鼻咽癌放疗后复发18FDG PET-CT定位再程适形放疗的疗效分析  

Result of 18FDG PET-CT positioning three-dimensional conformal radiotherapy for Nasopharyngeal carcinoma recurrence after radiotherapy

作　　者：任宝志[1] 周玉霞[1] 钟立松[1] 张仟仕[1] 幸泽鲜[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215000

出　　处：《中国肿瘤临床与康复》2012年第4期313-316,共4页Chinese Journal of Clinical Oncology and Rehabilitation

摘　　要：目的探讨鼻咽癌放疗后复发采用18FDG PET-CT定位再程三维适形放疗的疗效、不良反应及失败原因。方法对56例鼻咽癌放疗后复发患者用信封法随机分为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),每组各28例。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(大体肿瘤体积和计划靶体积)和重要脏器勾画、三维重建,制定治疗计划后常规分割三维适形放疗40 Gy左右,然后适当缩野放疗至总剂量50～60Gy。普通CT组采用普通CT定位设野,三维适形放疗至相同剂量。两组放疗后均用TP方案(紫杉醇135～175mg/m2,d1;顺铂40mg,d2～4)辅助化疗4～6周期。结果 PET-CT组大体肿瘤体积和计划靶体积均小于普通CT组,两者差异有统计学意义(均P<0.05)。PET-CT组再次局部复发17例,中位复发时间11.7个月,普通CT组再次局部复发19例,中位复发时间10.3个月,两者差异有统计学意义(P<0.01)。多因素分析表明,在年龄、性别、卡氏评分、T分期和疗前大体肿瘤体积等因素中,只有T分期和疗前大体肿瘤体积是独立的预后因子,T分期早和疗前大体肿瘤体积≤100cm3者预后好,P值均<0.01。结论鼻咽癌放疗后复发用PET-CT定位三维适形再程放疗可以优化放疗计划,延长中位复发时间,分期早的病变预后好。Objective To analyse the result of 18FDG PET-CT positioning three-dimensional con- formal radiotherapy（3DCRT） for Nasopharyngeal carcinoma recurrence after radiotherapy. Methods 56 cases of Nasopharyngeal carcinoma recurrence after radiotherapy patients were randomly divided into 18FDG PET-CT group and the 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 to- gether ;The target volume and critical organs were determined by the fused image,then conventional fraction＇s 3DCRT （40Gy or so） was followed to a total dose of radiotherapy 50-670Gy by reduced radiation field;The lo- cation of normal CT group＇s cases was determined by normal CT and were treated by 3DCRT to the same dose. All eases were treated by the TP program（paelitaxel 135-175mg/m2, dl, eisplatin Zl0mg, d2-d4） adjuvant chemotherapy for 4-6 cycles later. Results The average GTV＇s and PTV＇s volume of the PET-CT group were smaller than that of the normal CT group,there was statistically significant difference（all P 〈0. 05） between the two groups; The median recurrence time of the PET-CT group was 11.7 months, and the median recurrence time of the normal CT group was 10. 3 months, there was significant difference between the two groups （P 〈0. 01 ） ; Multivariate analysis showed that early T stage lesions and small GTV （ ≤ 100cm3 ） were better than that of others（all P 〈 0. 01 ）. Conclusions PET-CT positioning 3DCRT can optimize the radiation treatment planning and extend the median time to recurrence for Nasopharyngeal carcinoma recurrence after radiothera- py, the patients with early stage lesions have better prognosis than others.

关 键 词：鼻咽肿瘤 放射疗法 正电子断层显像 三维适形放射治疗 预后 

分 类 号：R739.63[医药卫生—肿瘤]