Assessment of tumour response after stereotactic ablative radiation therapy for lung cancer: A prospective quantitative hybrid 18F-fluorodeoxyglucose-positron emission tomography and CT perfusion study
Assessment of tumour response after stereotactic ablative radiation therapy for lung cancer: A prospective quantitative hybrid 18F-fluorodeoxyglucose-positron emission tomography and CT perfusion study
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DOI：
10.1111/1754-9485.12807
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发表时间：
2019-02-01
影响因子：
1.6
通讯作者：
Lee, Ting-Yim
中科院分区：
文献类型：
--
作者：
Yang, Dae-Myoung;Palma, David;Lee, Ting-Yim
前言：立体定向消融放射治疗(SABR)是不能手术的I期非小细胞肺癌(NSCLC)的推荐治疗方案，但对SABR后的疗效进行影像评估是困难的。本研究的目的是使用动态F-18-FDG-PET和CT灌注(CTP)来评估基于成像的肿瘤反应生物标志物。方法：31例早期非小细胞肺癌患者参与了这项前瞻性的相关性研究。每个患者在SABR前和术后8周在PET/CT扫描仪上进行动态F-18-FDG-PET/CTP检查。动态F-18-FDG-PET测量肿瘤的最大血流速度、平均血流速度和K-1、k(2)、k(3)、k(4)和K-I，均采用Johnson-Wilson-Lee动力学模型。CTP定量标测肿瘤内的BF、BV、MTT值和PS，并测量肿瘤最大直径。由于在CTP扫描过程中允许自由呼吸，因此在生成CTP功能图之前，对CT图像进行非刚性图像配准以减少配准错误。结果：SABR后肿瘤大小变化不大(SABR前中位数26 mm，SABR后中位数23 mm；P=0.01)。然而，动态F-18-FDG-PET和CTP研究显示，SUVmax、SUVean、k(3)、k(4)和K-I均有显著变化。SUVmax(中位数6.1vs.2.6；P<；0.001)、SUV均值(中位数2.5vs.1.5；P<；0.001)、K(3)(相对下降52%；P=0.002)、K-I(相对下降27%；P=0.03)显著下降，而k(4)(+367%；P<；结论：杂交F-18-FDG-PET/CTP可以评估非小细胞肺癌对SABR的代谢和功能参数的反应。未来的研究需要与长期结果相关联，以评估这些发现作为潜在的反应的成像生物标记物。
Introduction: Stereotactic ablative radiotherapy (SABR) is a guideline-recommended treatment for inoperable stage I non-small cell lung cancer (NSCLC), but imaging assessment of response after SABR is difficult. The goal of this study was to evaluate imaging-based biomarkers of tumour response using dynamic F-18-FDG-PET and CT perfusion (CTP).Methods: Thirty-one patients with early-stage NSCLC participated in this prospective correlative study. Each underwent dynamic F-18-FDG-PET/CTP studies on a PET/CT scanner pre-and 8 weeks post-SABR. The dynamic F-18-FDG-PET measured the tumour SUVmax, SUVmean and the following parameters: K-1, k(2), k(3), k(4) and K-i, all using the Johnson-Wilson-Lee kinetic model. CTP quantitatively mapped BF, BV, MTT and PS in tumours and measured largest tumour diameter. Since free-breathing was allowed during CTP scanning, non-rigid image registration of CT images was applied to minimize misregistration before generating the CTP functional maps. Differences between pre-and post-SABR imaging-based parameters were compared.Results: Tumour size changed only slightly after SABR (median 26 mm preSABR vs. 23 mm post-SABR; P = 0.01). However, dynamic F-18-FDG-PET and CTP study showed substantial and significant changes in SUVmax, SUVmean, k(3), k(4) and K-i. Significant decreases were evident in SUVmax (median 6.1 vs. 2.6; P < 0.001), SUVmean (median 2.5 vs. 1.5; P < 0.001), k(3) (relative decrease of 52%; P = 0.002), K-i (relative decrease of 27%; P = 0.03), whereas there was an increase in k(4) (+ 367%; P < 0.001).Conclusions: Hybrid F-18-FDG-PET/CTP allowed the response of NSCLC to SABR to be assessed regarding metabolic and functional parameters. Future studies are needed, with correlation with long-term outcomes, to evaluate these findings as potential imaging biomarkers of response.