Chaiken L, Rege S, Hoh C, Choi Y, Jabour B, Juillard G, Hawkins R, Parker R
Department of Radiation Oncology, Jonsson Comprehensive Cancer Clinic, UCLA School of Medicine.
Int J Radiat Oncol Biol Phys. 1993 Sep 30;27(2):455-64. doi: 10.1016/0360-3016(93)90259-x.
Following radiation therapy, evaluation of viable tumor can often be difficult with anatomic imaging criteria (tumor size alone). In this study, the utility of biochemical imaging with the glucose analog 2-[F-18]fluoro-2-deoxy-D-glucose and positron emission tomography was investigated in patients treated with radiation therapy.
Between 1990 and 1992, 19 patients were studied, including 15 patients with head and neck cancer, (4 oropharynx, 4 sinus, 3 larynx, 2 hypopharynx, 2 oral cavity [one patient], 1 nasopharynx), and 4 patients with breast cancer. Post-radiation positron emission tomography with 2-[F-18]fluoro-2-deoxy-D-glucose studies were done in all patients, with 9 head and neck patients receiving pre-radiation positron emission tomography with 2-[F-18]fluoro-2-deoxy-D-glucose scans as well. Results were correlated with other imaging techniques and pathology.
Positron emission tomography with 2-[F-18]fluoro-2-deoxy-D-glucose detected head and neck primary tumors and lymph node metastases in all nine pre-radiation scans, while magnetic resonance imaging failed to detect two primary tumors. Serial positron emission tomography with 2-[F-18]fluoro-2-deoxy-D-glucose showed a significant decrease in tumor activity after radiation therapy, compared to pre-radiation levels, (p < 0.05), except for two patients with increased uptake at the primary site. Biopsies of these two patients showed persistent/recurrent disease after radiation therapy, which was not detected by magnetic resonance imaging. Six additional head and neck patients, with suspicious examination and inconclusive magnetic resonance imaging, were imaged with positron emission tomography after radiation therapy only. Five patients had increased positron emission tomography activity, with corresponding biopsies positive in four patients, and negative in one patient with clinically worsening symptoms. The remaining sixth patient had minimal and stable positron emission tomography uptake, and is improving clinically. Four patients had mammogram findings suspicious for recurrence after conservation treatment for breast cancer. Positron emission tomography with 2-[F-18]fluoro-2-deoxy-D-glucose showed no focal activity in the breast in two patients, and increased activity in the area suspicious for recurrence in the other two patients. Biopsies correlated with positron emission tomography results.
Changes and presence of positron emission tomography with 2-[F-18]fluoro-2-deoxy-D-glucose activity correlated with pathologic findings in head and neck and breast cancer patients in this series. In patients with elevated or rising positron emission tomography activity after radiation therapy, persistent or recurrent disease was found in 89% of patients, (8/9). Magnetic resonance imaging did not detect the head and neck recurrences, and mammography was suspicious in patients with both benign and malignant breast changes after radiation therapy. In addition, our data indicate that in head and neck patients with pre-radiation positron emission tomography scans, a significant decrease in activity should occur after radiation therapy, if local control is to be expected.
放射治疗后，仅依据解剖成像标准（仅肿瘤大小）来评估存活肿瘤常常具有挑战性。在本研究中，我们探讨了使用葡萄糖类似物2-[F-18]氟-2-脱氧-D-葡萄糖进行生化成像及正电子发射断层扫描在接受放射治疗患者中的应用价值。
1990年至1992年间，对19例患者进行了研究，其中包括15例头颈癌患者（4例口咽癌、4例鼻窦癌、3例喉癌、2例下咽癌、2例口腔癌[1例患者]、1例鼻咽癌）以及4例乳腺癌患者。所有患者均接受了放射治疗后使用2-[F-18]氟-2-脱氧-D-葡萄糖的正电子发射断层扫描检查，9例头颈癌患者还接受了放射治疗前使用2-[F-18]氟-2-脱氧-D-葡萄糖的正电子发射断层扫描。结果与其他成像技术及病理结果进行了对比。
在所有9例放射治疗前的扫描中，使用2-[F-18]氟-2-脱氧-D-葡萄糖的正电子发射断层扫描均检测出头颈原发性肿瘤及淋巴结转移，而磁共振成像未能检测出2例原发性肿瘤。与放射治疗前水平相比，使用2-[F-18]氟-2-脱氧-D-葡萄糖的系列正电子发射断层扫描显示放射治疗后肿瘤活性显著降低（p < 0.05），但有2例患者原发部位摄取增加。这2例患者的活检显示放射治疗后存在持续性/复发性疾病，而磁共振成像未检测到。另外6例头颈癌患者，检查结果可疑且磁共振成像结果不明确，仅在放射治疗后接受了正电子发射断层扫描。5例患者正电子发射断层扫描活性增加，4例患者相应活检结果为阳性，1例临床症状恶化的患者活检结果为阴性。其余第6例患者正电子发射断层扫描摄取极少且稳定，临床症状正在改善。4例乳腺癌患者在保乳治疗后乳房X线摄影结果可疑为复发。使用2-[F-18]氟-2-脱氧-D-葡萄糖的正电子发射断层扫描显示，2例患者乳房无局灶性活性，另外2例患者可疑复发区域活性增加。活检结果与正电子发射断层扫描结果相符。
本系列研究中，使用2-[F-18]氟-2-脱氧-D-葡萄糖的正电子发射断层扫描活性的变化及存在情况与头颈癌和乳腺癌患者的病理结果相关。在放射治疗后正电子发射断层扫描活性升高或上升的患者中，89%（8/9）的患者被发现存在持续性或复发性疾病。磁共振成像未检测出头颈复发情况，放射治疗后乳房X线摄影对乳房良性和恶性改变的患者均存在可疑情况。此外，我们的数据表明，对于放射治疗前进行正电子发射断层扫描的头颈癌患者，如果预期实现局部控制，放射治疗后活性应显著降低。
