ĐÁNH GIÁ MỐI LIÊN QUAN GIỮA GIÁ TRỊ TIÊN LƯỢNG CỦA PET/CT VÀ ĐÁP ỨNG SAU HOÁ XẠ TRỊ ĐỒNG THỜI Ở NHÂN UNG THƯ THỰC QUẢN GIAI ĐOẠN III KHÔNG PHẪU THUẬT ĐƯỢC=Evaluated the relationship between the prognostic value of PET/CT and response after concurrent chemoradiotherapy in patients with inoperable stage III esophageal cancer

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Tác giả: Quỳnh Anh Châu, Thị Quỳnh Mai, Quang Toàn Nguyễn, Lâm Sơn Phạm, Thế Hoàng Trần

Ngôn ngữ: vie

Ký hiệu phân loại:

Thông tin xuất bản: Tạp chí Điện quang và Y học hạt nhân Việt Nam, 2024

Mô tả vật lý: tr.53-61

Bộ sưu tập: Metadata

ID: 486826

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Mục đích: Đánh giá mối liên quan giữa giá trị tiên lượng của PET/CT và đáp ứng sau hoá xạ trị đồng thời ở bệnh nhân ung thư thực quản giai đoạn III không phẫu thuật được.Đối tượng và phương pháp: Nghiên cứu (NC) mô tả hồi cứu và tiến cứu 48 Bệnh nhân ung thư thực quản biểu mô vảy giai đoạn III (T1,2N2M0 hoặc T3,N1,2,M0) bệnh nhân được chụp PET/CT tính toán các giá trị (SUVmax,MTV,TLG) của tổn thương u thực quản, sau đó được điều trị hoá xạ trị đồng thời tại bệnh viện K thời gian từ tháng 1/2023 đến tháng 6/2024. Theo dõi dọc qúa trình điều trị và sau điều trị tìm mối liên quan giữa giá trị PET/CT và tiên lượng dựa vào thời gian sống thêm không bệnh (PFS) và toàn bộ (OS).Kết quả: Nhóm NC 100% nam giới, tuổi trung bình 61,25 6,67 tuổi. Tiền sử hút thuốc và lạm dụng rượu bia 81,25 %. Vị trí tổn thương hay gặp 1/3 giữa (45,8%), hai đoạn thực quản (22,9%), ít gặp ở đoạn 1/3 trên (10,4%). Giai đoạn trước điều trị T1,2N2 (43,8%) và T3,N1,2 (56,3%). Phân tích đường cong ROC cho các thông số PET/CT nhóm NC liên quan đến giai đoạn cT3 tương ứng SUVmax >
18,5 g/mL (độ nhạy 51,9%, độ đặc hiệu 76,2%, p <
0.01), TLG >
181,5 g (độ nhạy 70 %, độ đặc hiệu 95,6%, p <
0.001), MTV >
25,5 cm3 (độ nhạy 66,7%, độ đặc hiệu 99 %, p <
0.001). Bệnh nhân điều trị hoá xạ trị đồng thời với xạ trị liều≤ 50.4 (83,3%), hoá chất: FOLFOX (56.3%), XELOX (35,4%) và CF (8%). Thời gian theo dõi trung bình nhóm NC là 9,6 tháng (khoảng 3,02-18,2). Sau điều trị, 36 bệnh nhân (75%) bệnh còn tiến triển. Thời gian sống thêm không bệnh (PFS) sau 12 tháng có sự khác biệt của nhóm cT1,2 và cT3 tương ứng là 33,4% và 22,2% (p<
0,05). SUVmax <
18,5 g/mL, MTV <
25.5 cm3 và TLG <
181,5 g có tiên lượng tiên lượng tốt với PFS (tương ứng p<
0,05, p<
0,001 và p<
0,01). Tuy nhiên, không có sự khác biệt các chỉ số SUVmax, MTV,TLG với thời gian sống thêm toàn bộ của nhóm NC.Kết luận: Giai đoạn T và các thông số u thực quản trên PET/CT có ý nghĩa dự báo tiên lượng đánh giá đáp ứng sau hoá xạ trị đồng thời ở bệnh nhân ung thư thực quản biểu mô vảy giai đoạn III không phẫu thuật được.Purpose : This study evaluated the relationship between the prognostic value of PET/CT and response after concurrent chemoradiotherapy (CCRT) in patients with inoperable stage III esophageal cancer.Methods: We analyzed retrospective and prospective descriptive study of 48 patients with stage III squamous esophageal cancer (T1,2N2M0 hoặc T3,N1,2,M0) who underwent PET/CT scan to calculate values (SUVmax,MTV,TLG) of the esophageal tumor lesion, then received CCRT at K hospital from January 2023 to June 2024. Longitudinal monitoring of treatment and post-treatment to evaluated the relationship between PET/CT values and prognosis based on disease-free survival (PFS) and overall survival (OS).Results: Research group was 100% male, average age 61,25 6,67. History of smoking and alcohol abuse 81.25%. The most common location tumor is the middle third (45.8%), two segments of the esophagus (22.9%), and rarely the upper third (10.4%). Pre-treatment period T1,2N2 (43.8%) and T3,N1,2 (56.3%). ROC curve analysis for PET/CT parameters related to cT3 stage corresponding SUVmax >
18.5 g/mL (sensitivity(se): 51.9%, specificity(sp): 76.2%, p <
0.01) , TLG >
181.5 g (se: 70 %, sp: 95.6%, p <
0.001), MTV >
25.5 cm3 (se: 66.7%, sp: 99 %, p <
0.001). Patients received CCRT with radiotherapy dose 50.4 (83.3%), chemical regimens: FOLFOX (56.3%), XELOX (35.4%) and CF (8%). The average follow-up time of the study group was 9.6 months (range 3.02-18.2). After treatment, 36 patients (75%) had disease progression. The significant difference in disease-free survival (PFS) after 12 months of the cT1,2 and cT3 groups was 33.4% and 22.2%, respectively (p<
0.05). SUVmax <
18.5 g/mL, MTV <
25.5 cm3 and TLG <
181.5 g had a good prognosis with PFS (p<
0.05, p<
0.001 and p<
0.01, respectively). However, there was no significant difference in the SUVmax, MTV, TLG with the OS of the research group.Conclusion: T stage and esophageal tumor parameters on PET/ CT are meaningful in predicting prognosis and assessing response after concurrent CCRT in patients with inoperable stage III esophageal cancer.

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