 NSUVmax、NSUVmean 和 CT-GTV 的变化与 OS 无关（所有 P>0.1）。接受常规放疗（60-70Gy）的患者，若 MTV 降低幅度大于平均值，中位生存期为 14 个月，而 MTV 降低幅度小于平均值的患者，中位生存期为 22 个月。相比之下，接受治疗中期 PET 调整放疗的患者，若 MTV 降低幅度大于平均值，中位生存期为 33 个月，而 MTV 降低幅度小于平均值的患者，中位生存期为 19 个月。总体而言，与常规放疗相比，PET 调整治疗使 5 年生存率提高了 19%。
治疗中期 PET 体积参数的变化与 NSCLC 患者的生存显著相关。在接受标准放疗的患者中，治疗中期 MTV 降低幅度较大与生存较差相关，但在接受治疗中期 PET 调整治疗的患者中，与生存较好相关。
