Department of Nuclear Medicine, Istanbul Bagcılar Training and Research Hospital, University of Health Sciences, 34200, Bagcılar, Istanbul, Turkey.
Department of Nuclear Medicine, Istanbul Training and Research Hospital, University of Health Sciences, Istanbul, Turkey.
Clin Transl Oncol. 2022 Oct;24(10):1903-1913. doi: 10.1007/s12094-022-02840-9. Epub 2022 May 20.
Immunotherapy is an effective treatment method for cancer cells with humoral and cellular immune mechanisms of action but triggers an inflammatory response and disrupts standard protective immune tolerance. Early detection of immune-related adverse events (irAEs) on PET/CT is crucial for patient management and subsequent therapy decisions. In this study, we aimed to evaluate the impact of F-FDG PET/CT on detecting of irAEs in patients receiving immunotherapy.
Forty-six patients with advanced RCC (n: 32), malign melanoma (n: 9), lung cancer (n: 4), and laryngeal carcinoma (n: 1), who underwent F-FDG PET/CT imaging for response assessment after immunotherapy, were enrolled in the study. Newly detected findings associated with irAEs on posttreatment PET/CT images were compared with the pretreatment PET/CT, both qualitatively and semi-quantitatively.
Twenty-eight (61%) patients developed irAEs as observed on PET/CT. Enteritis/colitis was the most frequent irAE visualized on PET/CT with 13 patients (28.2%), followed by gastritis (17.3%), thyroiditis (13%), and myositis/arthritis (13%). Hepatitis (6.5%), pneumonitis (6.5%), sarcoid-like reaction (4.3%), and hypophysitis (4.3%) were observed to a lesser extent. The median time between the appearance of irAEs on PET/CT and the initiation of immunotherapy was 4.3 months. There were no significant differences in age, sex, and treatment response status of patients with and without irAEs.
F-FDG PET/CT plays a fundamental role in cancer immunotherapy with the potential to show significant irAEs both in the diagnosis and in follow-up of irAEs. IrAEs were present on PET/CT images of more than half of the patients who received immunotherapy in our study.
免疫疗法是一种有效的癌症治疗方法，具有体液和细胞免疫作用机制，但会引发炎症反应并破坏标准的保护性免疫耐受。在 PET/CT 上早期检测免疫相关不良事件（irAEs）对于患者管理和后续治疗决策至关重要。在本研究中，我们旨在评估 F-FDG PET/CT 对检测接受免疫治疗患者的 irAEs 的影响。
本研究纳入了 46 例接受免疫治疗后进行 F-FDG PET/CT 成像以评估疗效的晚期 RCC（n=32）、恶性黑色素瘤（n=9）、肺癌（n=4）和喉癌（n=1）患者。比较了治疗后 PET/CT 图像上新发现的与 irAEs 相关的发现与治疗前 PET/CT 图像，定性和半定量均进行了比较。
28 例（61%）患者在 PET/CT 上出现 irAEs。肠炎/结肠炎是 PET/CT 上最常见的 irAE，有 13 例（28.2%），其次是胃炎（17.3%）、甲状腺炎（13%）和肌炎/关节炎（13%）。肝炎（6.5%）、肺炎（6.5%）、类肉瘤样反应（4.3%）和垂体炎（4.3%）则较少见。irAEs 在 PET/CT 上出现与免疫治疗开始之间的中位时间为 4.3 个月。有无 irAEs 的患者在年龄、性别和治疗反应状态方面无显著差异。
F-FDG PET/CT 在癌症免疫治疗中起着重要作用，具有在诊断和随访 irAEs 中显示出显著 irAEs 的潜力。在我们的研究中，接受免疫治疗的患者中有一半以上在 PET/CT 图像上出现了 irAEs。
