评估扩散加权磁共振成像和（18F）氟代胸苷正电子发射断层扫描生物标志物在接受新辅助化疗的可手术非小细胞肺癌患者中进行早期反应评估的作用。
Evaluation of diffusion-weighted MRI and (18F) fluorothymidine-PET biomarkers for early response assessment in patients with operable non-small cell lung cancer treated with neoadjuvant chemotherapy.
作者信息
Carlin Dominic, Weller Alexander, Kramer Gem, Liu Yan, Waterton John C, Chiti Arturo, Sollini Martina, Joop de Langen A, O'Brien Mary E R, Urbanowicz Maria, Jacobs Bart Km, deSouza Nandita
机构信息
CRUK Imaging Centre, The Institute of Cancer Research, Sutton, Surrey SM2 5NG, UK.
Department of Respiratory Diseases, VU University Medical Center, Amsterdam, The Netherlands.
出版信息
BJR Open. 2019 Jul 20;1(1):20190029. doi: 10.1259/bjro.20190029. eCollection 2019.
OBJECTIVE
To correlate changes in the apparent diffusion coefficient (ADC) from diffusion-weighted (DW)-MRI and standardised uptake value (SUV) from fluorothymidine (FLT)-PET/CT with histopathological estimates of response in patients with non-small cell lung cancer (NSCLC) treated with neoadjuvant chemotherapy and track longitudinal changes in these biomarkers in a multicentre, multivendor setting.
METHODS
14 patients with operable NSCLC recruited to a prospective, multicentre imaging trial (EORTC-1217) were treated with platinum-based neoadjuvant chemotherapy. 13 patients had DW-MRI and FLT-PET/CT at baseline (10 had both), 12 were re-imaged at Day 14 (eight dual-modality) and nine after completing chemotherapy, immediately before surgery (six dual-modality). Surgical specimens (haematoxylin-eosin and Ki67 stained) estimated the percentage of residual viable tumour/necrosis and proliferation index.
RESULTS
Despite the small numbers,significant findings were possible. ADC increased ( < 0.001) and SUV decreased ( < 0.001) significantly between baseline and Day 14; changes between Day 14 and surgery were less marked. All responding tumours (>30% reduction in unidimensional measurement pre-surgery), showed an increase at Day 14 in ADC75 centile and reduction in total lesion proliferation (SUV x proliferative volume) greater than established measurement variability. Change in imaging biomarkers did not correlate with histological response (residual viable tumour, necrosis).
CONCLUSION
Changes in ADC and FLT-SUV following neoadjuvant chemotherapy in NSCLC were measurable by Day 14 and preceded changes in unidimensional size but did not correlate with histopathological response. However, the magnitude of the changes and their utility in predicting (non-) response (tumour size/clinical outcome) remains to be established.
ADVANCES IN KNOWLEDGE
During treatment, ADC increase precedes size reductions, but does not reflect histopathological necrosis.
目的
将非小细胞肺癌（NSCLC）患者在接受新辅助化疗后，扩散加权磁共振成像（DW-MRI）的表观扩散系数（ADC）变化以及氟代胸苷（FLT）-正电子发射断层扫描/计算机断层扫描（PET/CT）的标准化摄取值（SUV）变化，与组织病理学评估的反应进行关联，并在多中心、多设备环境中追踪这些生物标志物的纵向变化。
方法
14例符合手术条件的NSCLC患者被纳入一项前瞻性多中心成像试验（欧洲癌症研究与治疗组织-1217），接受铂类新辅助化疗。13例患者在基线时进行了DW-MRI和FLT-PET/CT检查（10例同时进行了两种检查），12例患者在第14天进行了再次成像（8例为双模态成像），9例患者在完成化疗后、手术前即刻进行了成像（6例为双模态成像）。手术标本（苏木精-伊红染色和Ki67染色）评估了残留存活肿瘤/坏死的百分比和增殖指数。
结果
尽管样本量较小，但仍有显著发现。在基线和第14天之间，ADC显著增加（<0.001），SUV显著降低（<0.001）；第14天和手术之间的变化不太明显。所有有反应的肿瘤（手术前一维测量减少>30%），在第14天时ADC第75百分位数增加，总病变增殖（SUV×增殖体积）减少，且大于既定的测量变异性。成像生物标志物的变化与组织学反应（残留存活肿瘤、坏死）无关。
结论
NSCLC患者新辅助化疗后，第14天时可测量到ADC和FLT-SUV的变化，且早于一维大小的变化，但与组织病理学反应无关。然而，这些变化的幅度及其在预测（无）反应（肿瘤大小/临床结果）方面的效用仍有待确定。
知识进展
在治疗过程中，ADC升高先于肿瘤大小缩小，但并不反映组织病理学坏死。
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