Therapiemonitoring mit ¹⁸F-FDG-PET / CT

Zusammenfassung

Die funktionelle Bildgebung mittels ¹⁸F-FDG-PET bzw. PET / CT liefert zusätzliche Informationen über das Tumoransprechen während und nach einer zytostatischen Therapie (Chemo- und Strahlentherapie). Semiquantitative Auswertungen des FDG-Uptakes durch SUV-Messungen erlauben die Prädiktion histopathologischer Remissionsergebnisse mit einer Sensitivität und Spezifität zwischen 65-85 %. Gleichzeitig werden prognostische Vorteile für Responder erkennbar, die bei SUV-Abnahmen von > 40-60 % gegenüber der Ausgangsuntersuchung bessere krankheitsfreie und Gesamtüberlebensraten zeigen. Bei einigen Tumorentitäten ist es mittlerweile gelungen, eine frühe Responseprädiktion (schon nach dem 1. Chemo- / Chemoradiotherapie-Zyklus) durchzuführen, was eine Adaptation der Therapie ermöglicht. An die Durchführung der Untersuchungen im Hinblick auf Standardisierung und Vergleichbarkeit sind, ebenso wie an die Interpretation, hohe methodische Anforderungen zu stellen. Der optimale Zeitpunkt von Verlaufsscans während und nach Strahlentherapie ist nicht geklärt und macht weitere prospektive Interventionsstudien notwendig.

Abstract

Functional imaging using ¹⁸F-FDG-PET provides the clinician with additional information about the tumour response during and / or after induction chemo- / chemo-radiotherapy. Semiquantitative analysis with SUV measurements allows prediction of histopathologic remission with sensitivity and specificity of 65-85 %. In addition, SUV reductions by > 40-60 % in relation to the baseline scan indicate better disease-free and overall survival rates. Successful response prediction has been shown in some tumour entities early during or after the first chemo- / chemo-radiotherapy cycle. This allows an early adaptation of therapeutic strategies including avoidance of invasive procedures or surgical tumour removal. Standardization of the application and performance of PET-scans is of crucial importance with respect to inter-institutional comparisons and diagnostic validity. The optimal time-point of sequential investigations during / after radiotherapy remains unclear and warrants further interventional studies.

Schlüsselwörter

PET / CT - FDG - Strahlentherapie - Therapiemonitoring

Key words

FDG - PET / CT - radiotherapy - therapy monitoring

Literatur

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