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PSMA/18F-FDG PET显像在前列腺癌骨转移223Ra治疗中的应用体会
PSMA and 18F-FDG PET Imaging in the Treatment of Metastatic Prostate Cancer with 223Ra: Initial Application and Experience
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摘要:目的 分享前列腺特异性膜抗原(prostate specific membrane antigen, PSMA)和/或18F-氟代脱氧葡萄糖(18F-fluoroodexyglucose, 18F-FDG)正电子发射断层显像(positron emission tomography, PET)在前列腺癌(prostate cancer, PCa)骨转移患者氯化镭-223(radium-223 dichloride, 223Ra)治疗中的应用心得, 以期为国内开展223Ra治疗提供借鉴。方法 本研究为描述性分析。研究对象为2021年9月-2023年1月北京协和医院因骨转移行223Ra治疗的PCa患者。记录223Ra治疗效果及患者生存状态, 并对治疗前后骨扫描及PET显像特征(包括PSMA PET和/或18F-FDG PET)进行总结。结果 共入选9例接受不同针次223Ra治疗的PCa患者(另外2例拟行223Ra, 因基线PET显像检出存在内脏转移而排除), 包括8例转移性去势抵抗性前列腺癌患者, 1例转移性激素敏感性前列腺癌患者。9例患者共接受36针223Ra治疗, 其中6针、5针、4针、2针、1针治疗者分别为3例、1例、2例、2例、1例; 治疗中期或治疗结束时, 部分缓解1例, 病情稳定1例, 疾病进展6例, 余1例于1针223Ra治疗后转为内分泌治疗, 未进行疗效评估。截至末次随访时(2023年3月15日), 9例患者中, 死亡4例(1例死因为心力衰竭, 3例为疾病进展), 存活5例。死亡或疾病进展患者的基线PET显像所示的转移灶与骨扫描图像存在不一致性, 前者可发现更多的骨转移灶; 在治疗过程中PET显像可更精准地进行病情评估, 尤其PSMA PET显像可避免因骨闪烁现象导致治疗效果评价不准确的现象。结论 PSMA PET和/或18F-FDG PET显像可检出内脏转移灶, 辅助临床进行223Ra治疗病例筛选, 且基线PSMA PET和/或18F-FDG PET显像特征与骨扫描结果存在不一致时, 提示223Ra治疗效果可能较差; 在治疗过程中, 相较于骨扫描, PSMA PET和/或18F-FDG PET显像(尤其PSMA PET)对疗效的评价更为准确。Abstract:Objective To share our experience of the use of prostate specific membrane antigen (PSMA) and/or 18F-fluoroodexyglucose (18F-FDG) positron emission tomography (PET) in the setting of radium-223 dichloride (223Ra) in treatment of bone metastases of prostate cancer in order to broaden the know-ledge of application of 223Ra in China.Methods Retrospective analysis was conducted for the patients with advanced prostate cancer treated with 223Ra in Peking Union Medical College Hospital between September 2021 to January 2023.The treatment outcomes and survival status were recorded.Characteristics of bone scans and PET imaging (including PSMA PET and/or 18F-FDG PET) before and after treatment were summarized.Results Nine patients were enrolled (2 additional patients were excluded for the reason of visceral metastases confirmed by pretreatment PET imaging), among whom 8 patients had metastatic castration resistant prostate cancer and 1 had metastatic hormone-sensitive prostate cancer.In total the 9 patients received 36 doses of 223Ra, and the numbers of patients receiving 6, 5, 4, 2, and 1 doses were 3, 1, 2, 2, and 1, respectively.At the middle or end of treatment, there was 1 case of partial remission, 1 case of stable disease, 6 cases of progressive disease, and 1 case was switched to endocrine therapy after 1 shot of 223Ra treatment so that the efficacy was not evaluated.At the time of the last follow-up (March 15, 2023), among the 9 patients, 4 died (1 due to heart failure and 3 due to disease progression) and 5 survived.For patients who died or with progressive disease, there was an inconsistency between the metastases shown on baseline PET images and bone scans, with the former modality revealing more bone metastases.PET imaging especially PSMA PET was more accurate than bone scan in assessing response and could avoid bone scintillation.Conclusions PSMA PET and/or 18F-FDG PET could help detect visceral metastases and assist in patient screening.The inconsistency between baseline PET images and bone scan images suggests a worse outcome of 223Ra treatment.During the efficacy evaluation process, PSMA and/or 18F-FDG PET (especially PSMA PET) also outperforms bone scan.
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