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Impact of 18F-FDG-PET/CT on the identification of regional lymph node metastases and delineation of the primary tumor in esophageal squamous cell carcinoma patients.
Strahlentherapie und Onkologie ( IF 3.1 ) Pub Date : 2020-05-19 , DOI: 10.1007/s00066-020-01630-y Stefan Münch 1, 2 , Lisa Marr 1 , Benedikt Feuerecker 3 , Hendrik Dapper 1 , Rickmer Braren 4 , Stephanie E Combs 1, 2, 5 , Marciana-Nona Duma 6
Strahlentherapie und Onkologie ( IF 3.1 ) Pub Date : 2020-05-19 , DOI: 10.1007/s00066-020-01630-y Stefan Münch 1, 2 , Lisa Marr 1 , Benedikt Feuerecker 3 , Hendrik Dapper 1 , Rickmer Braren 4 , Stephanie E Combs 1, 2, 5 , Marciana-Nona Duma 6
Affiliation
PURPOSE
In patients undergoing chemoradiation for esophageal squamous cell carcinoma (ESCC), the extent of elective nodal irradiation (ENI) is still discussed controversially. This study aimed to analyze patterns of lymph node metastases and their correlation with the primary tumor using 18F‑fludeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) scans.
METHODS
102 ESCC patients with pre-treatment FDG-PET/CT scans were evaluated retrospectively. After exclusion of patients with low FDG uptake and patients without FDG-PET-positive lymph node metastases (LNM), 76 patients were included in the final analysis. All LNM were assigned to 16 pre-defined anatomical regions and classified according to their position relative to the primary tumor (above, at the same height, or below the primary tumor). In addition, the longitudinal distance to the primary tumor was measured for all LNM above or below the primary tumor. The craniocaudal extent (i.e., length) of the primary tumor was measured using FDG-PET imaging (LPET) and also based on all other available clinical and imaging data (endoscopy, computed tomography, biopsy results) except FDG-PET (LCT/EUS).
RESULTS
Significantly more LNM were identified with 18F‑FDG-PET/CT (177 LNM) compared to CT alone (131 LNM, p < 0.001). The most common sites of LNM were paraesophageal (63% of patients, 37% of LNM) and paratracheal (33% of patients, 20% of LNM), while less than 5% of patients had supraclavicular, subaortic, diaphragmatic, or hilar LNM. With regard to the primary tumor, 51% of LNM were at the same height, while 25% and 24% of lymph node metastases were above and below the primary tumor, respectively. For thirty-three LNM (19%), the distance to the primary tumor was larger than 4 cm. No significant difference was seen between LCT/EUS (median 6 cm) and LPET (median 6 cm, p = 0.846) CONCLUSION: 18F‑FDG-PET can help to identify subclinical lymph node metastases which are located outside of recommended radiation fields. PET-based involved-field irradiation might be the ideal compromise between small treatment volumes and decreasing the risk of undertreatment of subclinical metastatic lymph nodes and should be further evaluated.
中文翻译:
18F-FDG-PET / CT对食管鳞状细胞癌患者区域淋巴结转移的鉴定和原发肿瘤轮廓的影响。
目的在食管鳞状细胞癌(ESCC)接受化学放射治疗的患者中,选择性淋巴结照射(ENI)的程度仍存在争议。这项研究旨在使用18 F-氟脱氧葡萄糖正电子发射断层扫描/计算机断层扫描(FDG-PET / CT)扫描来分析淋巴结转移的模式及其与原发肿瘤的相关性。方法回顾性分析102例经治疗前FDG-PET / CT扫描的ESCC患者。排除FDG摄取量低的患者和无FDG-PET阳性淋巴结转移(LNM)的患者后,将76名患者纳入最终分析。将所有LNM分配到16个预定义的解剖区域,并根据它们相对于原发肿瘤的位置(在原发肿瘤的上方,相同高度或下方)进行分类。此外,测量在原发肿瘤上方或下方的所有LNM到原发肿瘤的纵向距离。使用FDG-PET成像(LPET)并基于除FDG-PET(LCT / EUS)以外的所有其他可用临床和影像学数据(内窥镜检查,计算机断层扫描,活检结果)测量原发肿瘤的颅尾大小(即长度) )。结果与单独使用CT相比,使用18F-FDG-PET / CT(177 LNM)可以识别出更多的LNM(131 LNM,p <0.001)。LNM最常见的部位是食管旁(63%的患者,LNM的37%)和气管旁(33%的患者,LNM的20%),而锁骨上,主动脉下,diaphragm肌或肺门LNM的患者少于5% 。对于原发肿瘤,51%的LNM处于相同的高度,而25%和24%的淋巴结转移分别在原发肿瘤的上方和下方。对于33个LNM(19%),到原发肿瘤的距离大于4 cm。LCT / EUS(中位数6 cm)和LPET(中位数6 cm,p = 0.846)之间没有发现显着差异。结论:18F-FDG-PET可以帮助鉴定亚临床淋巴结转移灶,这些转移灶不在推荐的放射线范围内。基于PET的受累场照射可能是小剂量治疗与降低亚临床转移性淋巴结治疗不足风险之间的理想折衷方案,应进一步评估。
更新日期:2020-05-19
中文翻译:
18F-FDG-PET / CT对食管鳞状细胞癌患者区域淋巴结转移的鉴定和原发肿瘤轮廓的影响。
目的在食管鳞状细胞癌(ESCC)接受化学放射治疗的患者中,选择性淋巴结照射(ENI)的程度仍存在争议。这项研究旨在使用18 F-氟脱氧葡萄糖正电子发射断层扫描/计算机断层扫描(FDG-PET / CT)扫描来分析淋巴结转移的模式及其与原发肿瘤的相关性。方法回顾性分析102例经治疗前FDG-PET / CT扫描的ESCC患者。排除FDG摄取量低的患者和无FDG-PET阳性淋巴结转移(LNM)的患者后,将76名患者纳入最终分析。将所有LNM分配到16个预定义的解剖区域,并根据它们相对于原发肿瘤的位置(在原发肿瘤的上方,相同高度或下方)进行分类。此外,测量在原发肿瘤上方或下方的所有LNM到原发肿瘤的纵向距离。使用FDG-PET成像(LPET)并基于除FDG-PET(LCT / EUS)以外的所有其他可用临床和影像学数据(内窥镜检查,计算机断层扫描,活检结果)测量原发肿瘤的颅尾大小(即长度) )。结果与单独使用CT相比,使用18F-FDG-PET / CT(177 LNM)可以识别出更多的LNM(131 LNM,p <0.001)。LNM最常见的部位是食管旁(63%的患者,LNM的37%)和气管旁(33%的患者,LNM的20%),而锁骨上,主动脉下,diaphragm肌或肺门LNM的患者少于5% 。对于原发肿瘤,51%的LNM处于相同的高度,而25%和24%的淋巴结转移分别在原发肿瘤的上方和下方。对于33个LNM(19%),到原发肿瘤的距离大于4 cm。LCT / EUS(中位数6 cm)和LPET(中位数6 cm,p = 0.846)之间没有发现显着差异。结论:18F-FDG-PET可以帮助鉴定亚临床淋巴结转移灶,这些转移灶不在推荐的放射线范围内。基于PET的受累场照射可能是小剂量治疗与降低亚临床转移性淋巴结治疗不足风险之间的理想折衷方案,应进一步评估。