贲门癌患者采用PET-CT定位三维适形放疗的疗效及预后分析  

Result and prognostic analysis of ^(18)FDG PET/CT positioning three-dimensional conformal radiotherapy for gastric cardiac carcinoma

作　　者：任宝志[1] 周玉霞[1] 钟立松[1] 张仟仕[1] 袁建军[1] 陶星[2] 

机构地区：[1]四川省德阳市人民医院肿瘤科,德阳618000 [2]上海交通大学医学院苏州九龙医院核医学科,苏州21502

出　　处：《中国肿瘤临床与康复》2012年第1期55-58,共4页Chinese Journal of Clinical Oncology and Rehabilitation

摘　　要：目的对比研究18FDG PET/CT定位三维适形常规分割放疗贲门癌的疗效、副反应及失败原因。方法对46例贲门癌患者采用信封法随机分为18FDG PET/CT定位三维适形放疗组(PET/CT组)和普通CT定位三维适形放疗组(普通CT组)。PET/CT组采用PET/CT扫描定位,经PET/CT扫描后将扫描数据输入治疗计划系统,将PET图像和CT图像融合后进行靶区和重要脏器勾画、三维重建,制定治疗计划后进行常规分割三维适形放疗40 Gy,然后适当缩野针对残存肿瘤病灶放疗至总剂量60～70 Gy。普通CT组采用普通CT定位设野,三维适形放疗至相同剂量。结果PET/CT组的平均大体肿瘤靶区(GTV)和计划治疗靶区(PTV)体积、左肺、右肺、左肾与右肾V20、胃、心脏、食管与脊髓V40均比普通CT组小(均P<0.05);PET/CT组的局部控制率和1、2、3年生存率均比普通CT组高(均P<0.01);PET/CT组早期气管、食管、胃肠道、肺的1、2级不良反应均低于普通CT组(均P<0.05)。多因素分析表明,年轻、病变长度≤5 cm、病变T分期早是影响预后的主要因素(均P<0.01)。结论 PET/CT定位三维适形放疗贲门癌可以优化放疗计划,减轻正常组织的早期放射不良反应,年轻、病变分期早的患者预后较好。Objective To analyse the result of 18FDG PET/CT positioning three-dimensional conformal radiotherapy（3DCRT） for gastric cardiac carcinoma.Methods 46 cases of gastric cardiac carcinoma patients were randomly divided into 18FDG PET/CT positioning 3DCRT group（PET/CT group）and the general CT dimensional conformal radiotherapy group（normal CT group）.The location of PET/CT group′s cases was determined by PET/CT and the date was transmitted to the treatment planning system（TPS）,the PET image and CT image were fused together;Target volume and critical organs were determined and the treatment plan was worked out by the fused image,then conventional fraction′s 3DCRT（40 Gy or so） was followed to a total dose of radiotherapy 60 Gy-70 Gy by reduced radiation field;The location of normal CT group′s cases was determined by normal CT and the date was transmitted to the TPS and were treated by 3DCRT to the same dose.Results The average GTV′s and PTV′s volume、left and right lung′s V20、left and right kidney′s V20、stomach、heart、esophagusspinal and cord′s irradiated volume of the PET/CT group were smaller than that of the normal CT group（all P〈0.05）;The local control rates and 1,2,3-year survival rates of the PET/CT group were higher than that of the normal CT group（all P〈0.01）;The early trachea、esophagus and lung′s 1,2-grade side effects of the PET/CT group were lower than that of normal CT group（P〈0.05）;Multivariate analysis showed youth and that lesion length ≤5cm and early T stage lesions were better than that of others（all P〈0.01）.Conclusion PET/CT positioning 3DCRT can optimize the radiation treatment planning of gastric cardiac carcinoma,reduce the early radiation side-effects of normal tissue,lesion length ≤5cm and early T stage lesions were better than that of others.

关 键 词：贲门癌 正电子断层显像 三维适形放射治疗 预后 

分 类 号：R735.1[医药卫生—肿瘤] R730.55[医药卫生—临床医学]