~(18)F-FDG PET-CT用于指导局部晚期食管鳞癌同期加量放疗的可行性的临床研究
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摘要
第1部分治疗前18F-FDG PET-CT对局部晚期食管鳞癌放疗／放化疗后总生存疗效预测价值的研究
目的：探讨治疗前的18F-FDG PET-CT是否具有预测局部晚期食管鳞癌非手术治疗后总生存的疗效的价值。
方法：研究对象为近年在我院初治的食管鳞癌患者,入组条件为：1)病理确诊为食管鳞癌；2)治疗前未接受化放疗和手术；3)放疗为根治性剂量放疗；4)治疗前接受了18F-FDG PET/CT检查；5)分期检查无远处转移。排除条件：1)病人未完成预定放疗；2)治疗过程中出现远处转移。在PET图像上以SUV=2.5和本底确定原发灶的边界,统计MTV(以SUV=2.5为阈值所确定的食管癌原发灶的几何体积)、SUV等生物代谢参数及性别、年龄、分期、化疗等临床因素并随访生存情况后进行生存分析,观察指标为OS。生存统计采用Kaplan-Meier法,组间生存差异采用log-rank检验,用Cox风险回归模型进行多因素分析。
结果：本研究共纳入2007年1月至2010年8月在我院行过治疗前FDG PET-CT检查的不可手术的局部晚期食管鳞癌患者30例。全组1、2、3年总生存率分别为76.7%、52.1%、26.5%,单因素分析显示原发灶的长度越长(p=0.024)代谢体积越大(p=0.006)的患者,总生存越差,多因素分析显示MTV是预测OS的独立影响因子(p=0.012)
结论：食管鳞癌原发灶代谢体积是预测食管癌患者非手术治疗生存疗效的独立预测因子。
第2部分治疗前18F-FDG PET-CT对局部晚期食管鳞癌原发灶放疗后局部控制预测价值的研究
目的：探讨治疗前的18F-FDG PET-CT是否能预测局部晚期食管鳞癌非手术治疗后原发灶局部控制?
方法：研究对象为近年我院初治的食管鳞癌患者,入组条件为：1)病理确诊为食管鳞癌；2)治疗前未接受化放疗和手术；3)放疗为根治性剂量放疗；4)治疗前接受了18F-FDGPET/CT检查；5)分期检查无远处转移。排除条件：1)病人未完成预定放疗；2)治疗过程中出现远处转移。在PET图像上以SUV=2.5和本底确定原发灶的边界,统计MTV(以SUV=2.5为阈值所确定的食管癌原发灶的几何体积)、SUV等生物代谢参数及性别、年龄、分期、化疗等临床因素并随访食管癌原发灶控制状况后进行生存分析,观察指标为食管癌的原发灶控制。生存统计采用Kaplan-Meier法,组间生存差异采用log-rank检验,用Cox风险回归模型进行多因素分析。
结果：本研究共纳入2007年1月至2010年8月在我院行过治疗前FDG-PET-CT检查的不可手术的局部晚期食管鳞癌患者30例。全组1、2、3年局控率分别为72.0%、56.7%、56.7%,单因素分析显示对局控有影响的因素是原发灶的suvmax, suvmean、MTV的大小,多因素分析显示MTV这一指标是预测局部控制的的独立影响因子,代谢体积越高者,原发灶控制率越低(P=0.031)。
结论：食管癌原发灶MTV与放疗后局控率密切相关,可评价和预测食管鳞癌的局部失败。
第3部分食管癌原发灶18F-FDG代谢分布对指导个体化局部加量放疗的潜在价值
目的：研究原发灶内18F-FDG高摄取区域的分布情况与食管鳞癌放疗局控之间的关系,探讨选择局部高危区域进行加量放疗的可行性。
方法：收集2007年1月至2010年8月在我院行过治疗前18F-FDG PET-CT检查的不可手术的局部晚期食管鳞癌患者30例,在PET图像上以SUV=2.5和本底确定原发灶的边界,COV定义为原发灶内SUV的标准差与suvmean的比值,用其来评价不同MTV大小的肿瘤的异质性。读取PET图像上ROI内每个像素点的SUV值后,绘制成累积SUV值-体积直方图(Cumulative SUV-volume histograms,CSH),计算分别以SUV=9,8,7,6,5,4,3为阈值时CSH图上所对应的体积MTV的大小以及与原发灶局控的关系。
结果：根据第2部分结果按MTV的中位值19.45cm3分组,局控较差的一组COV大于局控较好的一组(0.51：0.35,p=0.0001)。按不同阈值勾画所得ROI在SUV=3,4,5,6,7的情况下MTV高于中位值与低于中位值组局控有显著差异,而SUV=8,9为阈值则无法观察到局控的统计学差别。将各阈值下MTV与局控的关系绘制成ROC曲线按AUC的高低,在SUV=5组中找出最佳阈值为MTVSuv≥5=12.85cm3(敏感性为72.7%、特异性为72.2%)Kaplan-Meier生存分析显示MTVsuv≥5<12.85cm3一组2年无局部复发生存率为76.6%,而MTVsuv≥5>12.85cm3为27.7%,两组有显著统计学差异(p=0.003)。
结论：体积因素是与放疗局部控制密切相关的因素,特别是肿瘤内部某些高摄取区域体积较大可能与局部治疗失败密切相关,具有对其进行加量放疗的潜在价值,但具体最佳界值还需要大样本的进一步研究和证实。
第4部分食管鳞癌放疗前中18F-FDG高摄取区域的空间位置关系的研究
目的：本研究的目的是观察放疗前和放疗中两次PET-CT所显示的食管原发病灶18F-FDG高摄取区域的空间位置关系,从而推测依据放疗前的PET图像上所显示的食管癌原发灶高18F-FDG摄取的信息进行区域选择性加量放疗的可行性。
方法：入组病人为2011年在我院放疗科接受同步放化疗治疗的初治食管鳞癌患者。入组条件包括：1)病理确诊为食管鳞癌；2)入组前未接受过化放疗且KPS评分>70分；3)分期检查无远处转移；4)无心肺肾等慢性疾病。排除条件：1)病人不能完成预定放疗；2)治疗过程中出现远处转移。所有入组患者在治疗前和放疗45Gy时(第二次同步化疗前)分别行18F-FDG PET-CT扫描。在第一次PET图像上原发灶勾画首先以SUV=2.5,5,40%-70%SUVmax-pr。为阈值在PET图像上自动勾画得到GTV25pre、GTV5pre、GTV40%pre、GTV50%opre、GTV60%pre、GTV70%pre。在第二次PET图像上,以SUV=2.5和70%-90%SUVmax.dur为阈值勾画得GTV25dur、GTV70%dur、GTV80%dur、GTV90%dur。计算两次PET图像上以阈值自动勾画的区域的空间交集分数(OF)。OF定义为两个ROI的交集的体积与两个ROI相对较小的体积的比值,OF越接近于100%,代表放疗中所残留的高FDG代谢体积被放疗前高FDG代谢区域包括的体积越高。
结果：研究共入组2011年4月至2011年11月在我院行根治性同步放化疗的局部晚期食管鳞癌患者7例.。所有患者的原发灶SUVmax, SUVmean均有显著下降(p=0.05和0.03)。残留高摄取区域与治疗前GTV50%pre的OF达到70%以上其中热点区域GTV90%dur完全处于原发灶的高摄取区域内,OF达到100%。以不同阈值勾画的体积有很大差异,而放疗前和放疗中的食管癌原发灶高代谢区域尽管体积变化很大,但空间位置保持相对的稳定。
结论：在治疗中,食管鳞癌原发灶的SUV有显著的下降,但食管癌原发灶残留的18F-FDG高摄取区域仍然较稳定的落在治疗前原发灶GTV及治疗前PET上所显示的18F-FDG高摄取区域内,提示依据治疗前PET图像来选择性对食管癌原发病灶的部分区域进行局部加量放疗是可行的。
Part I The predictive value of pretreatment18F-FDG PET-CT on overall survival of patients with inoperable esophageal squamous cell carcinoma
Purpose To analysis metabolic parameters of pretreatment18F-FDG PET-CT and investigate the relationship between pretreatment PET-CT and overall survival of those patients with inoperable ESCC.
Materials and Methods Patients of ESCC with a pretreatment PET-CT scan treated with chemoradiotherapy or radiotherapy in our center in recent years were included in this study. A threshold of SUV=2.5was used to establish the primary lesion in PET image. Metabolic factors including MTV, SUV and clinical factors like sex, age, stage, et al were calculated. The association of these factors and the results of long-term follow-up of the patients were examined. Overall survival was estimated were estimated using the Kaplan-Meier method. Significance between groups was assessed by Log-Rank test. Multivariate analysis was performed to identify the prognostic factors influencing OS using Cox proportional hazards regression model.
Results Between2007.1and2010.8,30,30patients were enrolled in this study.Mean follow-up for all analyzable patients was19.5months, lyr-,2yr-,3yr-OS for the whole group was76.7%、52.1%、26.5%、 Univariate analysis showed patients having tumors with a length of primary lesion less than4cm (p=0.024) or MTV less than19.45cm3(p=0.006) had a better survival than those with a greater one, In the Cox multivariate analysis, MTV (p=0.012) were significant predictors of overall survival.We didn't find a significant relationship between SUV and OS.
Conclusion The present study shows that tumor volume parameters, especially MTV was valuable for predicting long-term survival.
Part Ⅱ The predictive value of pretreatment18F-FDG PET-CT on local control of patients with inoperable esophageal squamous cell carcinoma
Purpose The objective of this study is to evaluate the prognostic value of pretreatment18F-FDG PET/CT on local control after radical radiotherapy or chemoradiotherapy in patients with ESCC.
Materials and Methods Patients with a pretreatment PET-CT scan treated with chemoradiotherapy or radiotherapy were included in this study. A threshold of SUV=2.5was used to establish the primary lesion in PET image. Metabolic factors including MTV, SUV and clinical factors like sex, age, stage, et al were calculated. The association of these factors and the results of long-term follow-up of the patients were examined. Local progression-free survival was estimated were estimated using the Kaplan-Meier method. Significance between groups was assessed by Log-Rank test. Multivariate analysis was performed to identify the prognostic factors influencing local control using Cox proportional hazards regression model.
Results Between2007.1and2010.8,30,30patients were enrolled in this study.Mean follow-up for all analyzable patients was19.5months, lyr-,2yr-,3yr-local control rate for the whole group was72.0%、56.7%、56.7%. Univariate analysis showed patients having tumors with a SUVmax<12.6(p=0.032) or SUVmean<5.79(p=0.044) or MTV<19.45cm3(p=0.018) had a better local control than those with a greater one, In the Cox multivariate analysis, MTV (p=0.031) were significant predictors of local control.
Conclusion The present study shows that tumor volume parameters, especially MTV was valuable for predicting local progression-free survival.
Part Ⅲ The potential value of pretreatment18F-FDG PET-CT in in guiding individualized radiotherapy of patients with esophageal squamous cell carcinoma
Purpose:The objective of this study is to evaluate the prognostic value of pretreatment18F-FDG PET/CT on local control (LC) after radical radiotherapy or chemoradiotherapy in patients with ESCC, and investigate its potential value in establishing optimal radiation treatment plans.
Materials and methods:Thirty patients with pathologically proven ESCC who underwent pretreatment18F-FDG PET-CT in our cancer center were retrospectively reviewed. A threshold of SUV2.5was used to delineate the target volume of primary tumor separately. Coefficient of variation (COV) was used to evaluate the heterogeneity within the primary lesion. SUV and MTV of every pixel in all primary malignant lesions delineated on PET-CT images were measured. Cumulative SUV-volume histograms (CSH), describing total tumor volume above threshold of SUV (from2.5to SUVmax), were calculated. Receiver operating characteristics (ROC) curve was used to further evaluate the optimal cutoff for predicting local control. The local control was estimated using the Kaplan-Meier method and significance between groups was assessed by Log-Rank test.
Results:COV of the group with a MTV<19.45cm3was0.35, smaller than that of the group with a MTV>19.45cm3(0.51, p=0.0001). ROC curve showed MTV=12.85cm3when delineated with a threshold of SUV=5might be the best cut off values. Local control for patients with MTVSUV≥5<12.85cm3on pretreatment18F-FDG PET-CT scan were better than those with higher MTVSuv≥5>12.85cm3(p=0.003).
Conclusions:In this study, MTV above some threshold of SUV assessed by pretreatment PET/CT might be an adverse factor predicting local control in esophageal SCC, which indicated variation of biologically metabolic level within tumors should be consider as well as tumor volume promising for selecting risk-adapted therapies. These results will need to be validated in larger cohorts with longer follow-up, and evaluated prospectively.
Part IV Spatial dynamic distribution and stability of F-FDG uptake locations within tumor during radiotherapy for esophageal squamous cell carcinoma
Purpose:Because individual tumors are heterogeneous, including for18F-FDG uptake and, most likely, for radioresistance, selective boosting of high FDG uptake zones within the tumor has been suggested. To do this, it is critical to know whether the location of these high FDG uptake patterns within the tumor remain stable during radiotherapy (RT).
Materials and methods:Seven patients with ESCC treated with concurrent chemo-radiation underwent repeated F-FDG PET-CT scans before RT and after20fractions of RT. On all scans, the high and low FDG uptake regions were autodelineated using several SUV thresholds, varying from40%to70%of SUVmax on the pretreatment scan (GTV4o%pre, GTV5o%Pre, GTV6o%Pre, GTV7o%Pre)and from70%to90%of SUVmax on the dur-treatment scan (GTV7o%dur, GTV8o%dur, GTV9o%dur) and fixed thresholds of2.5and5(GTV2.5pre, GTV5pre). The volumes and overlap fractions of these delineations were calculated to demonstrate the stability of the high FDG uptake regions during RT.
Results:The high uptake regions within the tumor during RT largely corresponded (OF>70%) with the50%SUVmax high FDG uptake area (GTV50%pre,) of the pretreatment scan. The hotspot within the residual area (GTV9o%dur) was completely within the GTV and pre-radiotherapy high uptake regions (OF=100%). The volumes of the thresholds varied markedly. Although the location of the high FDG uptake patterns within the tumor during RT remained stable, the delineated volumes varied markedly.
Conclusions:The location of the high FDG uptake areas within the tumor remained stable during RT. This knowledge may enable selective boosting of high FDG uptake areas within the tumor.
目的：探讨治疗前的18F-FDG PET-CT是否具有预测局部晚期食管鳞癌非手术治疗后总生存的疗效的价值。
方法：研究对象为近年在我院初治的食管鳞癌患者,入组条件为：1)病理确诊为食管鳞癌；2)治疗前未接受化放疗和手术；3)放疗为根治性剂量放疗；4)治疗前接受了18F-FDG PET/CT检查；5)分期检查无远处转移。排除条件：1)病人未完成预定放疗；2)治疗过程中出现远处转移。在PET图像上以SUV=2.5和本底确定原发灶的边界,统计MTV(以SUV=2.5为阈值所确定的食管癌原发灶的几何体积)、SUV等生物代谢参数及性别、年龄、分期、化疗等临床因素并随访生存情况后进行生存分析,观察指标为OS。生存统计采用Kaplan-Meier法,组间生存差异采用log-rank检验,用Cox风险回归模型进行多因素分析。
结果：本研究共纳入2007年1月至2010年8月在我院行过治疗前FDG PET-CT检查的不可手术的局部晚期食管鳞癌患者30例。全组1、2、3年总生存率分别为76.7%、52.1%、26.5%,单因素分析显示原发灶的长度越长(p=0.024)代谢体积越大(p=0.006)的患者,总生存越差,多因素分析显示MTV是预测OS的独立影响因子(p=0.012)
结论：食管鳞癌原发灶代谢体积是预测食管癌患者非手术治疗生存疗效的独立预测因子。
第2部分治疗前18F-FDG PET-CT对局部晚期食管鳞癌原发灶放疗后局部控制预测价值的研究
目的：探讨治疗前的18F-FDG PET-CT是否能预测局部晚期食管鳞癌非手术治疗后原发灶局部控制?
方法：研究对象为近年我院初治的食管鳞癌患者,入组条件为：1)病理确诊为食管鳞癌；2)治疗前未接受化放疗和手术；3)放疗为根治性剂量放疗；4)治疗前接受了18F-FDGPET/CT检查；5)分期检查无远处转移。排除条件：1)病人未完成预定放疗；2)治疗过程中出现远处转移。在PET图像上以SUV=2.5和本底确定原发灶的边界,统计MTV(以SUV=2.5为阈值所确定的食管癌原发灶的几何体积)、SUV等生物代谢参数及性别、年龄、分期、化疗等临床因素并随访食管癌原发灶控制状况后进行生存分析,观察指标为食管癌的原发灶控制。生存统计采用Kaplan-Meier法,组间生存差异采用log-rank检验,用Cox风险回归模型进行多因素分析。
结果：本研究共纳入2007年1月至2010年8月在我院行过治疗前FDG-PET-CT检查的不可手术的局部晚期食管鳞癌患者30例。全组1、2、3年局控率分别为72.0%、56.7%、56.7%,单因素分析显示对局控有影响的因素是原发灶的suvmax, suvmean、MTV的大小,多因素分析显示MTV这一指标是预测局部控制的的独立影响因子,代谢体积越高者,原发灶控制率越低(P=0.031)。
结论：食管癌原发灶MTV与放疗后局控率密切相关,可评价和预测食管鳞癌的局部失败。
第3部分食管癌原发灶18F-FDG代谢分布对指导个体化局部加量放疗的潜在价值
目的：研究原发灶内18F-FDG高摄取区域的分布情况与食管鳞癌放疗局控之间的关系,探讨选择局部高危区域进行加量放疗的可行性。
方法：收集2007年1月至2010年8月在我院行过治疗前18F-FDG PET-CT检查的不可手术的局部晚期食管鳞癌患者30例,在PET图像上以SUV=2.5和本底确定原发灶的边界,COV定义为原发灶内SUV的标准差与suvmean的比值,用其来评价不同MTV大小的肿瘤的异质性。读取PET图像上ROI内每个像素点的SUV值后,绘制成累积SUV值-体积直方图(Cumulative SUV-volume histograms,CSH),计算分别以SUV=9,8,7,6,5,4,3为阈值时CSH图上所对应的体积MTV的大小以及与原发灶局控的关系。
结果：根据第2部分结果按MTV的中位值19.45cm3分组,局控较差的一组COV大于局控较好的一组(0.51：0.35,p=0.0001)。按不同阈值勾画所得ROI在SUV=3,4,5,6,7的情况下MTV高于中位值与低于中位值组局控有显著差异,而SUV=8,9为阈值则无法观察到局控的统计学差别。将各阈值下MTV与局控的关系绘制成ROC曲线按AUC的高低,在SUV=5组中找出最佳阈值为MTVSuv≥5=12.85cm3(敏感性为72.7%、特异性为72.2%)Kaplan-Meier生存分析显示MTVsuv≥5<12.85cm3一组2年无局部复发生存率为76.6%,而MTVsuv≥5>12.85cm3为27.7%,两组有显著统计学差异(p=0.003)。
结论：体积因素是与放疗局部控制密切相关的因素,特别是肿瘤内部某些高摄取区域体积较大可能与局部治疗失败密切相关,具有对其进行加量放疗的潜在价值,但具体最佳界值还需要大样本的进一步研究和证实。
第4部分食管鳞癌放疗前中18F-FDG高摄取区域的空间位置关系的研究
目的：本研究的目的是观察放疗前和放疗中两次PET-CT所显示的食管原发病灶18F-FDG高摄取区域的空间位置关系,从而推测依据放疗前的PET图像上所显示的食管癌原发灶高18F-FDG摄取的信息进行区域选择性加量放疗的可行性。
方法：入组病人为2011年在我院放疗科接受同步放化疗治疗的初治食管鳞癌患者。入组条件包括：1)病理确诊为食管鳞癌；2)入组前未接受过化放疗且KPS评分>70分；3)分期检查无远处转移；4)无心肺肾等慢性疾病。排除条件：1)病人不能完成预定放疗；2)治疗过程中出现远处转移。所有入组患者在治疗前和放疗45Gy时(第二次同步化疗前)分别行18F-FDG PET-CT扫描。在第一次PET图像上原发灶勾画首先以SUV=2.5,5,40%-70%SUVmax-pr。为阈值在PET图像上自动勾画得到GTV25pre、GTV5pre、GTV40%pre、GTV50%opre、GTV60%pre、GTV70%pre。在第二次PET图像上,以SUV=2.5和70%-90%SUVmax.dur为阈值勾画得GTV25dur、GTV70%dur、GTV80%dur、GTV90%dur。计算两次PET图像上以阈值自动勾画的区域的空间交集分数(OF)。OF定义为两个ROI的交集的体积与两个ROI相对较小的体积的比值,OF越接近于100%,代表放疗中所残留的高FDG代谢体积被放疗前高FDG代谢区域包括的体积越高。
结果：研究共入组2011年4月至2011年11月在我院行根治性同步放化疗的局部晚期食管鳞癌患者7例.。所有患者的原发灶SUVmax, SUVmean均有显著下降(p=0.05和0.03)。残留高摄取区域与治疗前GTV50%pre的OF达到70%以上其中热点区域GTV90%dur完全处于原发灶的高摄取区域内,OF达到100%。以不同阈值勾画的体积有很大差异,而放疗前和放疗中的食管癌原发灶高代谢区域尽管体积变化很大,但空间位置保持相对的稳定。
结论：在治疗中,食管鳞癌原发灶的SUV有显著的下降,但食管癌原发灶残留的18F-FDG高摄取区域仍然较稳定的落在治疗前原发灶GTV及治疗前PET上所显示的18F-FDG高摄取区域内,提示依据治疗前PET图像来选择性对食管癌原发病灶的部分区域进行局部加量放疗是可行的。
Part I The predictive value of pretreatment18F-FDG PET-CT on overall survival of patients with inoperable esophageal squamous cell carcinoma
Purpose To analysis metabolic parameters of pretreatment18F-FDG PET-CT and investigate the relationship between pretreatment PET-CT and overall survival of those patients with inoperable ESCC.
Materials and Methods Patients of ESCC with a pretreatment PET-CT scan treated with chemoradiotherapy or radiotherapy in our center in recent years were included in this study. A threshold of SUV=2.5was used to establish the primary lesion in PET image. Metabolic factors including MTV, SUV and clinical factors like sex, age, stage, et al were calculated. The association of these factors and the results of long-term follow-up of the patients were examined. Overall survival was estimated were estimated using the Kaplan-Meier method. Significance between groups was assessed by Log-Rank test. Multivariate analysis was performed to identify the prognostic factors influencing OS using Cox proportional hazards regression model.
Results Between2007.1and2010.8,30,30patients were enrolled in this study.Mean follow-up for all analyzable patients was19.5months, lyr-,2yr-,3yr-OS for the whole group was76.7%、52.1%、26.5%、 Univariate analysis showed patients having tumors with a length of primary lesion less than4cm (p=0.024) or MTV less than19.45cm3(p=0.006) had a better survival than those with a greater one, In the Cox multivariate analysis, MTV (p=0.012) were significant predictors of overall survival.We didn't find a significant relationship between SUV and OS.
Conclusion The present study shows that tumor volume parameters, especially MTV was valuable for predicting long-term survival.
Part Ⅱ The predictive value of pretreatment18F-FDG PET-CT on local control of patients with inoperable esophageal squamous cell carcinoma
Purpose The objective of this study is to evaluate the prognostic value of pretreatment18F-FDG PET/CT on local control after radical radiotherapy or chemoradiotherapy in patients with ESCC.
Materials and Methods Patients with a pretreatment PET-CT scan treated with chemoradiotherapy or radiotherapy were included in this study. A threshold of SUV=2.5was used to establish the primary lesion in PET image. Metabolic factors including MTV, SUV and clinical factors like sex, age, stage, et al were calculated. The association of these factors and the results of long-term follow-up of the patients were examined. Local progression-free survival was estimated were estimated using the Kaplan-Meier method. Significance between groups was assessed by Log-Rank test. Multivariate analysis was performed to identify the prognostic factors influencing local control using Cox proportional hazards regression model.
Results Between2007.1and2010.8,30,30patients were enrolled in this study.Mean follow-up for all analyzable patients was19.5months, lyr-,2yr-,3yr-local control rate for the whole group was72.0%、56.7%、56.7%. Univariate analysis showed patients having tumors with a SUVmax<12.6(p=0.032) or SUVmean<5.79(p=0.044) or MTV<19.45cm3(p=0.018) had a better local control than those with a greater one, In the Cox multivariate analysis, MTV (p=0.031) were significant predictors of local control.
Conclusion The present study shows that tumor volume parameters, especially MTV was valuable for predicting local progression-free survival.
Part Ⅲ The potential value of pretreatment18F-FDG PET-CT in in guiding individualized radiotherapy of patients with esophageal squamous cell carcinoma
Purpose:The objective of this study is to evaluate the prognostic value of pretreatment18F-FDG PET/CT on local control (LC) after radical radiotherapy or chemoradiotherapy in patients with ESCC, and investigate its potential value in establishing optimal radiation treatment plans.
Materials and methods:Thirty patients with pathologically proven ESCC who underwent pretreatment18F-FDG PET-CT in our cancer center were retrospectively reviewed. A threshold of SUV2.5was used to delineate the target volume of primary tumor separately. Coefficient of variation (COV) was used to evaluate the heterogeneity within the primary lesion. SUV and MTV of every pixel in all primary malignant lesions delineated on PET-CT images were measured. Cumulative SUV-volume histograms (CSH), describing total tumor volume above threshold of SUV (from2.5to SUVmax), were calculated. Receiver operating characteristics (ROC) curve was used to further evaluate the optimal cutoff for predicting local control. The local control was estimated using the Kaplan-Meier method and significance between groups was assessed by Log-Rank test.
Results:COV of the group with a MTV<19.45cm3was0.35, smaller than that of the group with a MTV>19.45cm3(0.51, p=0.0001). ROC curve showed MTV=12.85cm3when delineated with a threshold of SUV=5might be the best cut off values. Local control for patients with MTVSUV≥5<12.85cm3on pretreatment18F-FDG PET-CT scan were better than those with higher MTVSuv≥5>12.85cm3(p=0.003).
Conclusions:In this study, MTV above some threshold of SUV assessed by pretreatment PET/CT might be an adverse factor predicting local control in esophageal SCC, which indicated variation of biologically metabolic level within tumors should be consider as well as tumor volume promising for selecting risk-adapted therapies. These results will need to be validated in larger cohorts with longer follow-up, and evaluated prospectively.
Part IV Spatial dynamic distribution and stability of F-FDG uptake locations within tumor during radiotherapy for esophageal squamous cell carcinoma
Purpose:Because individual tumors are heterogeneous, including for18F-FDG uptake and, most likely, for radioresistance, selective boosting of high FDG uptake zones within the tumor has been suggested. To do this, it is critical to know whether the location of these high FDG uptake patterns within the tumor remain stable during radiotherapy (RT).
Materials and methods:Seven patients with ESCC treated with concurrent chemo-radiation underwent repeated F-FDG PET-CT scans before RT and after20fractions of RT. On all scans, the high and low FDG uptake regions were autodelineated using several SUV thresholds, varying from40%to70%of SUVmax on the pretreatment scan (GTV4o%pre, GTV5o%Pre, GTV6o%Pre, GTV7o%Pre)and from70%to90%of SUVmax on the dur-treatment scan (GTV7o%dur, GTV8o%dur, GTV9o%dur) and fixed thresholds of2.5and5(GTV2.5pre, GTV5pre). The volumes and overlap fractions of these delineations were calculated to demonstrate the stability of the high FDG uptake regions during RT.
Results:The high uptake regions within the tumor during RT largely corresponded (OF>70%) with the50%SUVmax high FDG uptake area (GTV50%pre,) of the pretreatment scan. The hotspot within the residual area (GTV9o%dur) was completely within the GTV and pre-radiotherapy high uptake regions (OF=100%). The volumes of the thresholds varied markedly. Although the location of the high FDG uptake patterns within the tumor during RT remained stable, the delineated volumes varied markedly.
Conclusions:The location of the high FDG uptake areas within the tumor remained stable during RT. This knowledge may enable selective boosting of high FDG uptake areas within the tumor.
引文
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