Application Of ¹⁸F-FMISO PET/CT To The Clinical Practice Of Non-small Cell Lung Cancer In Radiotherapy

Part one The evaluation of hypoxia conditions of non-small cell lung cancer before treatment with 18F-FMISO PET / CTObjective:To explore the best developing time of 18F-FMISO,the hypoxia status of non-small cell lung cancer and metastasis lymph nodes,and the relationship between hypoxia and tumor volume,through the non-small cell lung cancer patients before treatment for ¹⁸F-FMISO PET/CT imaging.MethodsBetween Oct 2014 and June 2015 in our hospital,14 patients who was confirmed by pathological biopsy for non-small cell lung cancer.18F-FDG and ¹⁸F-FMISO PET/CT were successively performed one week before determine the radiotherapy plan, there was at least one day between each examination. The imaging results were conducted visual analysis and semi-quantitative analysis. The hypoxic zone was defined by T/M value was more than 1.3. The tumors, metastasis lymph nodes SUVmax, hypoxia volume and other parameters were measured in the region of interest, calculated T/M of tumor and metastasis lymph nodes. Use SPSS 15.0 statistical software for statistical analysis.Results1. Over time the tumor SUVmax gradually increased?2..15±0.47 vs. 2.50±0.73 vs. 2.86±0.80?, T/M also gradually increased?1.36±0.37 vs. 1.74±0.55 vs. 2.08±0.71?,the difference was statistically significant. The metastasis lymph nodes T/M gradually increased?1.72±0.26 vs. 0.1.73±0.30 vs. 1.85±0.39? over time, The difference was statistically significant.2. 78.6%?11/14? of non-small cell lung cancer primary tumor were hypoxic if the T/M value was 1.3 or higher as hypoxic threshold.The T/M of non-small cell lung cancer primary tumor was significantly associated with the original tumor volume and the hypoxia volume. The volume of primary tumor and hypoxia volume of primary tumor was also significantly related.Similarly, the metastasis lymph nodes T/M respectively significantly related to metastasis lymph nodes volume and hypoxia volume. The volume and the hypoxic volume of metastasis lymph nodes was also significantly correlated.3. It was positively correlated between primary tumors 18F-FDG PET/CT SUVmax and ¹⁸F-FMISO PET/CT T/M before treatment?r=0.60, P=0.041?.It was no significant correlation between positive lymph nodes 18F-FDG PET/CT SUVmax and ¹⁸F-FMISO PET/CT T/M?r=0.57, P=0.14>0.05?.Conclusions1. ¹⁸F-FMISO PET/CT can better reflect the hypoxic conditions of non-small cell lung cancer primary tumor and metastasis lymph nodes, Where 4h delayed imaging allows higher image contrast, is more conducive to analyse the hypoxic conditions of non-small cell lung cancer.2. The degree of hypoxic was gradually increased with the increase of tumor volume and metastasis lymph nodes. Most non-small cell lung cancer primary tumor and positive lymph nodes were present in the phenomenon of hypoxia and hypoxia degree more significant in some cases.3. The SUVmax of 18F-FDG PET/CT and T/M of ¹⁸F-FMISO PET/CT has some relevance.Part Two The hypoxic condition monitoring and treatment evaluation for non-small cell lung cancer before and after radiotherapy by ¹⁸F-FMISO PET/CTObjective:To evaluate the changes of hypoxia conditions of non-small cell lung cancer patients before and after radiotherapy, and the efficacy of a three-month follow-up. To investigated the value of ¹⁸F-FMISO PET/CT in radiotherapy efficacy evaluation.Methods:Between Oct 2014 and June 2015 in our hospital,11 patients who was confirmed by pathological biopsy for non-small cell lung cancer. All enrolled patients began accepting radiotherapy within one week after completed the first part of 18F-FDG and 18F-FMISO imaging.18F-FMISO PET / CT were performed after radiotherapy, patients followed up after the end of radiotherapy in three months and chest CT examination to evaluate the tumor shrink situation. Compare the changes of non-small cell lung cancer primary tumor, positive lymph nodes T/M and HV before and after radiotherapy, analysis the relationship between before and after radiotherapy T/M, hypoxia volume or other parameters with radiotherapy curative effect.Results:1. The primary tumor T/M, HV after radiotherapy was significantly lower than before radiotherapy?P=0.028, P=0.028?. Metastasis lymph nodes after radiotherapy hypoxic volume was significantly lower than before radiotherapy?P=0.018?, but the T/M value did not change significantly compared with the previous radiotherapy?P=0.24>0.05?.2. 11 cases of 7 patients with non-small cell lung cancer radiotherapy is effective?63.6%?,radiotherapy is invalid in 4 patients?36.4%?,the effective group T/M,HV before radiotherapy were significantly lower than invalid group T/M,HV?P=0.023,P=0.031?.Conclusions1. Radiation therapy can significantly alleviate hypoxia situation of tumor.2. It has a certain correlation between hypoxia conditions of primary tumor before radiotherapy and the curative effect of patients.Therefore,¹⁸F-FMISO PET/CT imaging for predicting the outcome of radiotherapy of non-small cell lung cancer patients have certain help.