摘要
目的单一影像评价食管癌的治疗疗效已得到广泛研究,食管癌疗效评价标准需更加全面。本研究建立了基于X射线钡餐、CT及MR的综合评价标准,联合治疗前和放疗中期的PET-CT及MR来评价食管鳞癌同步放化疗后的近期疗效。方法入组山东大学附属山东省肿瘤医院2016-11-05-2017-08-15病理学确诊为食管鳞癌,未有远处转移,卡氏功能状态量表(Karnofsky Performance Status,KPS)评分>70分并行根治性放化疗患者30例,最终完成的为24例。化疗方案为FP(氟尿嘧啶+顺铂)或TP(多西他赛+顺铂)方案;放疗方式为三维适形放疗或调强放疗,放疗剂量为60Gy/30次。分别于同步放化疗前及放疗15次时行PET-CT检查,同步放化疗前、放疗15次及放疗结束1个月内行MR、CT及X射线钡餐检查。运用Pearson相关性分析研究钡餐、CT和MR评价标准对应综合影像标准的符合率,以及PET-CT参数和MR参数的关联性;重复测量方法分析参数值变化趋势;Spearman相关性分析研究参数值变化率与疗效的关联;受试者工作特征(receiver operating characteristic,ROC)曲线分析参数临界值。结果钡餐、CT和MR评价标准对应综合影像标准的符合率分别为54.2%、83.3%和95.8%;CT、MR和钡餐之间差异无统计学意义。重复测量分析得出,治疗前中后3组患者表观弥散系数(apparent diffusion coefficient,ADC)和扩散加权成像(diffusion weighted imaging,DWI)值分别呈上升(F=99.976,P=0.001)和下降(F=30.648,P=0.001)趋势;治疗前与治疗中3组患者的最大标准化摄取(maximal standard uptake value,SUVmax)值(F=60.690,P<0.001)、代谢体积(metabolic tumor volume,MTV)值(F=13.161,P=0.002)及糖酵解总量(total lesion glycolysis,TLG)值(F=21.926,P=0.001)等参数的下降差异均有统计学意义。ROC曲线分析得出,治疗结束时ADC>2.47mm2/s、DWI≤15.28cm3,以及治疗中期SUVmax≤9.04、MTV≤20.55cm3、TLG≤87.95g为判断近期疗效有效的临界值。结论结合多种影像指定的综合评价标准用以评价食管鳞癌患者根治性放化疗的近期疗效更加全面准确;PET和MR与预测食管癌治疗疗效之间存在紧密联系,ADC、SUVmax、MTV和TLG参数评价疗效的准确性达90%以上。
OBJECTIVE The efficacy of single imaging evaluation of esophageal cancer has been extensively studied,and the e-valuation criteria for esophageal cancer need to be more comprehensive.In this paper,a comprehensive evaluation standard based on X-ray barium meal,CT and MR was established.The short-term effects of concurrent radiotherapy and chemotherapy for esophageal squamous cell carcinoma were evaluated by PET-CT and MR in combination with pre-treatment and mid-radiation.METHODS En- tered the Shandong Provincial Cancer Hospital from November 5,2016 to August 15,2017,pathology confirmed as esophageal squamous cell carcinoma,no distant metastasis,30 patients with Karnofsky Performance Status(KPS) score greater than 70,concurrent radical chemoradiotherapy.The final enrollment was 24 cases.The chemotherapy regimen was FP(fluorou- racil+cisplatin)or TP (docetaxel+cisplatin);the radiotherapy method was three-dimensional conformal radiotherapy or intensity-modulated radiotherapy,and the radiation dose was 60 Gy/30 times.All patients underwent PET-CT before and after chemoradiotherapy,and before and after radiotherapy and chemotherapy,15 times of radiotherapy and 1 month after radiotherapy,MR,CT scan and X-ray barium meal examination were performed.Pearson correlation analysis was used to study the coincidence rate of the comprehensive image standard for barium meal,CT and MR evaluation criteria,the corre-lation between PET-CT parameters and MR parameters.Repeated measurement method was used to analyze the change trend of parameter values;spearman correlation analysis was used to study the relationship between the change rate of pa- rameter values and curative effect;ROC curve analysis parameter critical value.RESULTS The coincidence rates of barley meal,CT,and MR evaluation criteriacorresponding to comprehensive imaging standards were 54.2%,83.3%,and 95.8%,respectively.There was no significant difference between CT,MR and barium meal.The apparent diffusion coeffi-cient(ADC) and diffusion weighted imaging(DWI)values of the three groups before and after treatment showed a signifi-cant increased (F=99.976,P=0.001) and decreased(F=30.648,P=0.001)trend respectively;The maximal standard uptake value(SUVmax)(F=60.690,P<0.001),metabolic tumor volume(MTV)(F=13.161,P=0.002)and total lesion glycolysis TLG (F=21.926,P=0.001)decreased significantly.ROC curve analysis showed that:at the end of treatment, ADC>2.47mm^2/s,DWI volume≤15.28cm^3 and treatment mid-term SUVmax≤9.04,MTV≤20.55cm^3,TLG≤87.95g was the critical value for judging the short-term efficacy.CONCLUSIONS Combined with a variety of imaging-specific com-prehensive evaluation criteria to evaluate the short-term efficacy of radical chemoradiotherapy in patients with esophageal squamous cell carcinoma is more comprehensive and accurate.There is a close relationship between PET and MR and the efficacy of esopha-geal cancer treatment.The accuracies of ADC,SUVmax,MTV,and TLG parameters are more than 90%.
作者
祝猷哲
李建彬
张英杰
郭延娈
徐亮
苏娜
ZHU You-zhe;LI Jian-bin;ZHANG Ying-jie;GUO Yan-luan;XU Liang;SU Na(School of Medcine and Life Sciences,University of Jinan-Shandong Academy of Medical Sciences,Jinan 250022,P.R.China;Shandong Cancer Hospital Affiliated to Shandong University,Shandong Academy of Medical Sciences, Jinan 250117,P.R.China)
出处
《中华肿瘤防治杂志》
CAS
北大核心
2019年第9期637-642,共6页
Chinese Journal of Cancer Prevention and Treatment
基金
国家重点研发计划(2016YFC0904700)
国家自然科学基金面上项目(81773287)
山东省科技发展计划(2015GGC03029)
