Sörensen A, Carles M, Bunea H, Majerus L, Stoykow C, Nicolay N H, Wiedenmann N E, Vaupel P, Meyer P T, Grosu A L, Mix M
Department of Nuclear Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106, Freiburg, Germany.
Department of Radiation Oncology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, 79106, Freiburg, Germany.
Eur J Nucl Med Mol Imaging. 2020 May;47(5):1056-1064. doi: 10.1007/s00259-019-04609-9. Epub 2019 Nov 26.
The aim of this study was to investigate whether textural features of tumour hypoxia, assessed with serial [F]fluoromisonidazole (FMISO)-PET, were able to predict clinical outcome in patients with head and neck squamous cell carcinoma (HNSCC, T1-4, N+, M0) during chemoradiotherapy (CRT).
In a preliminary evaluation of a prospective trial, tumour hypoxia was evaluated in 29 patients via serial FMISO-PET before and during CRT. All patients received an initial [F]fluorodeoxyglucose (FDG)-PET before CRT, and tumour regions were defined on this FDG-PET. The first-order metrics tumour-to-background ratio (TBR, TBR, TBR), coefficient of variation, total lesion uptake and integral non-uniformity were calculated for all scans. Further, 3 second-order (textural) features from two grey-level matrices were calculated, as well as differential non-uniformity (u). Prognostic value was examined by median split for group separation (GS) in Kaplan-Meier estimates and correlated with overall survival (OS), quantified via log-rank tests (p ≤ 0.05) and group-relative hazard ratios (HR).
Within a median follow-up of 29.6 months (95% CI: 16.8-48.0 months), no first-order metrics predicted OS with a significant GS (all p > 0.05) on any FMISO-PET scan. Only u before and in week 2 during CRT (p = 0.03, HR = 10.8 and p = 0.05, HR = 5.2) and non-uniformity from grey-level run length matrix in week 2 separated prognostic groups (p = 0.05, HR = 5.3); lower values were correlated with better OS. Further, the decrease in u from before CRT to week 2 was correlated with better OS (p = 0.04, HR = 9.4). FDG-PET before CRT did not predict outcome in any measure.
Textural features on FMISO-PET scans before CRT, in week 2 and, to a limited degree, the change of features during CRT, were able to identify head and neck squamous cell carcinoma patients with better OS, suggesting that a higher homogeneity of the degree of hypoxia in tumours could correlate with a better outcome after CRT.
本研究旨在探讨通过连续[F]氟米索硝唑（FMISO）-PET评估的肿瘤缺氧纹理特征是否能够预测头颈部鳞状细胞癌（HNSCC，T1-4，N+，M0）患者在放化疗（CRT）期间的临床结局。
在一项前瞻性试验的初步评估中，通过CRT前及CRT期间的连续FMISO-PET对29例患者的肿瘤缺氧情况进行评估。所有患者在CRT前均接受了初始[F]氟脱氧葡萄糖（FDG）-PET检查，并在该FDG-PET上确定肿瘤区域。计算所有扫描的一阶指标肿瘤与背景比值（TBR、TBR、TBR）、变异系数、总病变摄取量和积分不均匀性。此外，还计算了来自两个灰度矩阵的3个二阶（纹理）特征以及差异不均匀性（u）。通过在Kaplan-Meier估计中进行中位数分割以进行组间分离（GS）来检验预后价值，并与总生存期（OS）相关，通过对数秩检验（p≤0.05）和组相对风险比（HR）进行量化。
在中位随访29.6个月（95%CI：16.8-48.0个月）期间，在任何FMISO-PET扫描中，没有一阶指标通过显著的GS预测OS（所有p>0.05）。仅CRT前及CRT第2周时的u（p=0.03，HR=10.8和p=0.05，HR=5.2）以及第2周时灰度游程长度矩阵的不均匀性能够区分预后组（p=0.05，HR=5.3）；较低的值与更好的OS相关。此外，从CRT前到第2周u的降低与更好的OS相关（p=0.04，HR=9.4）。CRT前的FDG-PET在任何测量中均未预测结局。
CRT前、第2周时FMISO-PET扫描的纹理特征以及在一定程度上CRT期间特征的变化能够识别出OS较好的头颈部鳞状细胞癌患者，这表明肿瘤缺氧程度更高的同质性可能与CRT后更好的结局相关。
