Prospective Risk-Adjusted [18F]Fluorodeoxyglucose Positron Emission Tomography and Computed Tomography Assessment of Radiation Response in Head and Neck Cancer
Prospective Risk-Adjusted [18F]Fluorodeoxyglucose Positron Emission Tomography and Computed Tomography Assessment of Radiation Response in Head and Neck Cancer
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DOI：
10.1200/jco.2008.19.3300
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发表时间：
2009-05-20
影响因子：
45.3
通讯作者：
Schwartz, David L.
中科院分区：
文献类型：
--
作者：
Moeller, Benjamin J.;Rana, Vishal;Schwartz, David L.
目的[F-18]氟代脱氧葡萄糖正电子发射断层扫描（FDG-PET）/计算机断层扫描（CT）成像可改善头颈癌患者的放射反应评估，但尚不清楚这对哪些患者最有用。我们进行了一项前瞻性试验，以确定患者人群可能受益于除了功能成像的放射治疗responsibility.Patients和MethodsNine 8例局部晚期癌症的口咽部，喉，或下咽部前瞻性登记和治疗与原发性放疗，化疗或不化疗。患者在完成治疗后8周接受FDG-PET/CT和对比增强CT成像。功能和解剖成像反应与临床和病理反应相关。成像准确性之间进行了比较imaging models.ResultsAlthough postradiation最大标准摄取值显着较高的无反应者与反应者相比，FDG-PET/CT扫描的阳性和阴性预测值是相似的，单独的CT在cardiac研究人群。亚组分析显示，FDG-PET/CT在治疗失败高风险患者（人乳头瘤病毒[HPV]阴性疾病、非口咽原发病或吸烟史）的缓解评估中优于单独CT。没有好处FDG-PET/CT被认为是低风险患者缺乏这些features.ConclusionThese data do not support the broad application of FDG-PET/CT for radiation response assessment in cancer head and neck cancer patients.然而，FDG-PET/CT可能是高风险疾病患者的首选成像方式，特别是HPV阴性肿瘤患者。放疗后FDG-PET/CT成像的最佳时机值得进一步研究。
Purpose[F-18]Fluorodeoxyglucose positron emission tomography (FDG-PET)/computed tomography (CT) imaging may improve assessment of radiation response in patients with head and neck cancer, but it is not yet known for which patients this is most useful. We conducted a prospective trial to identify patient populations likely to benefit from the addition of functional imaging to the assessment of radiotherapy response.Patients and MethodsNinety-eight patients with locally advanced cancer of the oropharynx, larynx, or hypopharynx were prospectively enrolled and treated with primary radiotherapy, with or without chemotherapy. Patients underwent FDG-PET/CT and contrast-enhanced CT imaging 8 weeks after completion of treatment. Functional and anatomic imaging response was correlated with clinical and pathologic response. Imaging accuracy was then compared between imaging modalities.ResultsAlthough postradiation maximum standard uptake values were significantly higher in nonresponders compared with responders, the positive and negative predictive values of FDG-PET/CT scanning were similar to those for CT alone in the unselected study population. Subset analyses revealed that FDG-PET/CT outperformed CT alone in response assessment for patients at high risk for treatment failure ( those with human papillomavirus [HPV]-negative disease, nonoropharyngeal primaries, or history of tobacco use). No benefit to FDG-PET/CT was seen for low-risk patients lacking these features.ConclusionThese data do not support the broad application of FDG-PET/CT for radiation response assessment in unselected head and neck cancer patients. However, FDG-PET/CT may be the imaging modality of choice for patients with highest risk disease, particularly those with HPV-negative tumors. Optimal timing of FDG-PET/CT imaging after radiotherapy merits further investigation.