Westmead Hospital, Sydney, New South Wales, Australia; Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia.
Radiation Oncology - Mid North Coast Cancer Institute, Port Macquarie, New South Wales, Australia.
Int J Radiat Oncol Biol Phys. 2022 May 1;113(1):40-59. doi: 10.1016/j.ijrobp.2021.11.027. Epub 2021 Dec 5.
Posttreatment surveillance for local recurrence (LR) after stereotactic ablative body radiotherapy (SABR) can include both fluorodeoxyglucose-positron emission tomography (FDG-PET) and computed tomography (CT). Radiation-induced lung injury shares a similar appearance to LR after treatment, making the detection of LR on imaging difficult for clinicians. We aimed to summarize radiologic features of CT and FDG-PET predicting LR and to evaluate radiomics as another tool for detecting LR.
We searched MEDLINE, EMBASE, and PubMed databases for published studies and Web of Science, Wiley Online, and Science Direct databases for conference abstracts that had patient populations with non-small cell lung cancer and reported post-SABR radiologic features of FDG-PET or CT and radiomics from either FDG-PET or CT. Studies for inclusion were independently reviewed by 2 authors.
Across 32 relevant studies, the incidence of LR was 13% (222/1726). On CT, certain gross radiologic appearances and kinetic features of changes in size, diameter, volume, or 3 consecutive rises in volume of masslike consolidation are suggestive of LR. **Particular regard should be made for the presence of any ≥3 high-risk features on CT or the individual high-risk features of enlarging opacity at ≥12 month's post-SABR as being highly suspicious of LR. On FDG-PET a relative reduction of <5% of maximum standardised uptake value (SUV) from baseline in the first 12 months or cut-offs of SUV >5 and SUV >3.44 after 12 months can indicate LR. There is limited evidence available to corroborate radiomic features suggestive of LR.
This research has identified common features of LR compared with radiation-induced lung injury, which may aid in early and accurate detection of LR post-SABR; further research is required to validate these findings.
立体定向消融体放射治疗（SABR）后局部复发（LR）的治疗后监测可包括氟脱氧葡萄糖正电子发射断层扫描（FDG-PET）和计算机断层扫描（CT）。治疗后，放射性肺损伤与 LR 具有相似的表现，这使得临床医生难以在影像学上检测到 LR。我们旨在总结 CT 和 FDG-PET 预测 LR 的影像学特征，并评估放射组学作为另一种检测 LR 的工具。
我们在 MEDLINE、EMBASE 和 PubMed 数据库中搜索了发表的研究，并在 Web of Science、Wiley Online 和 Science Direct 数据库中搜索了关于非小细胞肺癌患者人群的会议摘要，并报告了 SABR 后 FDG-PET 或 CT 的影像学特征和来自 FDG-PET 或 CT 的放射组学。由 2 位作者独立对研究进行了审查。
在 32 项相关研究中，LR 的发生率为 13%（222/1726）。在 CT 上，某些大体影像学表现和大小、直径、体积或连续 3 次体积增加的变化的动力学特征提示 LR。应特别注意 CT 上是否存在任何≥3 个高危特征，或 SABR 后≥12 个月时增大不透明度的个别高危特征，因为这高度怀疑 LR。在 FDG-PET 上，在最初 12 个月内最大标准化摄取值（SUV）的相对减少<5%，或 12 个月后 SUV>5 和 SUV>3.44 的 SUV 可以提示 LR。目前尚无足够的证据支持提示 LR 的放射组学特征。
这项研究确定了与放射性肺损伤相比 LR 的常见特征，这可能有助于 SABR 后早期和准确地检测 LR；需要进一步的研究来验证这些发现。
