van Ginkel R J, Hoekstra H J, Pruim J, Nieweg O E, Molenaar W M, Paans A M, Willemsen A T, Vaalburg W, Koops H S
Department of Surgical Oncology, University Hospital Groningen, The Netherlands.
J Nucl Med. 1996 Jun;37(6):984-90.
We investigated FDG-PET in patients undergoing hyperthermic isolated limb perfusion (HILP) with rTNF-alpha, rIFN-gamma and melphalan for locally advanced soft-tissue sarcoma of the extremities.
Twenty patients (11 women, 9 men; aged 18-80 yr, mean age 49 yr) were studied. FDG-PET studies were performed before, 2 and 8 wk after HILP. After the final PET study, the tumor was resected and pathologically graded. Patients with pathologically complete response (pCR) showed no viable tumor after treatment. Those with pathologically partial response (pPR) showed various amounts of viable tumor in the resected specimens.
Seven patients showed a pCR (35%) and 12 patients showed a pPR (60%). In one patient, pathological examination was not performed (5%). The pre-perfusion glucose consumption in the pCR group was significantly higher than in the pPR group (p<0.05). Visual analysis of the PET images after perfusion showed a rim of increased FDG uptake around the core of absent FDG uptake in 12 patients. The rim signal contained a fibrous pseudocapsule with inflammatory tissue in the pCR group, viable tumor was seen in the pPR group. The glucose consumption in the pCR group at 2 and 8 wk after perfusion had decreased significantly (p<0.05) in comparison to the glucose consumption in the pPR.
Based on the pretreatment glucose consumption in soft-tissue sarcomas, one could predict the probability of a patient achieving complete pathological response after HILP. FDG-PET indicated the pathological tumor response to HILP, although the lack of specificity of FDG, in terms of differentiation between an inflammatory response and viable tumor tissue, hampered the discrimination between pCR and pPR.
我们对接受热灌注隔离肢体（HILP）联合重组肿瘤坏死因子-α（rTNF-α）、重组干扰素-γ（rIFN-γ）和美法仑治疗四肢局部晚期软组织肉瘤的患者进行了氟代脱氧葡萄糖正电子发射断层扫描（FDG-PET）研究。
研究了20例患者（11例女性，9例男性；年龄18 - 80岁，平均年龄49岁）。在HILP前、后2周和8周进行FDG-PET研究。最后一次PET研究后，切除肿瘤并进行病理分级。病理完全缓解（pCR）的患者治疗后无存活肿瘤。病理部分缓解（pPR）的患者在切除标本中显示有不同数量的存活肿瘤。
7例患者显示pCR（35%），12例患者显示pPR（60%）。1例患者未进行病理检查（5%）。pCR组灌注前的葡萄糖摄取显著高于pPR组（p<0.05）。灌注后PET图像的视觉分析显示，12例患者在FDG摄取缺失的核心周围有一圈FDG摄取增加。pCR组的边缘信号包含有炎症组织的纤维假包膜，pPR组可见存活肿瘤。与pPR组相比，pCR组灌注后2周和8周的葡萄糖摄取显著降低（p<0.05）。
基于软组织肉瘤的预处理葡萄糖摄取情况，可以预测患者在HILP后实现完全病理缓解的可能性。FDG-PET显示了对HILP的病理肿瘤反应，尽管FDG缺乏特异性，在炎症反应和存活肿瘤组织的区分方面，阻碍了pCR和pPR之间的鉴别。
