Positron emission tomography is superior to computed tomography scanning for response-assessment after radical radiotherapy or chemoradiotherapy in patients with non-small-cell lung cancer
Positron emission tomography is superior to computed tomography scanning for response-assessment after radical radiotherapy or chemoradiotherapy in patients with non-small-cell lung cancer
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DOI：
10.1200/jco.2003.07.054
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发表时间：
2003-04-01
影响因子：
45.3
通讯作者：
Ball, DL
中科院分区：
文献类型：
--
作者：
Mac Manus, MP;Hicks, RJ;Ball, DL
目的：前瞻性研究正电子发射断层扫描(PET)和计算机断层扫描(CT)判断根治性放疗或放化疗后近期疗效的能力，从而预测生存期。研究人员和方法：73例非小细胞肺癌患者在根治性放疗(n=10)或放化疗(n=63)前后接受了[F-18]脱氧葡萄糖PET和CT扫描。放射治疗后的中位数时间为70天，随后进行PET扫描。PET-CT检查的中位间隔时间为1天。每个患者都有PET和CT对治疗的反应，分为完全反应、部分反应、无反应、进展性疾病或不可评估。结果：PET随访后的中位生存期为24个月。PET和CT反应之间的一致性很差(加权kappa=0.35)，只有40%的患者是相同的。PET的完全有效者(n=34)明显多于CT(n=10)，但被PET判断为无反应的患者(PET为12例，CT为20例)或不可评估的患者(PET为0例，CT为6例)较少。CT和PET反应分别与生存期显著相关；但在包括CT反应、表现状态、体重减轻和分期等已知预后因素的多因素分析中，只有PET反应与生存期显著相关(P<；.0001)。结论：在非小细胞肺癌中，早期、治疗后的单次PET扫描比CT反应、分期或治疗前的表现状态更能预测生存。(C)2003年，由美国临床肿瘤学会提供。
Purpose: To prospectively study the capacity of positron emission tomography (PET) and computed tomography (CT) to determine response soon after radical radiotherapy or chemoradiotherapy and, thereby, predict survival. PET is known to provide a more accurate estimate of true extent of disease than CT when used to stage non-small-cell lung cancer (NSCLC).Patients and Methods: Seventy-three patients with NSCLC underwent [F-18]fluorodeoxyglucose PET and CT scans before and after radical radiotherapy (n = 10) or chemoradiotherapy (n = 63). Follow-up PET scans were performed at a median of 70 days after radiotherapy. The median PET-CT interval was 1 day. Each patient had determinations of response to therapy made with PET and CT, categorized as complete response, partial response, no response, progressive disease, or nonassessable. Responses were correlated with subsequent survival.Results: Median survival after follow-up PET was 24 months. There was poor agreement between PET and CT responses (weighted kappa = 0.35), which were identical in only 40% of patients. There were significantly more complete responders on PET (n = 34) than CT (n = 10), whereas fewer patients were judged to be nonresponders (12 patients on PET v 20 on CT) or nonassessable (zero patients on PET v six on CT) by PET. Both CT and PET responses were individually significantly associated with survival duration; but on multifactor analysis that included the known prognostic factors of CT response, performance status, weight loss, and stage, only PET response was significantly associated with survival duration (P < .0001).Conclusion: In NSCLC, a single, early, posttreatment PET scan is a better predictor of survival than CT response, stage, or pretreatment performance status. (C) 2003 by American Society of Clinical Oncology.