JCO:采用PET成像评估食管/食管胃交界癌早期治疗反应对患者预后的意义

2021-06-03 Nebula MedSci原创

使用PET成像作为生物标志物对食管和食管胃交界处腺癌患者进行个体化治疗的早期反应评估是有效的,提高了PET无反应者的pCR率

随着食管和食管胃交界处(EGJ)腺癌发病率的升高,预计这类恶性肿瘤的全球负担将在未来十年急剧增长,因此迫切需要更有效的治疗方法。

本研究旨在评估通过正电子发射断层扫描 (PET) 成像对化疗反应性进行的早期评估,在食管和食管胃交界处腺癌患者中定制治疗策略中的作用。

基线 PET 后,患者被随机分至两组,接受两种不同的诱导化疗方案:FOLFOX方案(改良的奥沙利铂、亚叶酸和氟尿嘧啶) 或CP方案(卡铂-紫杉醇)。诱导化疗后重复PET检查,以评估最大标准化摄取值 (SUV) 的变化。PET 无反应者(SUV 减少<35%)在放化疗期间(50.4 Gy/28 次)改用替代化疗。PET 反应者(SUV 降低 ≥35%)在放化疗期间继续接受相同的化疗。患者在放化疗后 6 周进行手术。主要终点是更改化疗方案的患者的病理完全缓解(pCR)率。

诱导化疗后有无反应的患者预后

共241名符合条件的患者接受了协议治疗,其中225名有可评估的重复 PET检查。 FOLFOX诱导化疗后PET无反应者,改用CP化疗方案(n=39)后的pCR率为18.0%,CP诱导化疗后的PET无反应者,改用FOLFOX方案(n=50)后的pCR率为20%。FOLFOX诱导化疗的PET反应者的 pCR 率为 40.3%,CP诱导化疗的PET反应者的 pCR率为14.1%。

不同方案诱导治疗后有无反应的患者预后

中位随访5.2年,PET反应者的中位总生存期为 48.8个月,无反应者的中位总生存期为27.4个月。FOLFOX诱导化疗的PET反应者的中位生存期未达到。

总之,使用PET成像作为生物标志物对食管和食管胃交界处腺癌患者进行个体化治疗的早期反应评估是有效的,提高了PET无反应者的pCR率。在诱导治疗和放化疗期间持续使用FOLFOX方案的PET反应者的5年总生存率高达53%。

原始出处:

Goodman Karyn A,Ou Fang-Shu,Hall Nathan C et al. Randomized Phase II Study of PET Response-Adapted Combined Modality Therapy for Esophageal Cancer: Mature Results of the CALGB 80803 (Alliance) Trial.[J] .J Clin Oncol, 2021, undefined: JCO2003611. https://doi.org/10.1200/JCO.20.03611

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    2021-12-30 lidong40
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    2021-11-07 1482963am12暂无昵称

    学习了

    0

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    2021-06-05 zhouqu_8

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