PET Imaging of Tumor Hypoxia Using 18F-Fluoroazomycin Arabinoside in Stage III-IV Non-Small Cell Lung Cancer Patients
PET Imaging of Tumor Hypoxia Using 18F-Fluoroazomycin Arabinoside in Stage III-IV Non-Small Cell Lung Cancer Patients
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DOI：
10.2967/jnumed.112.115014
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发表时间：
2013-08-01
影响因子：
9.3
通讯作者：
Langendijk, Johannes A.
中科院分区：
文献类型：
--
作者：
Bollineni, Vikram R.;Kerner, Gerald S. M. A.;Langendijk, Johannes A.
肿瘤缺氧会增加对电离辐射的抵抗力，从而影响放射治疗的疗效。本研究的目的是评估特异性缺氧示踪剂F-18-氟偶氮霉素阿拉伯糖苷（F-18-FAZA）在治疗晚期非小细胞肺癌（NSCLC）中相对于常用的F-18-FDG的潜在附加临床价值。方法：11例III期或IV期非小细胞肺癌患者在放化疗前接受了F-18-FDG和F-18-FAZA PET。最大标准摄取值（SUVmax）用于描述F-18-FDG摄取，肿瘤与背景（T/B）比率和肿瘤分数缺氧体积（FHV）用于定量缺氧。使用基于体素的分析研究F-18-FDG和F-18-FAZA摄取值之间的空间相关性。应用部分体积校正。结果：11例患者的原发肿瘤均显示明显的F-18-FAZA摄取。然而，观察到不同的模式的F-18-FDG和F-18-FAZA摄取分布，并在不同的肿瘤之间变化很大。F-18-FDG SUVmax与F-18-FAZA T/B比值之间无显著相关性（P = 0.055）。中位FHV 1.4为48.4%（范围：5.0-91.5）。F-18-FAZA T/B比值与FHV 1.4呈显著正相关（P < 0.001）。病灶大小与FHV或F-18-FDG SUVmax与FHV之间无相关性。肿瘤F-18-FDG摄取的模式是相当均匀的，而F-18-FAZA摄取是更不均匀的，这表明F-18-FAZA识别肿瘤代谢活性区域内的缺氧区域。观察到F-18-FDG SUVmax与病变大小之间存在显著相关性（P = 0.002）。结论：F-18-FAZA PET成像能够在临床环境中检测出均匀F-18-FDG背景中缺氧亚体积的不均匀分布。因此，F-18-FAZA可能被认为是一种指导剂量递增至肿瘤缺氧部分的工具。
Tumor hypoxia hampers the efficacy of radiotherapy because of its increased resistance to ionizing radiation. The aim of the present study was to estimate the potential added clinical value of the specific hypoxia tracer F-18-fluoroazomycin arabinoside (F-18-FAZA) over commonly used F-18-FDG in the treatment of advanced-stage non-small cell lung cancer (NSCLC). Methods: Eleven patients with stage Ill or stage IV NSCLC underwent F-18-FDG and F-18-FAZA PET before chemoradiotherapy. The maximum standardized uptake value (SUVmax) was used to depict F-18-FDG uptake, and the tumor-to-background (T/B) ratio and tumor fractional hypoxic volume (FHV) were used to quantify hypoxia. The spatial correlation between F-18-FDG and F-18-FAZA uptake values was investigated using voxel-based analysis. Partial-volume correction was applied. Results: All 11 patients showed clear uptake of F-18-FAZA in the primary tumor. However, different patterns of F-18-FDG and F-18-FAZA uptake distributions were observed and varied widely among different tumors. No significant correlation was observed between F-18-FDG SUVmax and F-18-FAZA T/B ratio (P = 0.055). The median FHV of 1.4 was 48.4% (range, 5.0-91.5). A significant positive correlation was found between the F-18-FAZA T/B ratio and FHV of 1.4 (P < 0.001). There was no correlation between the lesion size and FHV or between the F-18-FDG SUVmax and FHV. The pattern of tumoral F-18-FDG uptake was rather homogeneous, whereas F-18-FAZA uptake was more heterogeneous, suggesting that F-18-FAZA identifies hypoxic areas within metabolically active areas of tumor. A significant correlation between F-18-FDG SUVmax and lesion size (P = 0.002) was observed. Conclusion: F-18-FAZA PET imaging is able to detect heterogeneous distributions of hypoxic subvolumes out of homogeneous F-18-FDG background in a clinical setting. Therefore, F-18-FAZA might be considered a tool for guiding dose escalation to the hypoxic fraction of the tumor.