肺灌注显像在Ⅲ期非小细胞肺癌三维适形放疗中的应用价值  

Value of lung perfusion in stage Ⅲ non-small cell lung cancer patients treated with three dimensional conformal radiotherapy

作　　者：王中堂[1] 李宝生[1] 杨国仁[2] 付正[2] 胡旭东[3] 尹勇[4] 孙涛[4] 

机构地区：[1]山东省肿瘤医院放六科,山东济南250117 [2]山东省肿瘤医院PET-CT中心,山东济南250117 [3]山东省肿瘤医院核医学科,山东济南250117 [4]山东省肿瘤医院物理室,山东济南250117

出　　处：《中华肿瘤防治杂志》2007年第12期934-938,共5页Chinese Journal of Cancer Prevention and Treatment

基　　金：山东省科技攻关项目(2006GG2202012);山东省医药卫生计划项目(2005HZ090)

摘　　要：目的:探讨肺灌注显像在Ⅲ期非小细胞肺癌(non-small cell lung canc-er,NSCLC)三维适形放疗中的应用价值。方法:选择拟行三维适形放疗的Ⅲ期NSCLC患者8例,行PET-CT和肺灌注显像检查,并在治疗计划系统中进行图像融合,用PET-CT勾画大体肿瘤靶区,SPECT确定肺功能区域,通过肺灌注显像所提供的信息优化放疗计划,尽可能减少功能正常肺组织的照射体积剂量,统计分析放疗计划优化前后的肺组织剂量参数变化。结果:放疗计划优化后WLVx和FLVx均有不同程度降低,而FLVx降低程度更加明显。其中WLV10、WLV15、WLV20、WLV25、WLV30和FLV10、FLV15、FLV20、FLV25、FLV30在优化放疗计划前后差异有统计学意义,P值分别为0·001、0·002、0·014、0·046、0·017和0·000、0·000、0·004、0·027、0·023。结论:肺灌注显像在Ⅲ期NSCLC放疗计划优化方面,特别是对于肺灌注缺损明显的患者更有价值。OBJECTIVE：To investigate the value of lung perfusion single photon emission computed tomography （SPECT） scans in patients with stage Ⅲ non-small cell lung cancer （NSCLC） treated with three dimensional conformal radiotherapy （3DCRT）. METHODS： Eight patients with stage Ⅲ NSCLC who were candidated for 3DCRT were enrolled. All the patients had PET-CT scans and SPECT scans. The imagings were accurately co-registered in the planning system. The PET-CT images were used to define the gross tumor volume, and the SPECT images were used to define a volume of perfused ＂functioning＂ lung （FL）. The planning objective was to minimize the dose to FL. Statistical analysis was made for the difference between the two sets of 3DCRT plans. RESULTS： After 3DCRT was optimized, both the percentage of whole lung volume received dose ≥xGy （WLVx） and the percentage of functional lung volume received dose ≥xGy （FLVx） were decreased. However, the FLVx was decreased significantly. There were significant differences in WLV10, WLV15, WLV20, WLV25, WLV30 and FLV10, FLV15, FLV20, FLV25, FLV30 between before and after the 3DCRT was optimized （P=0.001, 0.002, 0.014, 0.046, 0.017 and0.000, 0.000, 0.004, 0. 027, 0. 023）. CONCLUSION： SPECT lung perfusion images are helpful in optimizing radiotherapy plans for patients with stage Ⅲ NSCLC, especially for patients with large perfusion deficits.

关 键 词：肺肿瘤/放射疗法 放射疗法 适形 放射性核素显像 肺灌注 

分 类 号：R734.2[医药卫生—肿瘤]