18F-FMISO PET/CT乏氧显像用于非小细胞肺癌患者重离子治疗响应的差异分析

Difference analysis of 18F-FMISO PET/CT hypoxia imaging in response to heavy ion radiotherapy in patients with non-small cell lung cancer

目的探索18F-氟硝基咪唑(FMISO)PET/CT乏氧显像对于非小细胞肺癌(NSCLC)患者重离子放疗早期治疗响应的临床价值。方法回顾性分析2018年4月至2021年1月在上海市质子重离子医院接受重离子放疗的23例NSCLC患者[男19例、女4例,年龄(64.9±10.3)岁]治疗前后18F-FMISO PET/CT图像。评价指标包括基线及治疗后病灶的肿瘤体积(TV)、肿瘤/本底比值(TBR)等参数。以基线病灶TBR≥1.4作为乏氧阈值,将患者分为乏氧组和非乏氧组。采用Wilcoxon符号秩检验比较2组患者TV和TBR在放疗前后的变化。结果23例NSCLC患者中,乏氧组17例、非乏氧组6例。与基线相比,乏氧组治疗后的TV[59.44(22.86,99.43)和33.78(8.68,54.44)cm^(3);z=-3.05,P=0.002]和TBR[2.25(2.09,2.82)和1.42(1.24,1.67);z=-3.39,P=0.001]均明显缩小;非乏氧组治疗后的TV[16.19(6.74,36.52)和8.59(4.38,25.47)cm^(3);z=-1.57,P=0.120]和TBR[1.19(1.05,1.27)和1.10(0.97,1.14);z=-1.89,P=0.060]亦下降,但差异无统计学意义。结论乏氧的NSCLC肿瘤对重离子射线敏感。与非乏氧肿瘤相比,乏氧肿瘤响应更快,放疗结束后早期就可以观察到TV明显缩小。重离子射线能够显著改善肿瘤乏氧程度。

Objective To explore the clinical value of 18F-fluoromisonidazole(FMISO)PET/CT hypoxia imaging in early response to heavy ion radiotherapy in patients with non-small cell lung cancer(NSCLC).Methods From April 2018 to January 2021,the 18F-FMISO PET/CT images of 23 NSCLC patients(19 males,4 females;age(64.9±10.3)years)who received heavy ion radiotherapy in Shanghai Proton and Heavy Ion Center were retrospectively analyzed.The evaluation parameters included tumor volume(TV),tumor to background ratio(TBR)before and after radiotherapy.Patients were divided into hypoxia group and non-hypoxia group with the baseline TBR value≥1.4 as hypoxia threshold.Wilcoxon signed rank test was used to compare the differences of TV and TBR before and after radiotherapy in 2 groups.Results Of 23 NSCLC patients,17 were hypoxia and 6 were non-hypoxia.Compared with the baseline,TV after the radiotherapy(59.44(22.86,99.43)and 33.78(8.68,54.44)cm3;z=-3.05,P=0.002)and TBR after the radiotherapy(2.25(2.09,2.82)and 1.42(1.24,1.67);z=-3.39,P=0.001)of the hypoxia group were significantly lower,while TV(16.19(6.74,36.52)and 8.59(4.38,25.47)cm3;z=-1.57,P=0.120)and TBR(1.19(1.05,1.27)and 1.10(0.97,1.14);z=-1.89,P=0.060)of the non-hypoxia group decreased with no significant differences.Conclusions Hypoxic NSCLC tumors are sensitive to heavy ion radiation.Compared with non-hypoxic tumors,hypoxic tumors respond more quickly,and a significant reduction in TV can be observed early after radiotherapy.Heavy ion radiation can significantly improve tumor hypoxia.