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首页> 外文期刊>Clinical nuclear medicine >Detecting Interval Metastases and Response Assessment Using ~18F-FDG PET/CT After Neoadjuvant Chemoradiotherapy for Esophageal Cancer
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Detecting Interval Metastases and Response Assessment Using ~18F-FDG PET/CT After Neoadjuvant Chemoradiotherapy for Esophageal Cancer

机译：食管癌新辅助放化疗后使用〜18F-FDG PET / CT检测间隔转移和反应评估

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Aim: The aim of this study is to evaluate the potential of FDG PET/CT for the detection of interval distant metastases after neoadjuvant chemoradiotherapy (CRT) and the prediction of the pathologic response to CRT in esophageal cancer patients.Patients and Methods: In this retrospective study, all esophageal cancer patients for whom CRT followed by surgery was planned between January 2008 and April 2013 and in whom an FDG PET/CT was performed before and after CRT were included. For the response analyses, both FDG PET/CT scans had to be made on a similar scanner. Metabolic response of the primary tumor was assessed using the SUV_(max), metabolic tumor volume (MTV), and total lesion glycolysis (TLG). These parameters were correlated with the pathologic response using the tumor regression grade (TRG) scale according to Mandard et al (Cancer. 1994;73:2680-2686).Results: In 6 (8%) of 76 consecutively treated patients, new distant metastases were detected on FDG PET/CT after neoadjuvant CRT; these patients therefore did not undergo operation. Forty-eight (63%) of 76 patients were eligible for response analysis. The relative change in SUV_(max), MTV, and TLG was significantly different between patients with a major (TRG, 1-2) and a minor response (TRG, 3-5) but not between patients with and without a pathologic complete response. The area under the curve of the receiver operating characteristic for predicting a major response was 0.70 (95% confidence interval, 0.65-0.92) for a relative decrease in SUV_(max), compared with 0.73 (95% confidence interval, 0.58-0.88) both for MTV and TLG. A relative decrease in SUV_(max)of 60% or more had the highest positive predictive value (75%). Conclusions: Futile surgery was prevented in 8% of our esophageal cancer patients because interval metastases were detected on an FDG PET/CT after neoadjuvant CRT. The accuracy for predicting a complete or major pathologic response was limited and does not support the use of FDG PET/CT for refraining from surgical treatment.
机译：目的：本研究的目的是评估FDG PET / CT在食管癌新辅助放化疗后检测间隔远处转移的可能性以及预测对CRT的病理反应的潜力。回顾性研究包括所有计划在2008年1月至2013年4月之间进行CRT手术的食管癌患者，以及在CRT前后进行FDG PET / CT的所有食管癌患者。为了进行响应分析，必须在类似的扫描仪上进行两次FDG PET / CT扫描。使用SUV_（max），代谢肿瘤体积（MTV）和总病变糖酵解（TLG）评估原发肿瘤的代谢反应。根据Mandard等（Cancer.1994; 73：2680-2686），使用肿瘤消退等级（TRG）量表将这些参数与病理反应相关联。结果：在76例连续接受治疗的患者中，有6例（8％）是新的新辅助CRT后在FDG PET / CT上检测到转移;这些患者因此未接受手术。 76名患者中有48名（63％）有资格进行反应分析。严重（TRG，1-2）和轻微（TRG，3-5）有反应的患者之间SUV_（max），MTV和TLG的相对变化显着不同，但有病理完全缓解和没有病理完全缓解的患者之间没有差异。 SUV_（max）相对下降时，用于预测主要响应的接收器运行特性曲线下面积为0.70（95％置信区间，0.65-0.92），而0.73（95％置信区间，0.58-0.88）适用于MTV和TLG。 SUV_（max）相对降低60％或更高具有最高阳性预测值（75％）。结论：由于新辅助CRT后在FDG PET / CT上检测到间隔转移，在我们的食管癌患者中8％的手术无效。预测完全或主要病理反应的准确性是有限的，并且不支持使用FDG PET / CT来避免手术治疗。

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