PET/CT可預測某些頭頸部癌症案例


  【24drs.com】St. John醫院的腫瘤科醫師在頭頸部鱗狀上皮細胞癌病患接受最後的放化療治療後6-9週,定期進行監測型正子攝影(PET)/電腦斷層(CT)掃描—甚至在臨床未懷疑復發時也進行。
  
  研究作者、St. John醫院的放射腫瘤科醫師Yasir Rudha醫師表示,雖然例行性追蹤這方面還有些爭議,基於在該中心進行的小型研究結果,這些醫師將繼續如此進行。
  
  Rudha醫師在2012年跨科別頭頸部癌症研討會的記者會中表示,我們將繼續這麼做,因為有高的陰性預測值。他所說的事實是,在他們的研究中,沒有臨床復發證據的病患,約半數的後續監測性掃描結果為陰性,在後續追蹤期間內全部都沒有局部復發。
  
  科羅拉多大學的David Raben醫師預測,監測性掃描結果陰性的這些患者幾乎都將可以避免頸部淋巴廓清術,在以前,這些病患多數會進行頸部淋巴廓清術。
  
  監測性掃描還有另一個好處— 確定了之前有任何臨床復發表現的病患。Raben醫師表示,這些「實際陽性」案例的比率為53%,不過,這個好處因為偽陽性比率高達46%而有點被抵銷了。
  
  他總結表示,例行性使用PET/CT掃描追蹤頭頸部鱗狀上皮細胞癌病患,有助於在臨床表徵明顯前偵測局部復發。
  
  Rudha醫師等人在他們的中心檢視了234名接受化放療治療的頭頸部癌症病患,之後在2006-2010年進行治療後的PET/CT 掃瞄。對其中45個案例進行回溯病歷回顧,在進行監測性PET/CT掃描時,全部都是沒有臨床疾病證據。
  
  這45個病患中,30人為PET/CT掃描陰性,這30人在最後追蹤期時依舊沒有局部復發,不過,Rudha醫師並未提到這30名病患的平均追蹤期間多久。
  
  掃描發現15名病患出現需要後續評估的異常現象,切片顯示其中8人為惡性腫瘤(53%) (8人中有6人顯示原來的病灶處復發)。其他7人證明為偽陽性(46%),因此,病患進行了不必要的檢查和/或切片評估。他表示,掃描異常後,醫囑切片前要小心,以免過多不必要的切片。
  
  Rudha 醫師總結指出,不過,整體而言,研究結果支持例行性使用PET掃描作為頭頸部癌症治療後的監測方式。Rudha醫師認為,這是文獻中少見的結果。多數研究中,只有在臨床有懷疑時才進行PET掃描,只有少數文獻提到在治療結束後固定時間進行PET檢查的價值。
  
  Raben醫師為治療後使用PET背書,對於這些病患的監測與追蹤,這類掃描是絕對重要的,但是他指出,使用PET掃描頭頸部癌症需持續探究。
  
  資料來源:http://www.24drs.com/professional/list/content.asp?x_idno=6719&x_classno=0&x_chkdelpoint=Y
  

PET/CT Predictive of Some Head and Neck Cancer Cases

By Nick Mulcahy
Medscape Medical News

January 31, 2012 (Phoenix, Arizona) — Oncologists at St. John Hospital in Grosse Pointe Woods, Michigan, routinely perform a surveillance positron emission tomography (PET)/computed tomography (CT) scan 6 to 9 weeks after the definitive chemoradiation treatment of patients with squamous cell carcinoma of the head and neck — even when a recurrence is not clinically suspected.

And these clinicians will continue to do so in light of the results from a small study conducted at their center, despite the "controversy" surrounding such routine follow-up, said study author Yasir Rudha, MD, MBChB, a radiation oncologist at the hospital.

"We will keep doing it because of the high negative predictive value," said Dr. Rudha during a press conference at the 2012 Multidisciplinary Head and Neck Cancer Symposium. He was referring to the fact that, in their study, about half of the patients with no clinical evidence of recurrence had a subsequent negative surveillance scan and that all of them remained free of locoregional recurrence on further follow-up.

"Almost all of those patients will be able to avoid neck dissection," predicted David Raben, MD, from the University of Colorado in Aurora, about patients with negative surveillance scans. He was moderator of the press conference. In the past, most of these patients would have automatically gone on to a neck dissection as part of treatment, he said.

The surveillance scans had another benefit — they identified patients with disease recurrence that preceded any clinical manifestation of recurrence. The rate for finding these "true positives" was 53%, Dr. Rudha reported. However, this benefit was somewhat offset by the "high false-positive rate" of 46%, he admitted.

"The routine use of PET/CT scanning in the follow-up of patients with squamous cell carcinoma of the head and neck may be useful for the detection of locoregional recurrences before they become clinically apparent," he summarized.

Study Results and Controversies

Dr. Rudha and colleagues identified 234 patients with head and neck cancer at their center who were treated with chemoradiation and then underwent a posttherapy PET/CT scan from 2006 to 2010.

A retrospective chart review was performed for 45 of those cases, all of whom had a "clinical no-evidence-of-disease " status at the time of the surveillance PET/CT scan.

Of these 45 patients, 30 had a negative PET/CT scan, and all 30 remained free from locoregional relapse at the time of last follow-up. However, the median time of follow-up for the 30 patients was not presented by Dr. Rudha.

The scans identified 15 patients with abnormalities requiring further evaluation. Biopsy showed malignancies in 8 of the 15 patients (53%). (Six of the 8 showed occult persistent disease at the primary site.)

The other 7 cases of abnormalities turned out to be false positives (46%). Thus, patients underwent "unnecessary work-up and/or biopsy evaluation," he said. "Caution should be shown when ordering biopsies after abnormal scans to prevent excessive unnecessary biopsies," he added.

However, overall, the study results provide "support for the routine use of PET scanning as a surveillance method following treatment of head and neck cancer," Dr. Rudha summarized.

Dr. Rudha suggested that this is an uncommon finding in the literature.

He acknowledged that, in most studies, PET scans are performed only when recurrent disease is clinically suspected. "Only a few publications report the value of PET examination at a fixed time after the end of treatment," he told reporters at the press conference.

Dr. Raben endorsed using PET after treatment. The scans are "absolutely critical" for the monitoring and follow-up of these patients. But he added that the use of PET scans in head and neck cancer "continues to evolve."

Dr. Rudha, his coauthors, and Dr. Raben have disclosed no relevant financial relationships.

2012 Multidisciplinary Head and Neck Cancer Symposium (MHNCS): Abstract 226. Presented January 26, 2012.

    
相關報導
齲齒與頭頸部癌症風險較低有關
2013/9/18 上午 10:59:54
p16抗體值高可能代表頭頸部癌症的HPV感染
2009/11/13 下午 02:12:00
疼痛可以預測頭頸部癌症治療病患的存活率
2009/8/25 下午 04:24:00

上一頁
   1   2   3   4   5   6  




回上一頁