^(18)F-硝基咪唑丙醇正电子发射断层显像/X线计算机体层成像对食管癌放疗前后乏氧情况的监测及疗效评价

The hypoxic condition monitoring and treatment evaluation for esophageal carcinoma before and after radiotherapy by^(18)F-FMISO PET/CT

目的通过^(18)F-硝基咪唑丙醇(^(18)F-fluoromisonidazole,^(18)F-FMISO)正电子发射断层显像/X线计算机体层成像(PET/CT)显像监测食管癌肿瘤组织放疗前后乏氧情况的变化,研究^(18)F-FMISOPET/CT显像在食管癌病人放疗疗效评估中的临床应用价值。方法选取安徽医科大学第一附属医院放疗科2016年8月至2017年8月经临床病理证实为食管癌的病人60例,所有入组病人在放射治疗前1周及治疗结束后1周均行^(18)F-FMISOPET/CT检查,比较放疗前后肿瘤乏氧状态的改变;参考实体瘤疗效评价标准RECIST1.1进行疗效评估,分为完全缓解(CR)、部分缓解(PR)、稳定(SD)和进展(PD),对上述病人随访3个月后,进行疗效评估,本实验以CR和PR为放疗有效组,SD和PD为无效组;另外,将放疗后肿瘤乏氧体积、原发灶及转移淋巴结的T/M值与放疗前进行比较,评价乏氧状态与放疗疗效的关系。结果放疗后肿瘤T/M值(1.83比2.36)及HV(3.11 cm^(3)比4.97 cm^(3))均低于放疗前(Z=−2.090、−2.805,均P<0.05),转移淋巴结的HV低于放疗前(1.22 cm^(3)比1.84 cm^(3),Z=−2.192,P<0.05),但转移淋巴结的T/M值治疗前后差异无统计学意义(1.81比1.71,Z=−0.866,P>0.05);60例病人中,42例治疗有效(70%),18例无效(30%);且治疗前有效组的HV、T/M值均低于无效组。结论放疗可以明显改善食管癌组织的乏氧情况,^(18)F-FMISOPET/CT显像在食管癌病人放疗疗效的预测及评估中具有重要意义。

Objective To evaluate the changes of hypoxic conditions by ^(18)F-FMISO PET/CT imaging before and after radiotherapy for patients with esophageal cancer,and to investigate the value of ^(18)F-FMISO PET/CT imaging in evaluating the efficacy of esophageal cancer radiotherapy.Methods Sixty patients pathologically diagnosed with esophageal cancer admitted to Department of Radiotherapy,the First Affiliated Hospital of Anhui Medical University from August 2016 to August 2017 were selected.All the enrolled patients received ^(18)F-FMISO PET/CT scan one week before radiotherapy and one week after treatment,the changes of hypoxic state were collected and analyzed.The response to radiotherapy was evaluated by the response evaluation criteria in solid tumors(RECIST1.1),which was assigned into complete response(CR),partial response(PR),stabilization(SD)and progression(PD)3 months after radiotherapy.In this experiment,CR and PR were the effective groups of radiotherapy,SD and PD were the ineffective groups.In addition,hypoxic volume(HV)and primary lesion and metastatic lymph node T/M after radiotherapy were compared with those before radiotherapy to evaluate the relationship between hypoxic state and radiotherapy effect.Results The primary tumor T/M and HV(cm^(3))after radiotherapy was significantly lower than before radiotherapy(T/M:1.83 vs.2.36,HV:3.11 vs.4.97,Z=−2.090 and−2.805,P<0.05).The HV of metastatic lymph nodes after radiotherapy was significantly lower than that before radiotherapy(1.22 vs.1.84,Z=−2.192,P<0.05),but the T/M did not change significantly compared with the previous radiotherapy(1.81 vs.1.71,Z=−0.866,P>0.05).Of the 60 patients,42 cases of effective treatment(70%),18 cases of invalid(30%);and the HV and T/M values of the effective group before treatment were significantly lower than those of the invalid group.Conclusions Radiotherapy can significantly improve the hypoxic condition of esophageal tumor and ^(18)F-FMISO PET/CT imaging is of great significance in predicting and evaluating the radiotherapy efficacy of esophageal cancer.