18F-FMISO PET/CT对非小细胞肺癌放疗前后乏氧情况的监测及疗效评价  

Hypoxic condition monitoring and treatment evaluation for non-small cell lung cancer before and after radiotherapy by 18F-FMISO PET/CT

作　　者：王珍珍 李啸天[1] 阮翘[2] 付巍[1] 李彦鹏[2] 韩星敏[2] 赵雪芹 陈瑜 Wang Zhenzhen;Li Xiaotian;Ruan Qiao;Fu Wei;Li Yanpeng;Han Xingmin;Zhao Xueqin;Chen Yu(Department of Nuclear Medicine, Affiliated Hospital of Guilin Medical University, Guilin 541001, China;Department of Nuclear Medicine, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China)

机构地区：[1]桂林医学院附属医院核医学科,541001 [2]郑州大学第一附属医院核医学科,450052

出　　处：《中华核医学与分子影像杂志》2019年第5期262-265,共4页Chinese Journal of Nuclear Medicine and Molecular Imaging

基　　金：河南省重点科技攻关项目(142102310052).

摘　　要：目的探讨非小细胞肺癌(NSCLC)患者在放疗前后乏氧情况的变化以及18F-氟硝基咪唑(FMISO) PET/CT对放疗疗效的评价作用。方法前瞻性收集2014年1月至2016年10月间的NSCLC患者21例(男15例、女6例,30~74岁),于放疗前后分别行18F-FMISO PET/CT显像,并在放疗前行18F-脱氧葡萄糖(FDG) PET/CT显像,在放疗结束后第3、6个月随访并行常规胸部CT检查以判断疗效。测量肿瘤最大标准摄取值(SUVmax)、肌肉SUVmax、肿瘤体积及乏氧体积(HV)。计算肿瘤/肌肉(T/M)值,以T/M值≥1.3作为乏氧阈值。采用Pearson相关、配对t检验、符号秩和检验、Wilcoxon秩和检验分析数据。结果81.0%(17/21)的NSCLC患者放疗前存在乏氧。18F-FMISO T/M值与肿瘤体积呈正相关(r=0.72, P<0.05),与18F-FDG SUVmax呈正相关(r=0.60, P<0.05);放疗后T/M值明显低于放疗前(1.42±1.12与2.08±0.71;t=3.62,P<0.05),中位HV亦明显低于放疗前(6.53与12.41 cm^3;z=-3.83,P<0.05)。放疗有效组(14例)与无效组(7例)放疗前中位T/M值和中位HV差异均有统计学意义(T/M值:2.14和2.87,HV:6.43和10.20 cm^3;z值:-2.27和-2.14,均P<0.05)。结论大部分NSCLC患者放疗前存在乏氧,且肿瘤体积越大乏氧程度越高;放疗可缓解肿瘤乏氧情况。放疗前行18F-FMISO PET/CT显像可早期预测NSCLC患者疗效。Objective To evaluate the changes of hypoxic conditions in non-small cell lung cancer (NSCLC) patients before and after radiotherapy and assess the value of 18F-fluoromisonidzaole (FMISO) PET/CT for radiotherapy efficacy evaluation. Methods A total of 21 NSCLC patients (15 males, 6 females, age 30-74 years) from January 2014 to October 2016 were prospectively enrolled. 18F-FMISO PET/CT was performed before and after radiotherapy, and all patients underwent 18F-fluorodeoxyglucose (FDG) PET/CT before radiotherapy. Routine chest CT was performed at the 3rd and 6th month after radiotherapy. The maximum standardized uptake value (SUVmax) of tumor and muscle, tumor volume and hypoxic volume (HV) were measured. Tumor-to-muscle (T/M) value of 18F-FMISO was calculated, and T/M ≥1.3 was considered as the hypoxia cut-off value. Data were analyzed using Pearson correlation, paired t test, signed rank sum test and Wilcoxon rank sum test. Results Totally 81.0%(17/21) of NSCLC patients had hypoxia. There were significant positive correlations between 18F-FMISO T/M value and tumor volume or 18F-FDG SUVmax (r: 0.72, 0.60, both P<0.05). The T/M value after radiotherapy was significantly lower than that before radiotherapy (1.42±1.12 vs 2.08±0.71;t=3.62, P<0.05), and median HV was also significantly lower than that before radiotherapy (6.53 vs 12.41 cm^3;z=-3.83, P<0.05). The median T/M values of effective group (n=14) and ineffective group (n=7) before radiotherapy were significantly different (2.14 vs 2.87;z=-2.27, P<0.05), and the median HV of 2 groups before radiotherapy was also significantly different (6.43 vs 10.20 cm^3;z=-2.14, P<0.05). Conclusions Most NSCLC patients have hypoxia before radiotherapy. The larger tumor volume, the higher degree of hypoxia. Radiotherapy can alleviate the hypoxia of tumors. 18F-FMISO PET/CT imaging before radiotherapy can be used to predict the efficacy of patients with NSCLC.

关 键 词：癌 非小细胞肺 放射疗法 细胞低氧 正电子发射断层显像术 体层摄影术 X线计算机 硝基咪唑类 

分 类 号：R734.2[医药卫生—肿瘤] R730.44[医药卫生—临床医学]