Yurday ÖZDEMİR, Neşe TORUN, Erkan TOPKAN

Stereotaktik radyocerrahi uygulanan vertebra metastazlarında yanıt değerlendirmesinde PET-BT’nin yeri

Amaç: Bu çalışmada vertebra metastazlarında stereotaktik radyocerrahi (SRC) sonrası yanıt değerlendirmesinde pozitron emisyon tomografisinin (PET-BT) rolü araştırılmıştır.Gereç ve Yöntem: Geriye dönük olarak 16 veya 18 Gy SRC uygulanmış hastalar incelenmiştir. Analizlere SRC öncesinde herhangi bir derecede vertebra kompresyon kırığı gelişmemiş, radyosensitif olarak bilinen küçük hücreli akciğer ve hematolojik kanserlerli olgular dışındaki tedavi öncesi ve sonrası PET-BT verileri olan hastalar dâhil edilmiştir. Tüm vertebra segmentleri stabilite açısından spinal instability neoplastic score ’e göre sınıflandırılmış ve yanıt değerlendirmesinde PET Response Criteria in Solid Tumors (PERCIST) kriterleri kullanılmıştır.Bulgular: Toplam 75 hasta 119 VS’e (101 tek, 9 çift) SRC uygulanmış olup büyük kısmını (%66,7) meme kanserli hastalar oluşturmaktadır. VS’lerin %70,6’sı SINS 0-6’ya uymaktadır. Lokal kontrol hastaların %87,4’nde sağlanmış olup 1 yıllık lokal nükssüz sağkalım oranı %92,5 olarak bulunmuştur. İlk yanıt değerlendirme PET-BT’si ortanca 3 ayda (aralık: 1-35 ay) çekilmiş olup sadece 4 (%3.3) VS’de progresyon raporlanırken diğer VS’lerde SRC’ye yanıt mevcuttur (%30.3 tam, %43.7 kısmi, %22.7 stabil). Son PET’de sadece 11 VS’de lokal nüks tespit edilirken ilk PET’de tam yanıt olan hiçbir VS’de nihai olarak lokal nüks gelişmemiştir. İlk PET’de tam yanıt olması son PET’de de yanıt olmasıyla ilişkili bulunmuştur.Sonuç: SRC sonrası yanıt değerlendirmesinde ilk PET-BT yanıtı gerek son kontrol durumunu göstermesi açısından gerekse alternatif tedavileri planlamak açısından değerli bulunmuştur.

Anahtar Kelimeler:

stereotaktik radyocerrahi, PET-BT cevap, vertabral metastaz

The role of PET-CT in the evaluation of the response of the vertebra metastases in stereotactic radiosurgery

Purpose: The aim of this study was to evaluate the role of positron emission tomography in assessing the response of stereotactic radiosurgery (SRS) for vertebral metastases (VM). Materials and Methods: Patients who received 16 Gy or 18 Gy SRS with no history of vertebral compression fracture, proven histologies except small-cell lung carcinoma and hematologic malignancies which are known as radiosensitive tumors, available pre- and post SRS PET images were included. All vertebral segments were categorized according to spinal instability neoplastic score in terms of stability and PET Response Criteria in Solid Tumors (PERCIST) criteria was utilized for treatment response.Results: Seventy-five patients with 119 VS (101 single, 9 double VS) received SRS. Breast cancer (66.7%) was the commonest pathology. Most patients (70.6%) had SINS 0-6. The local control was achieved in 87.4% VS with a 1-year local relapse-free survival rate of 92.5%. The median PET-CT time for the first SRS response assessment was 3 months (range:1-35 months) and there were only 4 (3.3%) local relapses in contrast to the positive responses in the remainders (30.3% complete, 43.7% partial responses and 22.7% stabil disease). While there were 11 local relapses in the last PET-CT response, no patient experienced any relapse complete response was achieved in the first PET-CT. Complete response in the first PET-CT was correlated with positive response in the last PET–CT also.Conclusion: First PET-CT response after SRS seems to be valuable in anticipation of both the final vertebral response status and planning of alternative interventions for non-responders.

Keywords:

stereotactic radiosurgery, PET-CT response, vertebral metastases,

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