早期非小细胞肺癌PET-CT定位三维适形放疗的疗效和预后分析  

Long-term result and prognostic analysis of 18FDG PET-CT positioning three-dimensional conformal radiotherapy for early non-small cell lung cancer

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

机构地区：[1]四川省德阳市人民医院肿瘤科,德阳618000

出　　处：《中国肿瘤临床与康复》2012年第6期518-521,共4页Chinese Journal of Clinical Oncology and Rehabilitation

摘　　要：目的探讨早期非小细胞肺癌(NSCLC)经18F-脱氧葡萄糖正电子发射断层-X线计算机体层成像(18F-FDGPET-CT)定位后进行三维适形放射治疗的疗效、不良反应及失败原因。方法68例早期NSCLC(临床Ⅰa～Ⅱb期),患者用信封法随机分为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组经PET-CT扫描,将PET图像和CT图像融合后进行靶区和重要脏器勾画,制定治疗计划后进行常规分割三维适形放疗40Gy左右,然后适当缩野针对残存肿瘤病灶放疗至总剂量65Gy～75Gy;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体积(GTV)、计划治疗靶体积(PTV)均比普通CT组小(均P<0.05);PET-CT组患者左肺V20、右肺V20、心脏V40、食管V40、脊髓V40分别比普通CT组小(均P<0.05);近期疗效中,两组的总有效率差异无统计学意义(P>0.05);PET-CT组患者1、2级肺和气管的放射损伤发生率低于普通CT组(P<0.05);PET-CT组患者1、2、3、4、5年局部控制率和生存率均高于普通CT组(均P<0.01);治疗失败的主要原因为远处转移。结论 PET-CT定位可以优化早期NSCLC的放疗设野计划,提高局部控制率和远期生存率,远处转移为主要失败原因。Objective To analyse the long-term result and prognosis of 18FDG PET-CT positioning three-dimensional conformal radiotherapy（3DCRT） for early non-small cell lung cancer.Methods 68 cases with early non-small cell lung cancer（clinical Ⅰa-Ⅱb period） were randomly divided into two groups： PET-CT positioning three-dimensional conformal radiotherapy 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,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（40Gy or so） was followed to a total dose of radiotherapy 65-75Gy by reduced radiation field;The location of normal CT group＇s cases was determined by CT and were treated by 3D-CRP to the same dose.Results The average volumes of GTV and PTV,and the left lung V20、 right lung V20、heart V40、esophageal V40、spinal V40 of the PET-CT group were smaller than that of the normal CT group（all P 0.05）;The 1,2-level radiation injury of the lung and trachea of the PET-CT group was lower than that of the normal CT group（P 0.05）;The 1,2,3,4,5-year local control rate and survival rate of the PET-CT group was higher than that of the normal CT group（all P 0.01）;The main reasons for treatment failure were distant metastasis.Conclusions Using PET-CT to determine the target of early non-small cell lung cancer can improve the radiation treatment plan and the local control rate and the long-term survival rate;Distant metastasis was the main reason for failure.

关 键 词：癌 非小细胞肺 正电子发射断层显像术 三维适形放疗 治疗效果 预后 

分 类 号：R734.2[医药卫生—肿瘤]