Prognostic value of tumour blood flow, [18F]EF5 and [18F]FDG PET/CT imaging in patients with head and neck cancer treated with radiochemotherapy
Prognostic value of tumour blood flow, [18F]EF5 and [18F]FDG PET/CT imaging in patients with head and neck cancer treated with radiochemotherapy
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DOI：
10.1007/s00259-014-2818-3
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发表时间：
2014-11-01
影响因子：
9.1
通讯作者：
Minn, Heikki
中科院分区：
文献类型：
--
作者：
Komar, Gaber;Lehtio, Kaisa;Minn, Heikki
目的为了提高头颈部鳞状细胞癌的治疗水平，需要获得关于所治疗肿瘤生物学的精确信息，并且需要确定不同生物学参数的预后重要性。本研究的目的是确定使用[F-18]FDG进行的治疗前PET/CT成像的预测价值，一种新的乏氧示踪剂[F-18] EF 5和灌注示踪剂[O-15]H2O在头颈部鳞状细胞癌放化疗中的应用。在任何治疗前使用上述示踪剂进行CT扫描。患者随后接受了放化疗和手术的联合治疗。使用单组织室模型从动态[O-15]H2O PET图像计算参数血流。通过计算标准化摄取值（SUV）和代谢活性肿瘤体积（MATV）分析[F-18]FDG图像。[F-18]通过计算肿瘤-肌肉摄取比（T/M比）分析EF 5图像。T/M比1.5被认为是一个重要的阈值，并用于确定肿瘤缺氧亚体积（HS）和缺氧分数面积。最后的研究结果与预处理的临床结果（总体阶段和TNM阶段），以及放疗后的局部控制和患者的总体survival.Results肿瘤分期和T-分类的结果没有显示出任何显着差异，比较患者的代谢和功能的PET测量的特点。使用考克斯比例风险模型，较短的总生存期与MATV（p = 0.008，HR = 1.108）、最大[F-18] EF 5 T/M比（p = 0.0145，HR = 4.084）和肿瘤HS（p = 0.0047，HR = 1.112）相关。在对数秩检验中，PET参数均未显示对患者生存率的显著影响，尽管[F-18] EF 5最大T/M比值最接近（p = 0.109）。相比之下，肿瘤血流量与任何临床终点均不相关。[F-18]FDG SUVmax、[F-18] EF 5 T/M比值与血流量无显著相关性。结论本研究在有限的病例中证实了MATV在局部晚期头颈部鳞癌预后中的重要性。值得注意的是，缺氧示踪剂[F-18] EF 5的高摄取显示出比[F-18]FDG摄取更强的与不良临床结局的相关性。这证实了缺氧在治疗结果中的重要性，并表明[F-18] EF 5可作为放射抗性的替代标志物。
Purpose In order to improve the treatment of squamous cell carcinoma of the head and neck, precise information on the treated tumour's biology is required and the prognostic importance of different biological parameters needs to be determined. The aim of our study was to determine the predictive value of pretreatment PET/CT imaging using [F-18]FDG, a new hypoxia tracer [F-18]EF5 and the perfusion tracer [O-15]H2O in patients with squamous cell cancer of the head and neck treated with radiochemotherapy.Methods The study group comprised 22 patients with confirmed squamous cell carcinoma of the head and neck who underwent a PET/CT scan using the above tracers before any treatment. Patients were later treated with a combination of radiochemotherapy and surgery. Parametric blood flow was calculated from dynamic [O-15]H2O PET images using a one-tissue compartment model. [F-18]FDG images were analysed by calculating standardized uptake values (SUV) and metabolically active tumour volumes (MATV). [F-18]EF5 images were analysed by calculating tumour-to-muscle uptake ratios (T/M ratio). A T/M ratio of 1.5 was considered a significant threshold and used to determine tumour hypoxic subvolumes (HS) and hypoxic fraction area. The findings were finally correlated with the pretreatment clinical findings (overall stage and TNM stage) as well as the outcome following radiochemotherapy in terms of local control and overall patient survival.Results Tumour stage and T-classification did not show any significant differences in comparison to the patients' metabolic and functional characteristics measured on PET. Using the Cox proportional hazards model, a shorter overall survival was associated with MATV (p = 0.008, HR = 1.108), maximum [F-18]EF5 T/M ratio (p = 0.0145, HR = 4.084) and tumour HS (p = 0.0047, HR = 1.112). None of the PET parameters showed a significant effect on patient survival in the log-rank test, although [F-18]EF5 maximum T/M ratio was the closest (p = 0.109). By contrast, tumour blood flow was not correlated with any of the clinical endpoints. There were no statistically significant correlations among [F-18]FDG SUVmax, [F-18]EF5 T/M ratio and blood flow.Conclusion Our study in a limited number of patients confirmed the importance of MATV in the prognosis of locally advanced squamous cell carcinoma of the head and neck. It is of interest that high uptake of the hypoxia tracer [F-18]EF5 showed a stronger correlation with a poor clinical outcome than [F-18]FDG uptake. This confirms the importance of hypoxia in treatment outcome and suggests that [F-18]EF5 may act as a surrogate marker of radioresistance.