Radiation Oncology Journal

The Korean Society for Radiation Oncology (대한방사선종양학회)
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Change of FDG Uptake According to Radiation Dose on Squamous Cell Carcinoma of the Head and Neck

두경부종양에서 방사선조사량에 타른 FDG-PET의 변화양상

  • Lee Sang-wook (Department of Radiation Oncology College of Medicine, University of Ulsan) ;
  • Kim Jae-Seung (Department of Nuclear Medicine, Asan Medical Center, College of Medicine, University of Ulsan) ;
  • Im Ki Chun (Department of Nuclear Medicine, Asan Medical Center, College of Medicine, University of Ulsan) ;
  • Ryu Jin Sook (Department of Nuclear Medicine, Asan Medical Center, College of Medicine, University of Ulsan) ;
  • Lee Hee Kwan (Department of Radiation Oncology College of Medicine, University of Ulsan) ;
  • Kim Jong Hoon (Department of Radiation Oncology College of Medicine, University of Ulsan) ;
  • Ahn Seung Do (Department of Radiation Oncology College of Medicine, University of Ulsan) ;
  • Shin Seong Soo (Department of Radiation Oncology College of Medicine, University of Ulsan) ;
  • Yoon Sang Min (Department of Radiation Oncology College of Medicine, University of Ulsan) ;
  • Song Siyeol (Department of Radiation Oncology College of Medicine, University of Ulsan) ;
  • Park Jin-hong (Department of Radiation Oncology College of Medicine, University of Ulsan) ;
  • Moon Dae Hyuk (Department of Radiation Oncology College of Medicine, University of Ulsan) ;
  • Choi Eun Kyung (Department of Radiation Oncology College of Medicine, University of Ulsan)
  • 이상욱 (울산대학교 의과대학 서울아산병원 방사선종양학과) ;
  • 김재승 (울산대학교 의과대학 서울아산병원 방사선종양학과 핵의학과) ;
  • 임기천 (울산대학교 의과대학 서울아산병원 방사선종양학과 핵의학과) ;
  • 류진숙 (울산대학교 의과대학 서울아산병원 방사선종양학과 핵의학과) ;
  • 이희관 (울산대학교 의과대학 서울아산병원 방사선종양학과) ;
  • 김종훈 (울산대학교 의과대학 서울아산병원 방사선종양학과) ;
  • 안승도 (울산대학교 의과대학 서울아산병원 방사선종양학과) ;
  • 신성수 (울산대학교 의과대학 서울아산병원 방사선종양학과) ;
  • 윤상민 (울산대학교 의과대학 서울아산병원 방사선종양학과) ;
  • 송시열 (울산대학교 의과대학 서울아산병원 방사선종양학과) ;
  • 박진홍 (울산대학교 의과대학 서울아산병원 방사선종양학과) ;
  • 문대혁 (울산대학교 의과대학 서울아산병원 방사선종양학과 핵의학과) ;
  • 최은경 (울산대학교 의과대학 서울아산병원 방사선종양학과)
  • Published : 2004.06.01
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Abstract

Purpose : To evaluate whether positron omission tomography (PET) with 2-[F-18]fluoro-2-deoxy-D-giucose(FDG) can be used to predict of early response to definitive aim radlotherapy (RT) in squamous cell carcinoma of the head and neck using response rate and locoreglonal control as study endpoints. Materials and Methods : Twenty-two patients with head and neck cancer underwent a FDG-PET study before RT, after a flrst dose of 45 Gy, and after a second dose on more 4han 70 Gy. Standard uptake value (SUV) was calculated for primary tumor (n=22) and neck lymph node (n:10). Attenuation corrected PET scans acquired 60 min after tracer injection were used for evaluation of FDG uptake In tumors. A quantitative FDG uptake index was expressed as Suvlean (corrected for iean body mass). The follow-up time was at least 5 months (range S-1 S months). Results : A total of 22 primary tumors and 10 metastatic lymph nodes were analyzed In FDG-PET. In the first PET study the mean SUVlean the primary tumors and nodes were 5.4 (SD, 2.5) and 4.6 (SD, 2.3), respectively. In the second PET, study peformed after 46 Gy RT the mean SUV in primary tumor and node decreased to 2.9 (SD, 1.9, p<0.001) and 1.7 (SD, 1.3) respectively. in the third PET study peformed at the full dose (more than 70 Gy), RT the mean SUV In the primary tumors and nodes decreased to 2.3 (SD, 1.5, p<0.001) and 1.5 (SD, 1 .1) respectively. Conclusions: FDG uptake In tumors showed a significant decrease after the 45 Gy and more than 70 Gy of RT for squamous cell carcinoma of the head and neck. Reduction of metabolic activity after 46 Gy of radiotherapy Is closely correlated with radiation response.

목적 : 두경부종양에서 근치적 목적의 방사선치료를 시행하는 경우 종양의 방사선 반응도를 예측하는 것은 방사선치료 계획을 세우는 데 있어서 매우 중요하다. 따라서 본 저자들은 방사선치료 46 Gy 시점과 종료 시점에서 FDG-PET을 시행하여 방사선치료 반응성을 예측할 수 있는지 알아보고자 하였다. 대상 및 방법 : 2002년 10월부터 2003년 5월까지 서울아산병원 방사선종양학과에서 두경부종양으로 진단 받고 근치적 목적의 방사선치료를 시행 받은 22명에 대한 전향적 분석을 시행하였다. 본 연구계획서는 본원 임상윤리위원회를 통과하였고, 자발적으로 참여한 환자들에서 서면으로 동의를 받고 연구대상에 포함하였다. 모든 환자는 1차 FDG-PET을 방사선치료 시작 4주 이내에 시행하고 방사선치료 45 Gy 시점에서 제 2차 FDG-PET을 촬영하였고, 처음 계획된 선량이 모두 조사되는 시점에서 제 3차 FDG-PET을 시행하였다. 모든 환자는 최소한 방사선치료 종료 후 3개월 이상 추적하여 방사선치료 반응을 평가하였다. 로즈노 연구대상에 포함된 환자 중에서 남자는 19명이었고 여자는 3명이었다 이들의 연령은 25세에서 70세까지 분포하였고, 중앙연령은 56세였다. 종양의 발생 부위에 따라 나누어 보면 비인강암이 13명이었고, 후두암이 6명이었고, 설암, 하인두암, 접형동암이 각각 1예였다. 방사선치료 46 Gy 시점에서 FDG- PET의 섭취가 변화 없는 경우는 1예였고 방사선치료 종료 시점에서 FDG-PET상 완전반응을 보인 경우는 20예였고 1예는 부분반응을 보였다. FDG-PET상 완전반응을 보인 20예 중에서 2예는 국소재발하였고 1예는 국소재발과 경부림프절에 동시에 재발하여 현재까지 3명이 재발하였다 결론 : 방사선치료 46 Gy 시점에서 FDG-PET의 FDG섭취 감소가 현저한 경우는 방사선에 반응을 보이는 것으로 생각되었고 FDG 섭취의 변화가 전혀 없거나 방사선치료 종료 시점에서 FDG-PET 촬영상 완전반응을 보이지 않는 경우 잔존종양의 가능성이 매우 높다고 생각되었다.

Keywords

References

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