Decazes P, Thureau S, Modzelewski R, Damilleville-Martin M, Bohn P, Vera P
Département de médecine nucléaire, centre Henri-Becquerel, 1, rue d'Amiens, 76038 Rouen, France; QuantIF-Litis, EA 4108, faculté de médecine, université de Rouen, 22, boulevard Gambetta, 76000 Rouen, France.
Département de médecine nucléaire, centre Henri-Becquerel, 1, rue d'Amiens, 76038 Rouen, France; QuantIF-Litis, EA 4108, faculté de médecine, université de Rouen, 22, boulevard Gambetta, 76000 Rouen, France; Département de radiothérapie et de physique médicale, centre Henri-Becquerel, 1, rue d'Amiens, 76038 Rouen, France.
Cancer Radiother. 2020 Aug;24(5):388-397. doi: 10.1016/j.canrad.2020.02.007. Epub 2020 May 21.
The assessment of tumour response during and after radiotherapy determines the subsequent management of patients (adaptation of treatment plan, monitoring, adjuvant treatment, rescue treatment or palliative care). In addition to its role in extension assessment and therapeutic planning, positron emission tomography combined with computed tomography provides useful functional information for the evaluation of tumour response. The objective of this article is to review published data on positron emission tomography combined with computed tomography as a tool for evaluating external radiotherapy for cancers. Data on positron emission tomography combined with computed tomography scans acquired at different times (during, after initial and after definitive [chemo-]radiotherapy, during post-treatment follow-up) in solid tumours (lung, head and neck, cervix, oesophagus, prostate and rectum) were collected and analysed. Recent recommendations of the National Comprehensive Cancer Network are also reported. Positron emission tomography combined with computed tomography with (F)-labelled fluorodeoxyglucose has a well-established role in clinical routine after chemoradiotherapy for locally advanced head and neck cancers, particularly to limit the number of neck lymph node dissection. This imaging modality also has a place for the evaluation of initial chemoradiotherapy of oesophageal cancer, including the detection of distant metastases, and for the post-therapeutic evaluation of cervical cancer. Several radiotracers for positron emission tomography combined with computed tomography, such as choline, are also recommended for patients with prostate cancer with biochemical failure. (F)-fluorodeoxyglucose positron emission tomography combined with computed tomography is optional in many other circumstances and its clinical benefits, possibly in combination with MRI, to assess response to radiotherapy remain a very active area of research.
放疗期间及放疗后的肿瘤反应评估决定了患者后续的治疗管理（调整治疗计划、监测、辅助治疗、挽救治疗或姑息治疗）。正电子发射断层扫描结合计算机断层扫描除了在评估肿瘤范围和制定治疗计划方面发挥作用外，还能为评估肿瘤反应提供有用的功能信息。本文的目的是综述已发表的关于正电子发射断层扫描结合计算机断层扫描作为评估癌症外照射放疗工具的数据。收集并分析了实体瘤（肺癌、头颈癌、宫颈癌、食管癌、前列腺癌和直肠癌）在不同时间（放疗期间、初始放疗后和根治性[化疗-]放疗后、治疗后随访期间）进行正电子发射断层扫描结合计算机断层扫描的数据。还报告了美国国立综合癌症网络的最新建议。正电子发射断层扫描结合计算机断层扫描及（F）标记的氟脱氧葡萄糖在局部晚期头颈癌放化疗后的临床常规应用中具有明确作用，尤其是可减少颈部淋巴结清扫的数量。这种成像方式在评估食管癌的初始放化疗（包括检测远处转移）以及宫颈癌的治疗后评估中也有一席之地。对于生化指标异常的前列腺癌患者，也推荐使用几种用于正电子发射断层扫描结合计算机断层扫描的放射性示踪剂，如胆碱。在许多其他情况下，（F）-氟脱氧葡萄糖正电子发射断层扫描结合计算机断层扫描是可选的，其结合MRI评估放疗反应的临床益处仍是一个非常活跃的研究领域。
