Hotta Masatoshi, Minamimoto Ryogo, Yamada Kazuhiko, Nohara Kyoko, Soma Daisuke, Nakajima Kazuhiko, Toyohara Jun, Takase Kei
Division of Nuclear Medicine, Department of Radiology, National Center for Global Health and Medicine, 1-21-1, Toyama, Shinjuku-ku, Tokyo, 162-8655, Japan.
Department of Diagnostic Radiology, Tohoku University Hospital, 1-1, Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan.
EJNMMI Res. 2019 Jan 30;9(1):10. doi: 10.1186/s13550-019-0478-9.
4'-[Methyl-11C] thiothymidine (4DST) has been introduced as a new cell proliferation imaging PET tracer that incorporates into DNA directly. The aim of this prospective study was to evaluate the efficacy of 4DST PET/CT for predicting responses to neoadjuvant therapy in patients with esophageal cancer comparing with FDG PET/CT.
Twenty-six patients who had pre- and post-therapeutic 4DST and FDG PET/CT and underwent esophagectomy following neoadjuvant therapy were used for the analysis. Based on pathological findings, patients were divided into two groups: non-responders and responders. The maximum standardized uptake value (SUVmax), metabolic tumor volume, total lesion glycolysis, and total lesion proliferation of the primary lesion were measured for FDG and 4DST PET.
The pathological diagnosis revealed 16 responders and 10 non-responders. Non-responders showed significantly higher 4DST post-therapeutic SUVmax (SUVmax) than responders, whereas FDG SUVmax showed no statistically significant difference (non-responders vs. responders: 4DST, 6.7 vs. 3.3, p = 0.001; FDG, 6.1 vs. 4.5, p = 0.11). Responders showed a greater reduction in percentage changes of 4DST and FDG SUVmax (ΔSUVmax) from baseline to post-therapeutic PET (non-responders vs. responders: 4DST, - 2.9% vs. - 56.7%, p < 0.001; FDG, - 36.3% vs. - 72.6%, p < 0.001). In ROC analysis, ΔSUVmax and SUVmax with 4DST provided great diagnostic performance for predicting responses (area under the curve: 4DST ΔSUVmax = 0.92, 4DST SUVmax = 0.88).
4DST PET/CT has a great potential for predicting pathologic response to neoadjuvant therapy in patients with esophageal cancer; it may be slightly superior to that with FDG PET/CT.
4'-[甲基-11C]硫代胸腺嘧啶核苷（4DST）已作为一种新的直接掺入DNA的细胞增殖成像正电子发射断层显像（PET）示踪剂被引入。这项前瞻性研究的目的是评估4DST PET/CT与氟代脱氧葡萄糖（FDG）PET/CT相比，在预测食管癌患者新辅助治疗反应方面的效能。
26例在新辅助治疗前后均接受了4DST和FDG PET/CT检查并在新辅助治疗后接受了食管切除术的患者被纳入分析。根据病理结果，患者被分为两组：无反应者和有反应者。测量了FDG和4DST PET的原发灶的最大标准化摄取值（SUVmax）、代谢肿瘤体积、总病灶糖酵解和总病灶增殖情况。
病理诊断显示16例有反应者和10例无反应者。无反应者治疗后的4DST SUVmax显著高于有反应者，而FDG SUVmax无统计学显著差异（无反应者与有反应者：4DST，6.7对3.3，p = 0.001；FDG，6.1对4.5，p = 0.11）。有反应者从基线到治疗后PET的4DST和FDG SUVmax的百分比变化（ΔSUVmax）下降幅度更大（无反应者与有反应者：4DST，-2.9%对-56.7%，p < 0.001；FDG，-36.3%对-72.6%，p < 0.001）。在ROC分析中，4DST的ΔSUVmax和SUVmax在预测反应方面具有良好的诊断性能（曲线下面积：4DST ΔSUVmax = 0.92，4DST SUVmax = 0.88）。
4DST PET/CT在预测食管癌患者新辅助治疗的病理反应方面具有很大潜力；它可能略优于FDG PET/CT。
