使用双能量CT建立监测贝伐单抗治疗非小细胞肺癌肿瘤内部变化标准的动物及临床研究

Bevacizumab is the anti-angiogenic targeted drugs in the first - line treatments of non-squamous non-small cell lung cancer (NSCLC). By now, the major method for the therapeutic efficacy evaluation is the traditional RECIST which focuses simply on the changes of tumor size. RECIST can not effectively reflect the microvascular changes as well as the subsequent ischemia and necrosis caused by bevacizumab, even leads to opposite decisions. To find the appropriate means to reflect the internal changes of tumor, dual energy CT (DECT) is chose which could effectively evaluate tumor angiogenesis, with more economic, more convenient and lower radiation. DECT is applied on animal model and human data analysis for the evaluation of bevacizumab treatment on NSCLC. On the basis of the animal pathological experiments and the clinical research data analysis, the new evaluation standard of DECT (net enhanced value, iodine value) is to be established for monitoring tumor response to bevacizumab in the treatment of NSCLC. Compared by the survival situation, DECT evaluation standard, RECIST standard, traditional Choi 's standard and PET-CT standard are evaluated on the effectiveness and accuracy, improving the tumor anti-angiogenesis therapy efficacy evaluation standard clinically.

贝伐单抗是国际上治疗非鳞型非小细胞肺癌（NSCLC）的一线抗血管生成靶向药物，目前其疗效判定主要采用传统RECIST评估方法单纯评价肿瘤大小变化，而不能有效反映贝伐单抗治疗后所产生的微血管减少以及后续肿瘤内部缺血坏死反应，甚至会导致对患者治疗策略修订的错误决定。为寻找合适手段反映出肿瘤内部变化情况，本研究创新性使用经济、便捷、低辐射并能有效反应肿瘤内部血管生成情况的双能量CT作为评估手段，针对贝伐单抗治疗NSCLC后的动物模型和人体数据进行双能量CT检测分析。通过动物模型和大样本临床研究数据为支持，探讨基于双能量CT（净增强值、碘量）的监测贝伐单抗治疗非小细胞肺癌肿瘤治疗后反应的改良评估标准，观测经贝伐单抗治疗后NSCLC患者的生存情况，评价DECT改良评估标准、传统RECIST标准、 Choi's 标准以及PET-CT标准的有效性和准确性，完善临床抗血管靶向治疗疗效评估标准。

贝伐单抗是国际上治疗非鳞型非小细胞肺癌（NSCLC）的一线抗血管生成靶向药物，本研究创新性使用经济、便捷、低辐射并能有效反应肿瘤内部血管生成情况的双能量CT作为评估手段，针对贝伐单抗治疗NSCLC后的小鼠模型，分析了小鼠模型中基于双能量CT（净增强值、碘量）的监测贝伐单抗治疗前后肿瘤参数变化情况，目前通过影像学判断肺癌患者是否存在淋巴结转亟待明确的量化指标，因此我们对临床肺癌患者的淋巴结进行双源CT 扫描及图像后处理，探索转移性淋巴结与非转移性淋巴结在碘图成像上表现的差异性，发现碘图成像可以初步诊断淋巴结是否有恶性转移，并且发现了相关的量化数据。单位容积碘含量来鉴别淋巴结转移比CT 值的变化判断更为敏感。