CT/CT图像融合用于非小细胞肺癌放射治疗对V_(20)及放射性肺炎影响的临床研究  

Study of the impact of CT/CT image fusion radiotherapy on V_(20) and radiation pneumonitis of non-small cell lung cancer

作　　者：张金忠[1] 戈伟[1] 张园如[2] 李长虎[1] 石磊[1] 徐细明[1] 张令[1] 郑永法[1] 

机构地区：[1]武汉大学人民医院肿瘤中心,武汉430060 [2]河南焦作市人民医院神经内科,454002

出　　处：《临床肿瘤学杂志》2011年第2期154-157,共4页Chinese Clinical Oncology

基　　金：湖北省科技攻关资助项目(2007A301B33)

摘　　要：目的探讨CT/CT图像融合技术应用于非小细胞肺癌(NSCLC)放射治疗计划对V20和放射性肺炎(RP)的影响。方法 40例入组患者均经病理组织学或细胞学证实为ⅢA、ⅢB期NSCLC,三维适形放疗(3D-CRT)剂量达到4000cGy肿块缩小达25%后随机分为常规缩野放疗组20例(A组)和CT/CT图像融合缩野放疗组20例(B组),两组均追加剂量至6600cGy。记录临床资料、V20、放疗结束3个月内RP发生情况等。RP用RTOG急性放射性损伤分级标准判断。采用SPSS11.5软件包进行统计学分析。结果 40例患者中RP发生率为22.5%(9/40),其中A组6例(30.0%),B组3例(15.0%),两组间差异无统计学意义(P=0.256)。A、B组的患侧肺V20(IV20)和全组的健侧肺V20(CV20)、患侧肺V20均与RP发生有关,差异有统计学意义(P<0.05),Wilcoxon检验两组间患侧肺V20、健侧肺V20差异均有统计学意义(P<0.05)。结论 CT/CT图像融合执行的缩野追加剂量放疗未增加RP的发生率,且有可能降低患侧肺V20,为进一步提高局部放疗剂量,获得更好的局控率提供了理论参考依据。Objective To investigate the value of CT/CT image fusion radiation treatment planning in non-small cell lung cancer（NSCLC） and the impact on V20 and radiation pneumonitis（RP）.Methods Patients who were pathologically or cytologically diagnosed of stage ⅢA and ⅢB NSCLC were treated with three-dimensional conformal radiation therapy（4000cGy）.Forty patients got at least 25% tumor reduction were randomly divided into two groups： group A of regular shrink field radiotherapy（20 cases） and group B of CT/CT image fused shrink field radiotherapy（20 cases）.Dosage reached 6600cGy.Clinical data,V20 and RP were observed within 3 months after radiotherapy.Statistical analysis was conducted for the NSCLC patients.Results 22.5%（9/40） patients got RP during follow up.Group A accounted for 6 cases（30%）,and group B had 3 cases（15%）.There was no marked difference between the two groups（P=0.256）,univariate analysis revealed that the IV20 of A and B groups,and IV20 and CV20 of all patients were statistically related to the incidence of RP（P〈0.05）.With Wilcoxon method assay,the ipsilateral lung V20 and contralateral lung V20 had statistical significance between the two groups（P〈0.05）.Conclusion The CT/CT image infusion treatment planning could increase the radical dosage with better tumor control probability but won＇t increase adverse reaction.

关 键 词：非小细胞肺癌 三维适形放射治疗 放射性肺炎 CT/CT图像融合 V20 

分 类 号：R730.55[医药卫生—肿瘤] R734.2[医药卫生—临床医学]