Nazofarenks kanserlerinde evreleme F-18 FDG pet/BT görüntülemede volümetri̇k parametreleri-n prognosti̇k değeri
Yükleniyor...
Tarih
2023
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Necmettin Erbakan Üniversitesi Meram Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Amaç: Nazofarenks karsinomu (NFK) ülkemiz için non-endemik bölge olmasına rağmen,
erken evrelerde bile tümörün persistan durumu, nüks ve metastaz yapma ihtimali yüksek olup,
prognozu kötü olarak sonuçlanabilir. Kişiselleştirilmiş tedavi protokolü hastalık sağkalımını
arttırmakla birlikte, hangi hastada daha agresif tedavi modaliteleri uygulanacağına dair henüz
bir yöntem bulunmamaktadır. Bu çalışma ile, evreleme F-18 Florodeoksiglukoz (FDG)
pozitron emisyon tomografi/bilgisayarlı tomografi (PET/BT)’nin volümetrik
paramaterelerinin hastalığın prognozunu öngörme başarısını saptamayı amaçladık.
Gereç ve yöntem: Bu retrospektif çalışmaya, histopatolojik olarak NFK tanısı alıp,
Necmettin Erbakan Üniversitesi Meram Tıp Fakültesi Nükleer Tıp Anabilim Dalı’nda Mayıs
2010-Temmuz 2021 tarihleri arasında tedavi öncesi evreleme amacıyla FDG PET/BT
görüntülemesi, daha sonra Radyasyon Onkolojisi Anabilim Dalı tarafından definitif tedavisi
yapılan toplam 62 hasta dahil edilmiştir. Hasta dosyaları retrospektif olarak incelenerek
cinsiyet, yaş, sigara-alkol kullanım durumu, tümör evresi, nodal evre, hastalığın genel evresi,
histopatolojik alt tipi, lokorejyonel nüks, uzak metastaz ve sağkalıma ait bulgular kaydedildi.
Evreleme FDG PET/BT görüntülemede primer lezyon ve lenf nodundan ölçülen Maksimum
Standardize Uptake Value (SUVmax), Ortalama Standart Tutulum Değeri (SUVmean),
Metabolik tümör volümü (MTV) ve Tümör Lezyon Glikolizis (TLG) değerleri, NTR (Nodal to
tumor ratio) oranı kaydedildi. Bu parametrelerin, hastalığın nüks, metastaz durumu ve
sağkalımı öngörmedeki değeri araştırıldı.
Bulgular: Araştırmaya 62 hasta dahil edilmiştir. Hastaların yaş ortalaması 49,6 ± 14,1 di.
Hastaların 50’si (%80.6) erkek, 28’i (%45.2) sigara içiyordu. Alkol kullanan 1 (%1.6) hasta
vardı. Tümür grade’ine göre 12 hasta (%19.4) keratinize, 9 hasta (%14.5) diferansiye nonkeratinize,
41 hasta (%66.1) ise indiferansiye-non keratinize olarak raporlanmıştı. Hastaların
18’i (%29) T1 evresinde, 27’si (%43.5) T2 evresinde, 6’sı (%9.7) T3 evresinde ve 11’i
(%17.7) ise T4 evresindeydi. N evrelemesine göre ise 9 (%14.5) hasta N0, 9 hasta (%14.5)
iv
N1, 32 (%51.6) hasta N2, 10 (%16.1) hasta N3a ve 2 (%3.2) hasta ise N3b olarak
sınıflanmıştı. Tümör büyüklüğü ve lenf nodu tutulumuna göre genel olarak bakıldığında ise
hastaların 3’ü (%4.8) evre 1, 11’i (%17.7) evre 2, 28’i (%45.2) evre 3 ve 20’si (%32.3) evre
4A olarak sınıflanmıştı. Volümetrik FDG PET/BT parametreleri dikkate alındığında, lenf
nodu (LN) SUVmax, LN SUVmean değerleri takiplerde uzak metastazı olan hastalarda
anlamlı biçimde daha yüksek saptanmıştı (her biri için p<0.05). NTR değerleri ise takiplerde
uzak metastazı olmayan hastalarda olan hastalara göre anlamlı biçimde daha düşüktü
(p=0.022). Genel sağkalım, lokorejyonel nükssüz sağkalım ve uzak metastazsız sağkalım
analizlerinde ise PET/BT volümetrik parametrelerle anlamlı ilişkisi saptanmamıştır.
Sonuç: Yeni tanı NFK hastalarında tedavi öncesi evreleme FDG PET/BT volümetrik
parametrelerinin prognostik değeri olup olmadığını araştırmak için planlanan ve yürütülen tez
çalışmamızda, ölçülen volümetrik parametrelerin sağkalımda anlamlı bir ilişkisi kurulamadı.
Bununla birlikte uzak metastazı öngörmede metastatik lenf nodundan ölçülen SUVmax,
SUVmean ve yeni NTR değerinin anlamlı ilişkide olduğu saptanmıştır. Bu parametrelerin,
anatomik evreleme ile birlikte kullanılması, prognoz açısından entegre risk değerlendirmesi
yapılması ve prognozu kötü hastaların tedavi klasifikasyonu açısından yol gösterici olacaktır.
Aim: Although nasopharyngeal carcinoma (NFC) is a non-endemic region for our country, the persistent state of the tumor, even in the early stages, has a high probability of recurrence and metastasis, and the prognosis may be poor. Although the personalized treatment protocol increases the disease survival, there is no method yet to determine which patient will be applied more aggressive treatment modalities. With this study, we aimed to determine the success of the volumetric parameters of staging F-18 Fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) in predicting the prognosis of the disease. Material and Methods: In this retrospective study, histopathological diagnosis of nasopharyngeal carcinoma was performed at Necmettin Erbakan University Meram Faculty of Medicine, Department of Nuclear Medicine between May 2010 and July 2021 for pretreatment staging with FDG PET/CT imaging, then by the Radiation Oncology Department. A total of 62 patients who underwent definitive treatment were included. The patient files were reviewed retrospectively and the findings of gender, age, smoking-alcohol use, tumor stage, nodal stage, general stage of the disease, histopathological subtype, locoregional recurrence, distant metastasis, and survival were recorded. SUVmax, SUVmean, MTV and TLG values measured from the primary lesion and lymph node in the staging FDG PET/CT imaging, and NTR ratio were recorded. The value of these parameters in predicting disease recurrence, metastasis status and survival was investigated. Results: 62 patients were included in the study. The mean age of the patients was 49.6 ± 14.1 years. Fifty (80.6%) of the patients were male and 28 (45.2%) were smokers. There was 1 (1.6%) patient who used alcohol. According to tumor grade, 12 patients (19.4%) were reported as keratinized, 9 patients (14.5%) as differentiated non-keratinized, and 41 patients (66.1%) as undifferentiated non-keratinized. Eighteen (29%) of the patients were at T1 stage, 27 (43.5%) at T2 stage, 6 (9.7%) at T3 stage, and 11 (17.7%) at T4 stage. According to N staging, 9 (14.5%) patients were classified as N0, 9 (14.5%) patients as N1, 32 (51.6%) patients as N2, 10 (16.1%) patients as N3a and 2 (3.2%) patients as N3b. In general, vi according to tumor size and lymph node involvement, 3 (4.8%) of the patients were stage 1, 11 (17.7%) stage 2, 28 (45.2%) stage 3 and 20 (32.3%) stage. It was classified as 4A. Considering the volumetric FDG PET/CT parameters, LN SUVmax, LN SUVmean values were found to be significantly higher in patients with distant metastases at follow-up (p<0.05 for each). NTR values were significantly lower in patients without distant metastases during follow-up (p=0.022). In the analysis of overall survival, locoregional recurrence-free and distant metastasis-free survival, no significant correlation was found with PET/CT volumetric parameters. Conclusion: In our thesis study, which was planned and conducted to investigate whether pre-treatment staging FDG PET/CT volumetric parameters have prognostic value in newly diagnosed NFC patients, a significant relationship between measured volumetric parameters and survival could not be established. On the other hand, SUVmax, SUVmean and new NTR values measured from metastatic lymph node were found to be significantly correlated in predicting distant metastasis. The use of these parameters together with anatomical staging, integrated risk assessment in terms of prognosis, and treatment classification of patients with poor prognosis will be guiding.
Aim: Although nasopharyngeal carcinoma (NFC) is a non-endemic region for our country, the persistent state of the tumor, even in the early stages, has a high probability of recurrence and metastasis, and the prognosis may be poor. Although the personalized treatment protocol increases the disease survival, there is no method yet to determine which patient will be applied more aggressive treatment modalities. With this study, we aimed to determine the success of the volumetric parameters of staging F-18 Fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) in predicting the prognosis of the disease. Material and Methods: In this retrospective study, histopathological diagnosis of nasopharyngeal carcinoma was performed at Necmettin Erbakan University Meram Faculty of Medicine, Department of Nuclear Medicine between May 2010 and July 2021 for pretreatment staging with FDG PET/CT imaging, then by the Radiation Oncology Department. A total of 62 patients who underwent definitive treatment were included. The patient files were reviewed retrospectively and the findings of gender, age, smoking-alcohol use, tumor stage, nodal stage, general stage of the disease, histopathological subtype, locoregional recurrence, distant metastasis, and survival were recorded. SUVmax, SUVmean, MTV and TLG values measured from the primary lesion and lymph node in the staging FDG PET/CT imaging, and NTR ratio were recorded. The value of these parameters in predicting disease recurrence, metastasis status and survival was investigated. Results: 62 patients were included in the study. The mean age of the patients was 49.6 ± 14.1 years. Fifty (80.6%) of the patients were male and 28 (45.2%) were smokers. There was 1 (1.6%) patient who used alcohol. According to tumor grade, 12 patients (19.4%) were reported as keratinized, 9 patients (14.5%) as differentiated non-keratinized, and 41 patients (66.1%) as undifferentiated non-keratinized. Eighteen (29%) of the patients were at T1 stage, 27 (43.5%) at T2 stage, 6 (9.7%) at T3 stage, and 11 (17.7%) at T4 stage. According to N staging, 9 (14.5%) patients were classified as N0, 9 (14.5%) patients as N1, 32 (51.6%) patients as N2, 10 (16.1%) patients as N3a and 2 (3.2%) patients as N3b. In general, vi according to tumor size and lymph node involvement, 3 (4.8%) of the patients were stage 1, 11 (17.7%) stage 2, 28 (45.2%) stage 3 and 20 (32.3%) stage. It was classified as 4A. Considering the volumetric FDG PET/CT parameters, LN SUVmax, LN SUVmean values were found to be significantly higher in patients with distant metastases at follow-up (p<0.05 for each). NTR values were significantly lower in patients without distant metastases during follow-up (p=0.022). In the analysis of overall survival, locoregional recurrence-free and distant metastasis-free survival, no significant correlation was found with PET/CT volumetric parameters. Conclusion: In our thesis study, which was planned and conducted to investigate whether pre-treatment staging FDG PET/CT volumetric parameters have prognostic value in newly diagnosed NFC patients, a significant relationship between measured volumetric parameters and survival could not be established. On the other hand, SUVmax, SUVmean and new NTR values measured from metastatic lymph node were found to be significantly correlated in predicting distant metastasis. The use of these parameters together with anatomical staging, integrated risk assessment in terms of prognosis, and treatment classification of patients with poor prognosis will be guiding.
Açıklama
Anahtar Kelimeler
Nazofarenks karsinomu, F-18 FDG PET/BT, SUVmax, MTV, TLG, NTR, Nasopharyngeal carcinoma
Kaynak
WoS Q Değeri
Scopus Q Değeri
Cilt
Sayı
Künye
Erol, Ç. (2023). Nazofarenks kanserlerinde evreleme F-18 FDG pet/BT görüntülemede volümetri̇k parametreleri-n prognosti̇k değeri. (Yayınlanmamış tıpta uzmanlık tezi) Necmettin Erbakan Üniversitesi, Meram Tıp Fakültesi Dahili Tıp Bilimleri Bölümü Radyoloji Anabilim Dalı, Konya.
