Radiother Oncol：食道肿瘤患者应尽早放疗

　　为了评估诊断性和治疗性FDG-PET扫描与早期肿瘤进展之间存在的关系，来自荷兰Groningen大学的Christina T. Muijs等进行了相关研究，其研究结果发表在Radiother Oncol 12月的期刊上。

　　研究共纳入了45名患者，所有的患者都接受了2次PET检查，第一次为入组时的PET检查，旨在应用高分辨率正电子照相机或PET/CT扫描确定肿瘤分期，第二次为治疗性PET检查，旨在应用PET/CT进行放疗计划的制定。由一个有经验的核医学医师随机审查所有的影像学资料。研究者评估了SUVmax、肿瘤大小、淋巴结转移情况和远处转移情况。

　　研究结果指出2次PET扫描的中位间隔时间为22天。SUVmax值或增或减，42%的患者出现SUVmax增加大于10%，24%的患者出现SUVmax降低。31%的患者出现肿瘤直径的增加超过1cm。27%的患者出现肿瘤TMN分期的进展，18%的患者出现新发的淋巴结转移，13%的患者出现新发的远处转移。没有发现显著影响预后的因素。然而，研究者注意到存在这样一种趋势——TMN进展程度与两次PET扫描间隔相关。

　　来自本研究的结果指出，食道肿瘤患者在较短的时间内容易出现病情进展。因此应该尽可能缩短相关的影像学检查和放疗开始的间隔时间。

Oesophageal tumour progression between the diagnostic (18)F-FDG-PET and the (18)F-FDG-PET for radiotherapy treatment planning

Background and purpose

To test whether the interval between diagnostic and therapeutic FDG-PET-scanning is associated with early tumour progression.

Material and methods

All patients (n=45) underwent two PET scans, one for staging (‘baseline PET’) using an HR+ positron camera or PET/CT-scanner and one for radiotherapy planning (‘therapeutic PET’) using a PET/CT-scanner.

All images were reviewed in random order by an experienced nuclear physician. If there were any discrepancies, the images were also compared directly. SUV_max, tumour length, lymph node metastases and distant metastases were assessed.

Results

The median time between the PET scans was 22days (range: 8–49). The SUV_max increased (>10%) (19 patients, 42%) or decreased (11 patients, 24%). Fourteen patients (31%) showed tumour length progression (>1cm). TNM progression was found in 12 patients (27%), with newly detected mediastinal nodes (N) in eight patients (18%) and newly detected distant metastases (M) in six patients (13%). No significant prognostic factors were found. However, a trend was noted towards TNM progression for the type of PET-camera (p=0.05, 95% CI 0.01–0.66) and for the interval between the PET scans (p=0.09, 95% CI −0.9 to 12.5).

Conclusion

This study suggests rapid oesophageal tumour progression. Therefore, the interval between relevant imaging and start of the radiotherapy should be minimized. Furthermore, ‘state of the art’ PET scanners should be used.