PET/CT in head and neck cancer: an update
PET/CT in head and neck cancer: an update
复制标题
DOI：
10.1007/s00259-009-1365-9
复制
发表时间：
2010-03-01
影响因子：
9.1
通讯作者：
Lucignani, Giovanni
中科院分区：
文献类型：
--
作者：
Hustinx, Roland;Lucignani, Giovanni
头颈癌（HNC）包括起源于口腔、口咽、下咽和喉的癌症。总的来说，这些癌症是世界上最常见的癌症之一，每年有超过55万新病例和超过30万人死亡，最大的负担落在低收入和中等收入国家。在西方世界，超过90%的HNC是鳞状细胞癌（HNSCC）。生存状况很差，在过去30年里几乎没有改善。虽然已知吸烟和饮酒至少占HNC的75%，但重要的病因学问题仍然存在：（1）低遗传易感性因素的作用及其与环境因素的相互作用，（2）罕见亚组的病因学，包括发病年龄小，不吸烟者和不饮酒者，以及（3）人乳头瘤病毒（HPV）的影响，特别是关于癌症亚位点[1]。HNSCC的最佳治疗取决于疾病阶段和部位。同步放化疗被广泛用于局部晚期疾病的确定性治疗，显示出比单独放疗更高的反应率。正如Subramaniam等人所指出的，[2]自2001年引入以来，混合FDG-PET/CT技术的影响是显著的：它现在是HNSCC成像的首选技术，为这种癌症的综合管理提供最佳的解剖和代谢体内信息。Schöder等人指出，FDG-PET的一个重要应用是，是其在治疗结束后检测残留存活肿瘤中的用途[3]。如果应用得当，FDG-PET/CT可以排除大多数患者的残留疾病，特别是残留肿大淋巴结的患者，从而避免不必要的颈清扫术（ND）。与其他恶性肿瘤相比，FDG-PET用于监测HNSCC诱导化疗反应以及在确定性放化疗过程中早期评估治疗反应的数据有限。缺氧是一种使癌症对化疗和放疗产生抗性的现象（在HNSCC中常见），可以用PET进行量化，并且其评估可能成为使用放射增敏药物或缺氧定向照射技术克服化疗和放射抗性的先决条件，以及用于监测在选择的肿瘤中对这些技术的反应。
Head and neck cancer (HNC) includes cancers originating in the oral cavity, the oropharynx, the hypopharynx and the larynx. Collectively, these cancers are among the most common in the world, accounting for over 550,000 new cases and over 300,000 deaths per year—with the greatest burden falling upon low-and medium-income countries. In the western world, more than 90% of HNCs are squamous cell carcinomas (HNSCCs). Survival is poor and has improved little over the past three decades. Although tobacco and alcohol use are known to account for at least75% of HNCs, important aetiological questions remain:(1) the role of low penetrance genetic susceptibility factors and their interactions with environmental factors,(2) aetiology in rare subgroups including young age at onset, nonsmokers and non-drinkers, and (3) the effect of human papillomavirus (HPV), particularly with regard to cancer subsites [1]. The most appropriate treatment for HNSCC depends on the disease stage and site. Concurrent chemoradiotherapy is widely used for the definitive treatment of locoregionally advanced disease, showing higher response rates than radiotherapy alone. As noted by Subramaniam et al.[2], the impact of the hybrid FDG-PET/CT technique, since its introduction in 2001, has been significant: it is now the technique of choice for imaging HNSCC, providing the best anatomical and metabolic in vivo information for the comprehensive management of this cancer. An important application of FDG-PET, pointed out by Schöder et al., is its use in the detection of residual viable tumour after the end of therapy [3]. When applied properly, FDG-PET/CT can exclude residual disease in most patients, particularly ones with residual enlarged lymph nodes, thereby sparing them needless neck dissection (ND). In contrast to other malignancies, data on the utility of FDG-PET for monitoring the response to induction chemotherapy in HNSCC, and for assessing treatment response early in the course of definitive chemoradiotherapy, are limited. Hypoxia, a phenomenon (common in HNSCC) that renders cancers resistant to chemo-and radiotherapy, can be quantified with PET, and its assessment may become a prerequisite for overcoming chemo-and radioresistance using radiosensitising drugs or hypoxia-directed irradiation techniques, and for monitoring the response to these techniques in selected