- 期刊
應用F-18 FDG PET/CT Glycolysis評估食道癌患者經放射治療後之腫瘤反應與肺臟發炎變化
Assessment of Tumor Responses and Lung Inflammatory Changes Using F-18 FDG PET/CT Glycolysis After Radiotherapy for Esophageal Cancer Patients
摘要
背景：放射線肺炎為病患接受胸腔放射治療後常見的併發症，文獻指出氟-18去氧葡萄糖正子電腦斷層檢查（fluorine-18-fluorodeoxyglucose positron emission tomography/computed tomography, F-18 FDG PET/CT）除了腫瘤細胞有高度攝取葡萄糖的情況，發炎的正常組織亦會有FDG代謝增加，可偵測其發炎反應。本研究目的為應用FDG-PET/CT評估食道癌患者經放射治療後之腫瘤反應與肺臟發炎變化。方法：本研究回溯收集25位接受新式弧形放射治療之食道癌病患放射治療計畫及治療前（pre-RT）與治療後（post-RT）的FDG-PET/CT影像，利用放射治療計畫軟體將放射治療計畫之CT影像分別與治療前與治療後之FDG-PET/CT影像對位及融合後，即可取得腫瘤和正常組織之劑量分布及PET/CT的代謝數值。將肺臟區分為≥ 5 Gy高劑量區（high dose, HD）及＜ 5 Gy低劑量區（low dose, LD）後，量化分析pre-RT與post-RT之肺臟位於高劑量區與低劑量區之FDG-PET/CT代謝數值前後變化，包括標準攝取值（standard uptake value, SUV）、最大標準攝取值（maximum standard uptake value, SUVmax）、平均標準攝取值（mean standardized uptake value, SUVmean）、病灶組織糖解值（total lesion glycolysis, TLG）及全肺糖解值（global lung glycolysis, GLG）等。結果：本研究分析25位食道癌病患在放射治療後與治療前相比，腫瘤病灶區域的SUV max（下降63 %）、SUVmean（下降48 %）、TLG（下降76%）皆有顯著變化（all p ＜ 0.05）。在治療後肺臟高劑量區的SUVmax（上升23%）、SUVmean（上升16%）、GLG（上升38%）皆有顯著上升（all p ＜ 0.05），而三者在肺臟低劑量區皆無顯著性的變化。結論：本研究分析發現食道癌病人接受放療後，腫瘤之FDG代謝指數、SUV max、SUVmean、TLG皆顯著下降，而在肺臟高劑量區（≥ 5 Gy）之SUV max、SUVmean、TLG上升有放射線肺炎之趨勢。藉由融合放射治療計畫之CT與FDG-PET/CT影像，分割出腫瘤區域及肺臟高劑量區之SUVmax、SUVmean、GLG，可作為臨床評估放療後腫瘤反應及放射線肺炎的參考指標。
並列摘要
Background: Radiation pneumonitis is one of the most common side effects after radiotherapy (RT) for thoracic malignancy. Functional and metabolic imaging with fluorine-18-fluorodeoxyglucose (F-18 FDG) positron emission tomography/computed tomography (PET/CT) has been applied to detect cancer cells and also to quantify the inflammation based on the metabolism of the FDG uptake in cancer cells and normal tissues. This study aimed to assess tumor response and lung inflammatory changes by using F-18 FDG PET/CT glycolysis after RT for esophageal cancer patients. Methods: This retrospective study enrolled the RT treatment planning (RTP), pre-RT and post-RT FDG-PET/CT images of 25 esophageal cancer patients receiving modern arc-modulated RT. Then we used RT planning software to fuse the CT images with the pre-RT and post-RT FDG-PET/CT images. We set the 5 Gy isodose line as the threshold of the irradiated area and divided the irradiated volume of lungs into a high dose (HD) ≥ 5 Gy area and a low dose (LD) ＜ 5 Gy area. The FDG-PET/CT metabolic value analysis was performed on the HD and LD areas of the right lung, the left lung, and the whole lung respectively. The values include standard uptake value (SUV), maximum SUV (SUVmax), mean SUV (SUVmean), total lesion glycolysis (TLG), global lung glycolysis (GLG) of pre-RT, and post-RT FDG-PET/CT were analyzed. Results: As compared with the metabolic response of pre-RT and post-RT in twenty-five enrolled esophageal cancer patients, there was a significant decrease in the SUVmax (63%), SUVmean (48%), and TLG (76%) (all p ＜ 0.05) of the primary esophageal tumor. After RT, the pre-RT SUVmax (23%), SUVmean (16%), and GLG (38%) (all p ＜ 0.05) of HD irradiated lung area were significantly higher than those of post-RT. There was no significant change in SUVmax, SUVmean, or GLG of the LD lung area. Conclusions: This study found that there were significant decreases in SUVmax, SUVmean, and TLG of the primary esophageal tumor. There were also significant increases in SUVmax, SUVmean, GLG of the HD ≥ 5 Gy lung area in esophageal cancer patients. By the integration of CT of RT planning and FDG-PET/CT images, segmentation of tumor and HL lung area, the SUVmax, SUVmean, TLG, GLG might be a potential clinical indicator of tumor response and post-RT lung inflammation.