18F-FMISO PET/CT对非小细胞肺癌放疗前后乏氧情况的监测及疗效评价

摘要

目的 探讨非小细胞肺癌(NSCLC)患者在放疗前后乏氧情况的变化以及18F-氟硝基咪唑(FMISO) PET/CT对放疗疗效的评价作用.方法 前瞻性收集2014年1月至2016年10月间的NSCLC患者21例(男15例、女6例,30～ 74岁),于放疗前后分别行18F-FMISO PET/CT显像,并在放疗前行18F-脱氧葡萄糖(FDG) PET/CT显像,在放疗结束后第3、6个月随访并行常规胸部CT检查以判断疗效.测量肿瘤最大标准摄取值(SUVmax)、肌肉SUVmax、肿瘤体积及乏氧体积(HV).计算肿瘤/肌肉(T/M)值,以T/M值≥1.3作为乏氧阈值.采用Pearson相关、配对t检验、符号秩和检验、Wilcoxon秩和检验分析数据.结果 81.0％(17/21)的NSCLC患者放疗前存在乏氧.18F-FMISO T/M值与肿瘤体积呈正相关(r=0.72,P＜0.05),与18F-FDG SUVmax呈正相关(r=0.60,P＜0.05);放疗后T/M值明显低于放疗前(1.42± 1.12与2.08±0.71;t=3.62,P＜0.05),中位HV亦明显低于放疗前(6.53与12.41 cm3;z=-3.83,P＜0.05).放疗有效组(14例)与无效组(7例)放疗前中位T/M值和中位HV差异均有统计学意义(T/M值:2.14和2.87,HV:6.43和10.20 cm3;z值:-2.27和-2.14,均P＜0.05).结论 大部分NSCLC患者放疗前存在乏氧,且肿瘤体积越大乏氧程度越高;放疗可缓解肿瘤乏氧情况.放疗前行18F-FMISO PET/CT显像可早期预测NSCLC患者疗效.%Objective To evaluate the changes of hypoxic conditions in non-small cell lung cancer (NSCLC) patients before and after radiotherapy and assess the value of 18F-fluoromisonidzaole (FMISO)PET/CT for radiotherapy efficacy evaluation.Methods A total of 21 NSCLC patients (15 males,6 females,age 30-74 years) from January 2014 to October 2016 were prospectively enrolled.18F-FMISO PET/CT was performed before and after radiotherapy,and all patients underwent 18F-fluorodeoxyglucose (FDG)PET/CT before radiotherapy.Routine chest CT was performed at the 3rd and 6th month after radiotherapy.The maximum standardized uptake value (SUVmax) of tumor and muscle,tumor volume and hypoxic volume (HV) were measured.Tumor-to-muscle (T/M) value of 18F-FMISO was calculated,and T/M ≥ 1.3 was considered as the hypoxia cut-off value.Data were analyzed using Pearson correlation,paired t test,signed rank sum test and Wilcoxon rank sum test.Results Totally 81.0％(17/21) of NSCLC patients had hypoxia.There were significant positive correlations between 18F-FMISO T/M value and tumor volume or 18F-FDG SUVmax(r:0.72,0.60,both P＜0.05).The T/M value after radiotherapy was significantly lower than that before radiotherapy (1.42± 1.12 vs 2.08±0.71;t =3.62,P＜0.05),and median HV was also significantly lower than that before radiotherapy (6.53 vs 12.41 cm3;z =-3.83,P＜0.05).The median T/M values of effective group (n =14) and ineffective group (n =7) before radiotherapy were significantly different (2.14 vs 2.87;z=-2.27,P＜0.05),and the median HV of 2 groups before radiotherapy was also significantly different (6.43 vs 10.20 cm3;z=-2.14,P＜0.05).Conclusions Most NSCLC patients have hypoxia before radiotherapy.The larger tumor volume,the higher degree of hypoxia.Radiotherapy can alleviate the hypoxia of tumors.18F-FMISO PET/CT imaging before radiotherapy can be used to predict the efficacy of patients with NSCLC.