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食管癌是常见的消化道恶性肿瘤,其发病率和病死率分别位居我国恶性肿瘤的第6位和第4位[1]。目前,其治疗手段主要为手术治疗、放疗、化疗和靶向治疗等。食管癌由于早期缺乏明显症状,发现时常处于疾病中晚期,无法行手术切除,因此放化疗成为当前研究的热点。随着精准医疗的到来,能够早期评价治疗后疗效、进一步制定个体化治疗方案,对食管癌的预后具有重要意义。既往使用CT、超声内镜等来评价疗效,是基于RECIST1.1肿瘤评价标准,但该标准用于食管等空腔器官的疗效评价存在一定的局限性,且放化疗后由于解剖学的变化存在严重的滞后性,治疗后会引起食管壁水肿、组织增生,导致CT和超声内镜的准确性有所下降[2-3]。而PET/CT作为分子影像可以先于解剖学的改变监测到肿瘤代谢、生化的变化,对治疗后疗效的评价有重要价值。目前最常用的PET/CT显像剂为18F-FDG,可从肿瘤代谢方面提供治疗后反应的信息,此外有研究者使用其他PET/CT显像剂研究疗效评价,例如18F-氟代脱氧胸腺嘧啶(3'-deoxy-3'-18F-fluorothymidine,18F-FLT)、18F-氟硝基咪唑(18F-fluoromisonidazole,18F-FMISO)、18F-氟赤硝基咪唑(18F-Fluoroerythronitromidazole,18F-FETNIM)、18F-5-氟代烷基-2-甲基丙二酸(18F-5-fluoropentyl-2-methyl-malonic acid,18F-ML-10)等。现从代谢、增殖、乏氧、凋亡等方面就多种PET/CT显像剂在食管癌治疗后疗效评价中的应用进展进行综述。
多种PET/CT显像剂在食管癌放化疗疗效评价中的应用进展
Review on multiple PET/CT imaging agents in treatment response evaluation for esophageal cancer
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摘要: 放疗和化疗是治疗食管癌的重要手段,治疗后疗效评价对于制定个体化治疗方案具有重要意义。既往用于评价疗效的影像学技术仅基于形态学的变化,不能早期准确地反应肿瘤大小的变化,存在一定的局限性,而分子影像学技术PET/CT能够使用不同类型的显像剂,分别从代谢、增殖、乏氧、凋亡等方面早期评价治疗后反应,提高了诊断的灵敏度和特异度,具有较好的发展前景。笔者就多种PET/CT显像剂在食管癌非手术治疗疗效评价中的应用进展进行综述。
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关键词:
- 食管肿瘤 /
- 放射性核素显像 /
- 正电子发射断层显像计算机体层摄影术 /
- 疗效评价
Abstract: Radiotherapy and chemotherapy are important methods in the treatment of esophageal cancer. The evaluation of response after treatment has considerable importance for individualized treatment. The conventional imaging technology used to evaluate the response after therapy is only based on morphological changes, which cannot accurately reflect the early changes in tumor size. By contrast, the molecular imaging technology, PET/CT, can use different types of imaging agents to evaluate treatment response in terms of metabolism, proliferation, hypoxia, and apoptosis, which improves the diagnosis' sensitivity and specificity. Therefore, molecular imaging using multiple PET tracers is a promising new method for the evaluation of therapy response in esophageal cancer. The article reviews the PET/CT imaging agents used to examine the non-operation treatment response of esophageal cancer in recent years. -
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