PET-CT与MR-DWI结合多影像评价24例食管鳞癌同步放化疗近期疗效
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摘要
目的单一影像评价食管癌的治疗疗效已得到广泛研究,食管癌疗效评价标准需更加全面。本研究建立了基于X射线钡餐、CT及MR的综合评价标准,联合治疗前和放疗中期的PET-CT及MR来评价食管鳞癌同步放化疗后的近期疗效。方法入组山东大学附属山东省肿瘤医院2016-11-05-2017-08-15病理学确诊为食管鳞癌,未有远处转移,卡氏功能状态量表(Karnofsky Performance Status,KPS)评分>70分并行根治性放化疗患者30例,最终完成的为24例。化疗方案为FP(氟尿嘧啶+顺铂)或TP(多西他赛+顺铂)方案;放疗方式为三维适形放疗或调强放疗,放疗剂量为60Gy/30次。分别于同步放化疗前及放疗15次时行PET-CT检查,同步放化疗前、放疗15次及放疗结束1个月内行MR、CT及X射线钡餐检查。运用Pearson相关性分析研究钡餐、CT和MR评价标准对应综合影像标准的符合率,以及PET-CT参数和MR参数的关联性;重复测量方法分析参数值变化趋势;Spearman相关性分析研究参数值变化率与疗效的关联;受试者工作特征(receiver operating characteristic,ROC)曲线分析参数临界值。结果钡餐、CT和MR评价标准对应综合影像标准的符合率分别为54.2%、83.3%和95.8%;CT、MR和钡餐之间差异无统计学意义。重复测量分析得出,治疗前中后3组患者表观弥散系数(apparent diffusion coefficient,ADC)和扩散加权成像(diffusion weighted imaging,DWI)值分别呈上升(F=99.976,P=0.001)和下降(F=30.648,P=0.001)趋势;治疗前与治疗中3组患者的最大标准化摄取(maximal standard uptake value,SUVmax)值(F=60.690,P<0.001)、代谢体积(metabolic tumor volume,MTV)值(F=13.161,P=0.002)及糖酵解总量(total lesion glycolysis,TLG)值(F=21.926,P=0.001)等参数的下降差异均有统计学意义。ROC曲线分析得出,治疗结束时ADC>2.47mm2/s、DWI≤15.28cm3,以及治疗中期SUVmax≤9.04、MTV≤20.55cm3、TLG≤87.95g为判断近期疗效有效的临界值。结论结合多种影像指定的综合评价标准用以评价食管鳞癌患者根治性放化疗的近期疗效更加全面准确;PET和MR与预测食管癌治疗疗效之间存在紧密联系,ADC、SUVmax、MTV和TLG参数评价疗效的准确性达90%以上。
OBJECTIVE The efficacy of single imaging evaluation of esophageal cancer has been extensively studied,and the evaluation criteria for esophageal cancer need to be more comprehensive.In this paper,a comprehensive evaluation standard based on X-ray barium meal,CT and MR was established.The short-term effects of concurrent radiotherapy and chemotherapy for esophageal squamous cell carcinoma were evaluated by PET-CT and MR in combination with pre-treatment and mid-radiation.METHODS Entered the Shandong Provincial Cancer Hospital from November 5,2016 to August 15,2017,pathology confirmed as esophageal squamous cell carcinoma,no distant metastasis,30 patients with Karnofsky Performance Status(KPS)score greater than70,concurrent radical chemoradiotherapy.The final enrollment was 24 cases.The chemotherapy regimen was FP(fluorouracil+cisplatin)or TP(docetaxel+cisplatin);the radiotherapy method was three-dimensional conformal radiotherapy or intensity-modulated radiotherapy,and the radiation dose was 60 Gy/30 times.All patients underwent PET-CT before and after chemoradiotherapy,and before and after radiotherapy and chemotherapy,15 times of radiotherapy and 1 month after radiotherapy,MR,CT scan and X-ray barium meal examination were performed.Pearson correlation analysis was used to study the coincidence rate of the comprehensive image standard for barium meal,CT and MR evaluation criteria,the correlation between PET-CT parameters and MR parameters.Repeated measurement method was used to analyze the change trend of parameter values;spearman correlation analysis was used to study the relationship between the change rate of parameter values and curative effect;ROC curve analysis parameter critical value.RESULTS The coincidence rates of barley meal,CT,and MR evaluation criteria corresponding to comprehensive imaging standards were 54.2%,83.3%,and95.8%,respectively.There was no significant difference between CT,MR and barium meal.The apparent diffusion coefficient(ADC)and diffusion weighted imaging(DWI)values of the three groups before and after treatment showed a significant increased(F=99.976,P=0.001)and decreased(F=30.648,P=0.001)trend respectively;The maximal standard uptake value(SUVmax)(F=60.690,P<0.001),metabolic tumor volume(MTV)(F=13.161,P=0.002)and total lesion glycolysis TLG(F=21.926,P=0.001)decreased significantly.ROC curve analysis showed that:at the end of treatment,ADC>2.47 mm2/s,DWI volume≤15.28 cm3 and treatment mid-term SUVmax≤9.04,MTV≤20.55 cm3,TLG≤87.95 g was the critical value for judging the short-term efficacy.CONCLUSIONS Combined with a variety of imaging-specific comprehensive evaluation criteria to evaluate the short-term efficacy of radical chemoradiotherapy in patients with esophageal squamous cell carcinoma is more comprehensive and accurate.There is a close relationship between PET and MR and the efficacy of esophageal cancer treatment.The accuracies of ADC,SUVmax,MTV,and TLG parameters are more than 90%.
OBJECTIVE The efficacy of single imaging evaluation of esophageal cancer has been extensively studied,and the evaluation criteria for esophageal cancer need to be more comprehensive.In this paper,a comprehensive evaluation standard based on X-ray barium meal,CT and MR was established.The short-term effects of concurrent radiotherapy and chemotherapy for esophageal squamous cell carcinoma were evaluated by PET-CT and MR in combination with pre-treatment and mid-radiation.METHODS Entered the Shandong Provincial Cancer Hospital from November 5,2016 to August 15,2017,pathology confirmed as esophageal squamous cell carcinoma,no distant metastasis,30 patients with Karnofsky Performance Status(KPS)score greater than70,concurrent radical chemoradiotherapy.The final enrollment was 24 cases.The chemotherapy regimen was FP(fluorouracil+cisplatin)or TP(docetaxel+cisplatin);the radiotherapy method was three-dimensional conformal radiotherapy or intensity-modulated radiotherapy,and the radiation dose was 60 Gy/30 times.All patients underwent PET-CT before and after chemoradiotherapy,and before and after radiotherapy and chemotherapy,15 times of radiotherapy and 1 month after radiotherapy,MR,CT scan and X-ray barium meal examination were performed.Pearson correlation analysis was used to study the coincidence rate of the comprehensive image standard for barium meal,CT and MR evaluation criteria,the correlation between PET-CT parameters and MR parameters.Repeated measurement method was used to analyze the change trend of parameter values;spearman correlation analysis was used to study the relationship between the change rate of parameter values and curative effect;ROC curve analysis parameter critical value.RESULTS The coincidence rates of barley meal,CT,and MR evaluation criteria corresponding to comprehensive imaging standards were 54.2%,83.3%,and95.8%,respectively.There was no significant difference between CT,MR and barium meal.The apparent diffusion coefficient(ADC)and diffusion weighted imaging(DWI)values of the three groups before and after treatment showed a significant increased(F=99.976,P=0.001)and decreased(F=30.648,P=0.001)trend respectively;The maximal standard uptake value(SUVmax)(F=60.690,P<0.001),metabolic tumor volume(MTV)(F=13.161,P=0.002)and total lesion glycolysis TLG(F=21.926,P=0.001)decreased significantly.ROC curve analysis showed that:at the end of treatment,ADC>2.47 mm2/s,DWI volume≤15.28 cm3 and treatment mid-term SUVmax≤9.04,MTV≤20.55 cm3,TLG≤87.95 g was the critical value for judging the short-term efficacy.CONCLUSIONS Combined with a variety of imaging-specific comprehensive evaluation criteria to evaluate the short-term efficacy of radical chemoradiotherapy in patients with esophageal squamous cell carcinoma is more comprehensive and accurate.There is a close relationship between PET and MR and the efficacy of esophageal cancer treatment.The accuracies of ADC,SUVmax,MTV,and TLG parameters are more than 90%.
引文
[1]任雪姣,王澜,陈丽滢,等.食管癌钡餐造影结合CT近期疗效评价标准的临床应用研究[J].中华放射肿瘤学杂志,2018,27(5):449-454.
[2] Wang L,Liu LH,Han C,et al.The diffusion-weighted magnetic resonance imaging(DWI)predicts the early response of esophageal squamous cell carcinoma to concurrent chemoradiotherapy[J].Radiother Oncol,2016,121(2):246-251.
[3]韩春,任雪姣,王澜,等.钡餐造影结合CT评价食管癌放疗近期疗效的研究[J].中华放射肿瘤学杂志,2013,22(1):26-29.
[4]黑忠林,陈俊杰,田兴仓,等.CT结合钡餐造影评价食管癌患者近期放疗疗效[J].包头医学院学报,2016,32(11):28-30.
[5]万钧,肖爱勤,高淑珍,等.食管癌放疗后近期疗效评价标准:附1000例分析[J].中国放射肿瘤学,1989,3(4):205-207.
[6] Eisenhauer EA,Therasse P,Bogaerts J,et al.New response evaluation criteria in solid tumours:revised RECIST guideline(version 1.1)[J].Eur J Cancer,2009,45(2):228-247.
[7] Qiu B,Wang D L,Yang H,et al.Combined modalities of magnetic resonance imaging,endoscopy and computed tomography in the evaluation of tumor responses to definitive chemoradiotherapy in esophageal squamous cell carcinoma[J].Radiother Oncol,2016,121(2):239-245.
[8]刘阳,赵妍,袁翎,等.食管鳞癌患者预后因素分析[J].中华肿瘤防治杂志,2016,23(2):91-95.
[9] Cheng B,Yu J.Predictive value of diffusion-weighted MR imaging in early response to chemoradiotherapy of esophageal cancer:a meta-analysis[J].Dis Esophagus,2019,32(4):pii:doy065.
[10] Sasaki K,Uchikado Y,Okumura H,et al.Role of 18F-FDG-PET/CT in esophageal squamous cell carcinoma after neoadjuvant Chemoradiotherapy[J].Anticancer Res,2017,37(2):859-864.
[11]郑向东,李天然,吴贵成,等.3.0T MR弥散加权成像对食管癌放化疗的疗效评价[J].功能与分子医学影像学杂志,2015,4(1):579-582.
[12] Harada K,Wang X,Shimodaira Y,et al.Early metabolic change after induction chemotherapy predicts histologic response and prognosis in patients with esophageal cancer:Secondary analysis of a randomized trial[J].Target Oncol,2018,13(1):99-106.
[13] Lordick F,Mariette C,Haustermans K,et al.Oesophageal cancer:ESMO Clinical Practice Guidelines for diagnosis,treatment and follow-up[J].Ann Oncol,2016,27(Suppl_5):v50-v57.
[14] Wang L,Han C,Zhu SC et al.Investigation of using diffusion-weighted magnetic resonance imaging to evaluate the therapeutic effect of esophageal carcinoma treatment[J].Oncol Res Treat,2014,37(3):112-116.
[15] Blom RL,Steenbakkers IR,Lammering G,et al.PET/CT-based metabolic tumour volume for response prediction of neoadjuvant chemoradiotherapy in oesophageal carcinoma[J].Eur J Nucl Med Mol Imaging,2013,40(10):1500-1506.
[16] Yap WK,Chang YC,Tseng CK,et al.Predictive value of nodal maximum standardized uptake value of pretreatment 18F fluorodeoxyglucose positron emission tomography imaging in patients with esophageal cancer[J].Dis Esophagus,2017,30(8):1-10.
[17]李建成,孙伟杰,陈少兴,等.18F-FDG PET-CT代谢参数对食管癌近期疗效预测价值研究[J].中华肿瘤防治杂志,2017,24(16):1157-1161.
[18] Weber MA,Bender K,von Gall CC,et al.Assessment of diffusion-weighted MRI and 18F-fluoro-deoxyglucose PET/CT in monitoring early response to neoadjuvant chemotherapy in adenocarcinoma of the esophagogastric junction[J].J Gastrointestin Liver Dis,2013,22(1):45-52.
[19] Goense L,Heethuis SE,Van Rossum PSN,et al.Correlation between functional imaging markers derived from diffusion-weighted MRI and 18F-FDG PET/CT in esophageal cancer[J].Nucl Med Commun,2018,39(1):60-67.
[2] Wang L,Liu LH,Han C,et al.The diffusion-weighted magnetic resonance imaging(DWI)predicts the early response of esophageal squamous cell carcinoma to concurrent chemoradiotherapy[J].Radiother Oncol,2016,121(2):246-251.
[3]韩春,任雪姣,王澜,等.钡餐造影结合CT评价食管癌放疗近期疗效的研究[J].中华放射肿瘤学杂志,2013,22(1):26-29.
[4]黑忠林,陈俊杰,田兴仓,等.CT结合钡餐造影评价食管癌患者近期放疗疗效[J].包头医学院学报,2016,32(11):28-30.
[5]万钧,肖爱勤,高淑珍,等.食管癌放疗后近期疗效评价标准:附1000例分析[J].中国放射肿瘤学,1989,3(4):205-207.
[6] Eisenhauer EA,Therasse P,Bogaerts J,et al.New response evaluation criteria in solid tumours:revised RECIST guideline(version 1.1)[J].Eur J Cancer,2009,45(2):228-247.
[7] Qiu B,Wang D L,Yang H,et al.Combined modalities of magnetic resonance imaging,endoscopy and computed tomography in the evaluation of tumor responses to definitive chemoradiotherapy in esophageal squamous cell carcinoma[J].Radiother Oncol,2016,121(2):239-245.
[8]刘阳,赵妍,袁翎,等.食管鳞癌患者预后因素分析[J].中华肿瘤防治杂志,2016,23(2):91-95.
[9] Cheng B,Yu J.Predictive value of diffusion-weighted MR imaging in early response to chemoradiotherapy of esophageal cancer:a meta-analysis[J].Dis Esophagus,2019,32(4):pii:doy065.
[10] Sasaki K,Uchikado Y,Okumura H,et al.Role of 18F-FDG-PET/CT in esophageal squamous cell carcinoma after neoadjuvant Chemoradiotherapy[J].Anticancer Res,2017,37(2):859-864.
[11]郑向东,李天然,吴贵成,等.3.0T MR弥散加权成像对食管癌放化疗的疗效评价[J].功能与分子医学影像学杂志,2015,4(1):579-582.
[12] Harada K,Wang X,Shimodaira Y,et al.Early metabolic change after induction chemotherapy predicts histologic response and prognosis in patients with esophageal cancer:Secondary analysis of a randomized trial[J].Target Oncol,2018,13(1):99-106.
[13] Lordick F,Mariette C,Haustermans K,et al.Oesophageal cancer:ESMO Clinical Practice Guidelines for diagnosis,treatment and follow-up[J].Ann Oncol,2016,27(Suppl_5):v50-v57.
[14] Wang L,Han C,Zhu SC et al.Investigation of using diffusion-weighted magnetic resonance imaging to evaluate the therapeutic effect of esophageal carcinoma treatment[J].Oncol Res Treat,2014,37(3):112-116.
[15] Blom RL,Steenbakkers IR,Lammering G,et al.PET/CT-based metabolic tumour volume for response prediction of neoadjuvant chemoradiotherapy in oesophageal carcinoma[J].Eur J Nucl Med Mol Imaging,2013,40(10):1500-1506.
[16] Yap WK,Chang YC,Tseng CK,et al.Predictive value of nodal maximum standardized uptake value of pretreatment 18F fluorodeoxyglucose positron emission tomography imaging in patients with esophageal cancer[J].Dis Esophagus,2017,30(8):1-10.
[17]李建成,孙伟杰,陈少兴,等.18F-FDG PET-CT代谢参数对食管癌近期疗效预测价值研究[J].中华肿瘤防治杂志,2017,24(16):1157-1161.
[18] Weber MA,Bender K,von Gall CC,et al.Assessment of diffusion-weighted MRI and 18F-fluoro-deoxyglucose PET/CT in monitoring early response to neoadjuvant chemotherapy in adenocarcinoma of the esophagogastric junction[J].J Gastrointestin Liver Dis,2013,22(1):45-52.
[19] Goense L,Heethuis SE,Van Rossum PSN,et al.Correlation between functional imaging markers derived from diffusion-weighted MRI and 18F-FDG PET/CT in esophageal cancer[J].Nucl Med Commun,2018,39(1):60-67.