FDG-PET to evaluate intraarterial chemoradiotherapy as organ preservation protocol in oral squamous cell carcinoma

近年来，新辅助放化疗作为一种器官保存方案在口腔癌患者中显示出良好的临床反应。综合考虑患者的预后和生活质量，准确评估治疗效果对决定放化疗后的进一步手术至关重要。本研究的目的是评估正电子发射断层扫描与18F标记的氟脱氧葡萄糖（FDG-PET）在预测动脉内放化疗（THP-ADM+5-FU+卡铂）的反应和口腔癌预后方面的可能用途。材料与方法：选取35例口腔鳞状细胞癌（SCC）患者。所有患者均完成了治疗方案，每位患者进行了2次FDG-PET检查，一次在放化疗前，一次在放化疗后4周。将治疗前后的PET图像与临床和组织病理学对治疗效果的评价进行比较。区域放射性定量评价采用标准化吸收值（suv）。结果：放化疗具有良好的临床反应（总临床反应率100%，CR率71%）和组织学反应（p-CR率83%）。所有肿瘤病变治疗前均有较高的suv（平均10.00mg/ml），治疗后显著降低（3.74mg/ml, p<0.01）。FDG摄取的变化与处理效果平行。25例患者中，有6例患者治疗后出现了较高的前suvs （_7 mg/mL）残留肿瘤细胞，3年生存率为79%。而低suv患者（<7mg/mL， 10例）治疗成功，3年生存率显著提高（100%）。4 mg/ml后，13例肿瘤中有6例存在活细胞，22/22例<4 mg/ml的肿瘤无活细胞。根据PET结果，10名患者完全避免了手术，19名患者接受了减少形式的手术。随访5年无局部复发。结论：放化疗联合治疗头颈部肿瘤疗效显著。预处理FDG-PET可用于预测治疗反应和预后。后处理FDG-PET可评估剩余活细胞。基于PET评估，器官保存可能是可行的。因此，FDG-PET在口腔癌的治疗中是一个有价值的工具。少

Recently, neoadiuvant chemoradiotherapy as an organ-preserving protocol has shown good clinical response in patients with oral cancer. Accurate evaluation of therapeutic effect is essential to determine further operation after the chemoradiotherapy in consideration of the patients prognosis and quality of life. The aim of this study was to evaluate the possible usefulness of positron emission tomography with 18F labeled fluorodeoxyglucose (FDG-PET) for predicting response to intraarterial chemoradiotherapy (THP-ADM+5-FU+carboplatin), and prognosis in oral carcinomas.Materials and Methods : Thirty-five patients with oral squamous cell carcinoma (SCC) were included in the study. All patients completed the treatment regimen, and each patient underwent 2 FDG-PET studies, one prior to and one at 4 weeks after the chemoradiotherapy. The pre-and post-treatment PET images were compared with clinical and histopathological evaluations of the treatment effect. For the quantitative evaluation of r … More egional radioactivity, standardized uptake values (SUVs) were used.Results : The chemoradiotherapy demonstrated good clinical response (Overall clinical response rate 100% ; CR rate 71%) and histological response (p-CR rate 83%). All neoplastic lesions showed high SUVs (mean, 10.00mg/ml) prior to the treatment, which values significantly decreased after the therapy (3.74mg/ml, p<0.01). Change in FDG uptake paralleled the treatment effect. Lesions with higher pre-SUVs (_7 mg/mL) showed residual viable tumor cells after the treatment in 6 out of 25 patients, and 3-year survival rate of 79%. whereas those with lower SUVs (<7mg/mL, 10 patients) were successfully treated, and showed significantly higher 3-year survival (100%). Six out of 13 tumors with post-SUVs _4 mg/ml had viable tumor cells, whereas all (22/22) tumors with post-SUVs <4 mg/mL showed no viable cells. Based on PET results, 10 patients avoided operation altogether, and 19 patients underwent a reduced form of surgery. Each patient showed no local recurrence within 5-year follow-up.Conclusions : Concomitant chemoradiotherapy is effective for head and neck carcinoma. Pretreatment FDG-PET is useful in predicting the response to treatment and prognosis. Posttreatment FDG-PET can evaluate residual viable cells. Organ preservation may be feasible based on PET evaluation. Hence FDG-PET is a valuable tool in the treatment of oral cancer. Less