18F-FLT PET During Radiotherapy or Chemoradiotherapy in Head and Neck Squamous Cell Carcinoma Is an Early Predictor of Outcome
18F-FLT PET During Radiotherapy or Chemoradiotherapy in Head and Neck Squamous Cell Carcinoma Is an Early Predictor of Outcome
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DOI：
10.2967/jnumed.112.105999
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发表时间：
2013-04-01
影响因子：
9.3
通讯作者：
Kaanders, Johannes H. A. M.
中科院分区：
文献类型：
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作者：
Hoeben, Bianca A. W.;Troost, Esther G. C.;Kaanders, Johannes H. A. M.
这项前瞻性研究使用序贯PET和增殖示踪剂3‘-脱氧-3’-F-18-氟胸苷(F-18-Flt)来监测头颈癌治疗的早期反应，并评估PET参数与临床结果之间的关系。方法：48例头颈部肿瘤患者在放疗或放化疗前、放疗后第2周和第4周进行F-18-Flt PET/CT检查。计算肿瘤最热体素及其周围8个体素在1个横断层面上的平均标准化摄取值(SUVmax(9))，并使用视觉描绘(GTV(VIS))和基于信号背景比(GTV(SBR))和最大信号强度50%等值线(GTV(50%))的非操作者方法计算PET分割的大体肿瘤体积。评估PET参数与预后的相关性。结果：F-18-Flt摄取在连续扫描之间显著降低。前两周SUVmax(9)下降45%和GTVVIS下降中位数(分别为88%和63%，P=0.035和91%和65%，P=0.037)与较好的3年无病存活率相关。治疗第四周的GTV(Vis)下降>；=中位数也与较好的3年区域控制率(100%vs.68%，P=0.021)有关。这些相关性在接受放化疗的患者亚群中最为显著。由于治疗期间F-18-Flt摄取水平较低，GTV(SBR)和GTV(50%)无法成功分割原发肿瘤体积。结论：在头颈癌患者中，放疗或放化疗早期F-18-Flt摄取的改变是长期预后的一个强有力的指标。因此，F-18-Flt PET可以通过在治疗的早期阶段指导治疗修改来帮助个性化的患者管理。
This prospective study used sequential PET with the proliferation tracer 3'-deoxy-3'-F-18-fluorothymidine (F-18-FLT) to monitor the early response to treatment of head and neck cancer and evaluated the association between PET parameters and clinical outcome. Methods: Forty-eight patients with head and neck cancer underwent F-18-FLT PET/CT before and during the second and fourth weeks of radiotherapy or chemoradiotherapy. Mean maximum standardized uptake values for the hottest voxel in the tumor and its 8 surrounding voxels in 1 transversal slice (SUVmax(9)) of the PET scans were calculated, as well as PET-segmented gross tumor volumes using visual delineation (GTV(VIS)) and operator-independent methods based on signal-to-background ratio (GTV(SBR)) and 50% isocontour of the maximum signal intensity (GTV(50%)). PET parameters were evaluated for correlations with outcome. Results: F-18-FLT uptake decreased significantly between consecutive scans. An SUVmax (9) decline >= 45% and a GTVVIS decrease >= median during the first 2 treatment weeks were associated with better 3-y disease-free survival (88% vs. 63%, P = 0.035, and 91% vs. 65%, P = 0.037, respectively). A GTV(VIS) decrease >= median in the fourth treatment week was also associated with better 3-y locoregional control (100% vs. 68%, P = 0.021). These correlations were most prominent in the subset of patients treated with chemoradiotherapy. Because of low F-18-FLT uptake levels during treatment, GTV(SBR) and GTV(50%) were unsuccessful in segmenting primary tumor volume. Conclusion: In head and neck cancer, a change in F-18-FLT uptake early during radiotherapy or chemoradiotherapy is a strong indicator for long-term outcome. F-18-FLT PET may thus aid in personalized patient management by steering treatment modifications during an early phase of therapy.