Measuring Tumor Cell Proliferation with 18F-FLT PET During Radiotherapy of Esophageal Squamous Cell Carcinoma: A Pilot Clinical Study
Measuring Tumor Cell Proliferation with 18F-FLT PET During Radiotherapy of Esophageal Squamous Cell Carcinoma: A Pilot Clinical Study
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DOI：
10.2967/jnumed.109.072124
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发表时间：
2010-04-01
影响因子：
9.3
通讯作者：
Li, Yuhui
中科院分区：
文献类型：
--
作者：
Yue, Jinbo;Chen, Lusheng;Li, Yuhui
本研究的主要目的是应用F-18-3‘-脱氧-3’-氟代胸苷(F-18-3‘-deoxy-3’-flu-othymidine，Flt)PET/CT检测食管鳞癌放射治疗过程中肿瘤细胞的增殖情况。方法：对21例不能手术的局部晚期食管鳞癌患者在放疗期间行系列F-18-Flt PET/CT检查。每个患者都接受一次预扫描，然后在肿瘤注射2、6、10、20、30、40、50或60Gy后进行1-3次扫描。结果：在19例连续完成放疗的患者中，反映肿瘤内F-18-Flt摄取的参数(即最大肿瘤标准摄取值[SUVmax]和增殖靶区体积)稳步下降。所有患者在30Gy后食道肿瘤几乎完全消失，在40Gy后完全消失。在2例放疗疗程中断的患者中，F-18-Flt在肿瘤内的摄取在中断后高于中断前。所有患者的受照骨髓中的F-18-Flt摄取早期明显减少，即使在仅2Gy后也是如此。10Gy后所有受照区域均未见骨髓增生性改变。两名患者在完成整个放疗疗程后接受扫描，F-18-Flt PET/CT显示肿瘤无摄取，但F-18-FDG PET/CT摄取较高。病理检查发现这些区域有炎性浸润物，但没有肿瘤残留。结论：F-18-Flt摄取可用于监测食管鳞癌及正常组织对放射治疗的生物学反应。在治疗中断后，F-18-Flt摄取增加可能反映了加速的再繁殖。F-18-Flt PET/CT在鉴别炎症和肿瘤方面可能比F-18-FDG PET/CT更具优势。
The primary aim of this study was to use serial F-18-3'-deoxy-3'-fluorothymidine (FLT) PET/CT to measure tumor cell proliferation during radiotherapy of squamous cell carcinoma (SCC) of the esophagus. Methods: Twenty-one patients with inoperable locally advanced SCC of the esophagus underwent serial F-18-FLT PET/CT during radiotherapy. Each patient received a pretreatment scan, followed by 1-3 scans after delivery of 2, 6, 10, 20, 30, 40, 50, or 60 Gy to the tumor. Results: Among the 19 patients who completed radiotherapy without interruption, parameters reflecting F-18-FLT uptake in the tumor (i.e., maximum tumor standardized uptake value [SUVmax] and proliferation target volume) decreased steadily. All patients demonstrated an almost complete absence of proliferating esophageal tumor after 30 Gy and a complete absence after 40 Gy. In the 2 patients whose radiotherapy course was interrupted, F-18-FLT uptake in the tumor was greater after the interruption than before the interruption. Marked early reduction of F-18-FLT uptake in irradiated bone marrow was observed in all patients, even after only 2 Gy. All showed a complete absence of proliferating marrow in irradiated regions after 10 Gy. Both patients who underwent scans after completing the entire radiotherapy course showed no tumor uptake on F-18-FLT PET/CT but high uptake on F-18-FDG PET/CT. Pathologic examination of these regions revealed inflammatory infiltrates but no residual tumor. Conclusion: F-18-FLT uptake can be used to monitor the biologic response of esophageal SCC and normal tissue to radiotherapy. Increased uptake of F-18-FLT after treatment interruptions may reflect accelerated repopulation. F-18-FLT PET/CT may have an advantage over F-18-FDG PET/CT in differentiating inflammation from tumor.