Evaluating Positron Emission Tomography-Based Functional Imaging Changes in the Heart After Chemo-Radiation for Patients With Lung Cancer
Evaluating Positron Emission Tomography-Based Functional Imaging Changes in the Heart After Chemo-Radiation for Patients With Lung Cancer
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DOI：
10.1016/j.ijrobp.2019.12.013
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发表时间：
2020-04-01
影响因子：
7
通讯作者：
Rusthoven, Chad
中科院分区：
文献类型：
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作者：
Vinogradskiy, Yevgeniy;Diot, Quentin;Rusthoven, Chad
目的：研究已经注意到接受放化疗的肺癌患者的心脏辐射剂量与总生存期（OS）之间的联系。本研究的目的是利用氟脱氧葡萄糖/正电子发射断层扫描（FDG-PET）图像表征治疗前后心脏代谢的变化，并评估心脏代谢的变化是否能预测OS。方法和材料：39名接受放化疗前和放化疗后FDG-PET成像的患者参加了一项功能回避前瞻性研究。对于每位患者，治疗前和治疗后的PET/CT严格注册到计划CT、剂量和结构集。通过比较治疗前和治疗后心脏平均标准化摄取值（SUVmean）作为剂量bin的函数来评估基于pet的代谢剂量反应。通过比较最后随访时存活或死亡患者的SUVmean变化，并使用多变量模型评估治疗前和治疗后SUVmean变化是否为OS的预测因子，进行OS分析。结果：剂量-反应曲线显示，SUV随心脏剂量的变化呈增加趋势，平均每10 Gy增加1.7%。患者随访时间中位数为437天（范围201-1131天）。多因素分析显示，SUVmean变化可显著预测OS，风险比为0.541（95%可信区间为0.312-0.937）。随访时存活患者的心脏suv平均值平均增加17.2%，而死亡患者的心脏suv平均值平均下降13.5% （P = 0.048）。结论：我们的数据表明，治疗后心脏的SUV变化是剂量反应的重要指标和OS的预测指标。目前的工作是假设产生，必须在一个独立的队列验证。如果得到验证，我们的数据显示心脏代谢变化可能是临床结果的早期预测指标。(C) 2019 Elsevier Inc.版权所有。
Purpose: Studies have noted a link between radiation dose to the heart and overall survival (OS) for patients with lung cancer treated with chemoradiation. The purpose of this study was to characterize pre- to posttreatment cardiac metabolic changes using fluorodeoxyglucose/positron emission tomography (FDG-PET) images and to evaluate whether changes in cardiac metabolism predict for OS.Methods and Materials: Thirty-nine patients enrolled in a functional avoidance prospective study who had undergone pre- and postchemoradiation FDG-PET imaging were evaluated. For each patient, the pretreatment and posttreatment PET/CTs were rigidly registered to the planning CT, dose, and structure set. PET-based metabolic dose-response was assessed by comparing pretreatment to posttreatment mean standardized uptake values (SUVmean) in the heart as a function of dose-bin. OS analysis was performed by comparing SUVmean changes for patients who were alive or had died at last follow-up and by using a multivariate model to assess whether pre- to posttreatment SUVmean changes were a predictor of OS.Results: The dose-response curve revealed increasing changes in SUV as a function of cardiac dose with an average SUVmean increase of 1.7% per 10 Gy. Patients were followed for a median of 437 days (range, 201-1131 days). SUVmean change was significantly predictive of OS on multivariate analysis with a hazard ratio of 0.541 (95% confidence intervals, 0.312-0.937). Patients alive at follow-up had an average increase of 17.2% in cardiac SUVmean while patients that died had an average decrease in SUVmean decrease of 13.5% (P = .048).Conclusions: Our data demonstrated that posttreatment SUV changes in the heart were significant indicators of dose-response and predictors of OS. The present work is hypothesis generating and must be validated in an independent cohort. If validated, our data show the potential for cardiac metabolic changes to be an early predictor for clinical outcomes. (C) 2019 Elsevier Inc. All rights reserved.