【多模态】[18F]FDG PET / CT对第四阶段非小细胞肺癌的反应评估,采用紫杉醇-卡铂-贝伐单抗治疗或无硝酸甘油贴片治疗

2017-01-28 12:19:35 admin 5

[18F]FDG PET/CT-based response assessment of stage IV non-small cell lung cancer treated with paclitaxel-carboplatin-bevacizumab with or without nitroglycerin patches.

Journal:Eur J Nucl Med Mol Imaging. 2017 Jan

Author:de Jong EE1, van Elmpt W2, Leijenaar RT2, Hoekstra OS3, Groen HJ4, Smit EF5,6, Boellaard R7, van der Noort V8, Troost EG2,9,10, Lambin P2, Dingemans AC11.

Author information

    1.Department of Radiation Oncology (MAASTRO), GROW-School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, Netherlands. evelyn.dejong@maastro.nl.

    2.Department of Radiation Oncology (MAASTRO), GROW-School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, Netherlands.

    3.Department of Nuclear Medicine & PET Research, VU University Medical Center, Amsterdam, Netherlands.

    4.Department of Pulmonary Diseases, University of Groningen and University Medical Center Groningen, Groningen, Netherlands.

    5.Department of Pulmonary Diseases, VU University Medical Center, Amsterdam, Netherlands.

    6.Department of Thoracic Oncology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands.

    7.Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, Groningen, Netherlands.

    8.Department of Biometrics, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands.

    9.Institute of Radiooncology, Helmholtz-Zentrum Dresden-Rossendorf, Dresden, Germany.

    10.Department of Radiotherapy and Radiation Oncology, Medical Faculty and University Hospital Carl Gustav Carus of Technische Universität Dresden, Dresden, Germany.

    11.Department of Pulmonology, GROW-School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, Netherlands.

Abstract

PURPOSE


Nitroglycerin (NTG) is a vasodilating drug, which increases tumor blood flow and consequently decreases hypoxia. Therefore, changes in [18F] fluorodeoxyglucose positron emission tomography ([18F]FDG PET) uptake pattern may occur. In this analysis, we investigated the feasibility of [18F]FDG PET for response assessment to paclitaxel-carboplatin-bevacizumab (PCB) treatment with and without NTG patches. And we compared the [18F]FDG PET response assessment to RECIST response assessment and survival.

METHODS


A total of 223 stage IV non-small cell lung cancer (NSCLC) patients were included in a phase II study (NCT01171170) randomizing between PCB treatment with or without NTG patches. For 60 participating patients, a baseline and a second [18F]FDGPET/computed tomography (CT) scan, performed between day 22 and 24 after the start of treatment, were available. Tumor response was defined as a 30 % decrease in CT and PET parameters, and was compared to RECIST response at week 6. The predictive value of these assessments for progression free survival (PFS) and overall survival (OS) was assessed with and without NTG.

RESULTS


A 30 % decrease in SUVpeak assessment identified more patients as responders compared to a 30 % decrease in CT diameter assessment (73 % vs. 18 %), however, this was not correlated to OS (SUVpeak30 p = 0.833; CTdiameter30 p = 0.557). Changes in PET parameters between the baseline and the second scan were not significantly different for the NTG group compared to the control group (p value range 0.159-0.634). The CT-based (part of the [18F]FDG PET/CT) parameters showed a significant difference between the baseline and the second scan for the NTG group compared to the control group (CT diameter decrease of 7 ± 23 % vs. 19 ± 14 %, p = 0.016, respectively).

CONCLUSIONS


The decrease in tumoral FDG uptake in advanced NSCLC patients treated with chemotherapy with and without NTG did not differ between both treatment arms. Early PET-based response assessment showed more tumor responders than CT-based responseassessment (part of the [18F]FDG PET/CT); this was not correlated to survival. This might be due to timing of the [18F]FDG PET shortly after the bevacizumab infusion.

KEYWORDS


Bevacizumab; Nitroglycerin; Response assessment; Stage IV NSCLC; [18F]FDG PET/CT


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