Prospective comparison of 18F-FDG PET with conventional imaging modalities (MRI, CT, and 67Ga scintigraphy) in assessment of combined intraarterial chemotherapy and radiotherapy for head and neck carcinoma.
Prospective comparison of 18F-FDG PET with conventional imaging modalities (MRI, CT, and 67Ga scintigraphy) in assessment of combined intraarterial chemotherapy and radiotherapy for head and neck carcinoma.
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发表时间：
2003-02
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通讯作者：
Y. Kitagawa;S. Nishizawa;K. Sano;T. Ogasawara;Mikiko Nakamura;N. Sadato;Masanori Yoshida;Y. Yonekura-Y.-Yon
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作者：
Y. Kitagawa;S. Nishizawa;K. Sano;T. Ogasawara;Mikiko Nakamura;N. Sadato;Masanori Yoshida;Y. Yonekura-Y.-Yon
为了保护头颈癌患者的口腔器官和功能，新辅助化疗和放疗后准确确定适当的治疗至关重要。我们评价了（18）F-FDG PET相对于其他常规成像方式在评估动脉化疗和放疗联合作为器官保存方案后的治疗反应方面的诊断准确性。方法前瞻性研究了23例连续的头颈部鳞状细胞癌患者，这些患者完成了治疗方案，并在新辅助放化疗前后进行了2（18）F-FDG PET研究。（67）仅在治疗前进行了造影，治疗前后均进行了MRI和CT检查。所有图像均在不了解组织学结果的情况下进行盲法和独立解释。通过5分评分系统（0 =明确无肿瘤至4 =明确肿瘤）对图像判读的置信度进行分级。结果治疗前，18 F-FDG PET检出所有23例患者的原发性肿瘤，其灵敏度（100%）高于MRI（18/23; 78.3%）、CT（15/22; 68.2%）和67 Ga造影（8/20; 40%），阳性肿瘤发现的置信水平为3或4。放化疗后，4例患者的残留肿瘤经组织学证实（病理完全缓解率，19/23; 82.6%）。尽管治疗后（18）F-FDG PET显示与MRI（3/3; 100%）或CT（3/4; 75%）几乎相同的敏感性（4/4; 100%），但其特异性（17/19; 89.5%）上级MRI（7/17，41.2%）和CT（10/17; 58.8%）。关于颈部淋巴结转移，仅计算治疗后图像的特异性，因为治疗后任何患者均未确认转移。6例受试者有（18）个F-FDG PET阳性淋巴结，病理学上无肿瘤细胞，提示治疗后出现炎症反应性变化。因此，治疗后（18）F-FDG PET（17/23; 73.9%）与MRI（17/20; 85%）和CT（16/21; 76.2%）对颈部转移瘤的特异性几乎相同。采用（18）F-FDG PET监测的联合放化疗，8例患者避免了手术，其余15例患者接受了简化形式的手术。结论（18）F-FDG PET有助于鉴别放化疗后的残留肿瘤和治疗相关变化，这些变化有时难以通过解剖图像来表征。（18）F-FDG PET通过优化每位患者的手术治疗，对新辅助放化疗后的头颈癌患者的管理具有临床影响，并有助于改善患者的生活质量。
UNLABELLED To preserve the oral organs and functions in patients with head and neck carcinoma, accurate determination of the appropriate treatment after neoadjuvant chemotherapy and radiotherapy is of critical importance. We evaluated the diagnostic accuracy of (18)F-FDG PET relative to that of other conventional imaging modalities in the assessment of therapeutic response after combined intraarterial chemotherapy and radiotherapy as an organ preservation protocol. METHODS The study was prospectively performed on 23 consecutive patients with head and neck squamous cell carcinoma who completed the treatment regimen and underwent 2 (18)F-FDG PET studies before and after neoadjuvant chemoradiotherapy. (67)Ga scintigraphy (only before therapy) as well as MRI and CT (both before and after therapy) were also performed. All images were blindly and independently interpreted without knowledge of histologic findings. The level of confidence in image interpretation was graded by means of a 5-point rating system (0 = definitely no tumor to 4 = definite tumor). RESULTS Before treatment, (18)F-FDG PET detected primary tumors in all 23 patients and was more sensitive (100%) than MRI (18/23; 78.3%), CT (15/22; 68.2%), and (67)Ga scintigraphy (8/20; 40%), with a confidence level of 3 or 4 as a positive tumor finding. After chemoradiotherapy, residual tumors were histologically confirmed in 4 patients (pathologic complete response rate, 19/23; 82.6%). Although posttreatment (18)F-FDG PET showed almost equal sensitivity (4/4; 100%) compared with MRI (3/3; 100%) or CT (3/4; 75%), its specificity (17/19; 89.5%) was superior to MRI (7/17, 41.2%) and to CT (10/17; 58.8%) for primary lesions. Regarding metastases to neck lymph nodes, only specificity for posttreatment images was calculated because no metastasis was confirmed in any patients after treatment. Six subjects had (18)F-FDG PET-positive lymph nodes, which had pathologically no tumor cells and suggested an inflammatory reactive change after therapy. Therefore, the specificity of posttreatment (18)F-FDG PET (17/23; 73.9%) was almost identical to that of MRI (17/20; 85%) and CT (16/21; 76.2%) for neck metastasis. With combined chemoradiotherapy monitored with (18)F-FDG PET, 8 patients avoided surgery and the remaining 15 patients underwent a reduced form of surgery. CONCLUSION (18)F-FDG PET facilitates differentiation of residual tumors from treatment-related changes after chemoradiotherapy, which may be occasionally difficult to characterize by anatomic images. (18)F-FDG PET has a clinical impact for the management of patients with head and neck cancers after neoadjuvant chemoradiotherapy by optimizing surgical treatment for each patient and contributes to the improvement of the patient's quality of life.