Metabolic and clinical assessment of efficacy of cryoablation therapy on skeletal masses by 18F-FDG positron emission tomography/computed tomography (PET/CT) and visual analogue scale (VAS): initial experience
Metabolic and clinical assessment of efficacy of cryoablation therapy on skeletal masses by 18F-FDG positron emission tomography/computed tomography (PET/CT) and visual analogue scale (VAS): initial experience
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通过 18F-FDG 正电子发射断层扫描/计算机断层扫描 (PET/CT) 和视觉模拟量表 (VAS) 对冷冻消融治疗骨骼质量疗效的代谢和临床评估：初步经验
作者：
S. Masala;O. Schillaci;A. Bartolucci;F. Calabria;M. Mammucari;G. Simonetti
已经提出了各种治疗方式作为骨转移管理的标准治疗。放射治疗仍然是局部骨痛患者的标准治疗，但其中高达30%的患者没有明显的疼痛缓解。经皮冷冻消融术是一种微创技术，通过交替冷冻和解冻靶组织来诱导坏死。该技术已成功用于治疗不同部位的各种恶性和良性疾病。18F-FDG正电子发射断层扫描/计算机断层扫描（18F-FDG PET/CT）是一种单一的成像技术，可在“单一步骤”中提供骨肿瘤病变的形态学和代谢特征。本研究的目的是根据半定量PET分析和视觉模拟评分（VAS）临床试验评价，评价冷冻手术技术对继发性肌肉骨骼肿块的疗效。我们入组了20例对治疗无反应的疼痛性骨病变（VAS疼痛评分超过4分）患者;每例患者治疗了1处病变。所有患者在冷冻治疗前和治疗后8周进行PET-CT评估;在治疗前和治疗后测量最大标准化摄取值（SUVmax），以评估对治疗的反应。治疗后，18例患者（90%）显示SUVmax值显著降低（>50%），表明对治疗有反应;只有2例患者的代谢活性未显示有意义的降低。我们的初步研究表明，PET提供的定量分析与CT数据和临床VAS评价评估的冷冻消融治疗反应相关。
Various therapy modalities have been proposed as standard treatments in management of bone metastases. Radiation therapy remains the standard of care for patients with localized bone pain, but up to 30% of them do not experience notable pain relief. Percutaneous cryoablation is a minimally invasive technique that induces necrosis by alternately freezing and thawing a target tissue. This technique is successfully used to treat a variety of malignant and benign diseases in different sites. 18F-FDG positron emission tomography/computed tomography (18F-FDG PET/CT) is a single technique of imaging that provides in a “single step” both morphological and metabolic features of neoplastic lesions of the bone. The aim of this study was to evaluate the efficacy of the cryosurgical technique on secondary musculoskeletal masses according to semi-quantitative PET analysis and clinical-test evaluation with the visual analogue scale (VAS). We enrolled 20 patients with painful bone lesions (score pain that exceeded 4 on the VAS) that were non-responsive to treatment; one lesion per patient was treated. All patients underwent a PET-CT evaluation before and 8 weeks after cryotherapy; maximum standardized uptake value (SUVmax) was measured before and after treatment for metabolic assessment of response to therapy. After treatment, 18 patients (90%) showed considerable reduction in SUVmax value (>50%) suggestive of response to treatment; only 2 patients did not show meaningful reduction in metabolic activity. Our preliminary study demonstrates that quantitative analysis provided by PET correlates with response to cryoablation therapy as assessed by CT data and clinical VAS evaluation.