^18FDG PET—CT显像在肺癌治疗方案决定中的应用  

Value of ^18FDG PET-CT in the determination of treatment regimen in lung cancer

作　　者：张雯杰[1] 郑容[1] 吴宁[1] 王绿化[2] 李晔雄[2] 李静 刘瑛[1] 赵平[1] 

机构地区：[1]中国医学科学院北京协和医学院肿瘤医院肿瘤研究所PET-CT中心,北京100021 [2]中国医学科学院北京协和医学院肿瘤医院放疗科,北京100021

出　　处：《中华放射肿瘤学杂志》2009年第5期367-371,共5页Chinese Journal of Radiation Oncology

基　　金：基金项目：卫生部临床学科重点项目（07090010）

摘　　要：目的回顾性分析肺癌患者放疗前PET—CT显像对其治疗方案中的影响。方法选择64例肺癌患者人组研究，其中病理诊断59例（鳞癌33例、腺癌15例、小细胞癌8例、大细胞癌2例、不典型类癌1例），细胞学诊断3例（非小细胞肺癌），2例仅为影像学和临床诊断并经影像学随诊所证实。用^18FDGPET—CT显像后将融合图像传输至放疗计划系统，并依据融合图像结果决定治疗方案。结果放疗前应用PET—CT显像改变了15例患者临床分期并由此改变了治疗方案，其中5例患者由根治性放疗改为姑息性放疗（剂量减低）；10例患者更改治疗方案，9例由放疗改为内科化疗，1例改为外科手术治疗。27例患者于PET-CT显像后放疗靶区发生改变，其中5例是由于同时明确了肺不张区和淋巴结转移部位，6例鉴别了肿瘤和肺不张区（靶区减小），10例改CT正常淋巴结为转移淋巴结（靶区增大），2例改CT肿大淋巴结为无转移（靶区减小）。4例化疗后患者PET—CT显像确定了化疗后残存的肿瘤病灶范围，较同期CT靶区减小。结论放疗前行^18FDG PET-CT显像有助于提高临床分期的准确性，选择更加合理的治疗方案。以PET-CT融合图像为基础制定放疗计划有助于鉴别肿瘤和周围正常组织，减少病灶遗漏。Objective To retrospectively investigate the value of integrated PET-CT images using ^18FDG in the determination of treatment regimen in lung cancer. Methods Sixty-four patients with lung cancer were chosen, including 33 squamous cell carcinoma, 15 adenocarcinoma, 8 small cell lung cancer, 2 large cell lung cancer and 1 atypical carcinoid. Of the remaining patients, 3 （non-small cell lung cancer） were cytologically diagnosed, and 2 were diagnosed by CT and clinical characteristics. Co-registered PET-CT images were transferred into the radiation treatment planning system to select proper therapeutic plans. Results Integrated 1SFDG PET-CT changed the clinical stage in 15 patients （23%）. Treatment strategy was changed from curative to palliative radiotherapy in 5 patients, from radiotherapy to chemotherapy in 9, from radiotherapy to surgery in 1. Among the remaining 49 patients considered for curative radiotherapy, PET-CT markedly altered the radiotherapy volume in 27 （55%） because of distinguishing the extent of atelectasis and the location of metastatic lymph nodes in 5, differentiating tumor tissue from atelectasis in 6, detecting unsuspected regional small lymph node metastases on CT in 10 with the target volume increased, and exclusion of suspected lymph node metastases on CT in 2 with the target volume decreased. Compared to CT imaging, PET-CT identified the residual tumor size of 4 patients after chemotherapy and decreased the target volume. Conclusions Integrated PET-CT imaging before radiotherapy can improve the accuracy of clinical staging and help to choose a proper treatment regimen. Moreover, it can clearly differentiate tumor from normal tissue and reduce the risk of geographic misses.

关 键 词：肺肿瘤 放疗计划 计算机辅助 体层摄影术 发射型计算机 体层摄影术 X线计算机 氟脱氧葡萄糖 

分 类 号：R686[医药卫生—骨科学]