Rudžianskas Viktoras, Korobeinikova Erika, Rudžianskienė Milda, Jaselskė Evelina, Adlienė Diana, Šedienė Severina, Kulakienė Ilona, Padervinskis Evaldas, Jurkienė Nemira, Juozaitytė Elona
Oncology Institute of Lithuanian University of Health Sciences, Eivenių g. 2, 50009 Kaunas, Lithuania.
Faculty of Mathematics and Natural Sciences, Department of Physics, Kaunas University of Technology, Studentų g. 50, 51368 Kaunas, Lithuania.
Medicina (Kaunas). 2018 Dec 10;54(6):107. doi: 10.3390/medicina54060107.
Induction chemotherapy (ICT) before definitive chemoradiation (CRT) gives high response rates in locally advanced squamous cell carcinoma of the head and neck (LA-SCCHN). However, pre-ICT gross tumor volume (GTV) for radiotherapy (RT) planning is still recommended. As F-FDG PET/CT has an advantage of biological tumor information comparing to standard imaging methods, we aimed to evaluate the feasibility of F-FDG PET/CT-based post-ICT GTV delineation for RT planning in LA-SCCHN and to assess the prognostic value of PET parameters: maximum standardized uptake value (SUV), metabolic tumor volume (MTV) and total lesion glycolysis (TLG). 47 LA-SCCHN patients were treated with 3 cycles of ICT (docetaxel, cisplatin, and 5-fluorouracil) followed by CRT (70 Gy in 35 fractions with weekly cisplatin). Pre- and post-ICT PET/CT examinations were acquired. Planning CT was co-registered with post-ICT PET/CT and RT target volumes were contoured according to post-ICT PET. Post-ICT percentage decrease of SUV, MTV and TLG in primary tumor and metastatic regional lymphnodes (LN) was counted. Loco-regional failure patterns, 3-year progression free (PFS) and overall survival (OS) were evaluated. 3-year PFS and OS rates for study population were 67% and 61% respectively. 31.9% of patients progressed loco-regionally. All progress was localized in high-to-intermediate dose (60⁻70 Gy) RT volumes and none in low dose (50 Gy) volumes. Decrease of SUV ≥ 74% ( = 0.04), MTV ≥ 68% ( = 0.03), TLG ≥ 76% ( = 0.03) in primary tumor, and LN TLG decrease ≥ 74% ( = 0.03) were associated with PFS. Decrease of primary tumor SUV ≥ 74% ( = 0.04), MTV ≥ 69% ( = 0.03), TLG ≥ 74% ( = 0.02) and LN TLG ≥ 73% ( = 0.02) were prognostic factors for OS. According to our results, F-FDG PET/CT-based post-ICT GTV delineation is feasible strategy without negative impacts on loco-regional control and survival. Percentage decrease of metabolic PET parameters SUV, MTV and TLG has a prognostic value in LA-SCCHN.
在确定性放化疗（CRT）之前进行诱导化疗（ICT），对于局部晚期头颈部鳞状细胞癌（LA-SCCHN）可产生较高的缓解率。然而，仍建议在ICT前确定放疗（RT）计划的大体肿瘤体积（GTV）。由于F-FDG PET/CT与标准成像方法相比具有提供肿瘤生物学信息的优势，我们旨在评估基于F-FDG PET/CT在LA-SCCHN中进行ICT后GTV勾画用于RT计划的可行性，并评估PET参数的预后价值：最大标准化摄取值（SUV）、代谢肿瘤体积（MTV）和总病变糖酵解（TLG）。47例LA-SCCHN患者接受3个周期的ICT（多西他赛、顺铂和5-氟尿嘧啶），随后进行CRT（35次分割给予70 Gy，每周给予顺铂）。在ICT前后进行PET/CT检查。将计划CT与ICT后的PET/CT进行配准，并根据ICT后的PET勾画RT靶区体积。计算原发肿瘤和转移区域淋巴结（LN）中SUV、MTV和TLG在ICT后的下降百分比。评估局部区域失败模式、3年无进展生存期（PFS）和总生存期（OS）。研究人群的3年PFS率和OS率分别为67%和61%。31.9%的患者出现局部区域进展。所有进展均局限于高至中等剂量（60⁻70 Gy）的RT靶区，低剂量（50 Gy）靶区无进展。原发肿瘤中SUV下降≥74%（ = 0.04）、MTV下降≥68%（ = 0.03）、TLG下降≥76%（ = 0.03），以及LN的TLG下降≥74%（ = 0.03）与PFS相关。原发肿瘤SUV下降≥74%（ = 0.04）、MTV下降≥69%（ = 0.03）、TLG下降≥74%（ = 0.02）以及LN的TLG下降≥73%（ = 0.02）是OS的预后因素。根据我们的结果，基于F-FDG PET/CT的ICT后GTV勾画是一种可行的策略，对局部区域控制和生存没有负面影响。代谢PET参数SUV、MTV和TLG的下降百分比在LA-SCCHN中具有预后价值。
