局限期小细胞肺癌PET—CT定位适形放疗联合化疗的疗效和预后分析  

Long-term result and prognostic analysis of PET-CT positioning three-dimensional conformal radio- therapy for limited small cell lung cancer

作　　者：任宝志[1] 周玉霞[1] 幸泽鲜[1] 张红[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》2014年第10期1208-1211,共4页Chinese Journal of Clinical Oncology and Rehabilitation

摘　　要：目的探讨局限期小细胞肺癌PET—CT定位适形放疗联合化疗的疗效、不良反应及失败原因。方法回顾性分析58例局限期小细胞肺癌的临床资料，28例经18F—FDGPET．CT扫描后（PET—CT组），将数据输入治疗计划系统，将PET和CT图像融合后进行靶区和重要脏器勾画、三维重建，制定计划后常规分割三维适形放疗40Gv左右；然后，缩野针对残存肿瘤病灶放疗至总剂量50Gy左右，少部分肿瘤消退不理想者加量至55—60Gy。30例用普通CT定位（普通CT组），同样适形放疗至相同剂量。所有患者均用EP方案（Vp16100mg／m^2，d1～5；顺铂40mg，d1～3）化疗4～6个周期。结果PET—CT组的平均GTV与fyllv均比普通CT组小，PET-CT组的左肺与右肺V20、心脏、食管与脊髓V40均比普通CT组小（P均〈0．05）。两组的近期总有效率差异无统计学意义（P〉0．05）。PET—CT组中，1、2级肺和气管的早期与晚期放射损伤发生率低于普通CT组（P均〈0．05）；PET—CT组的1、2、3年局部控制率与生存率均高于普通CT组（P均〈0．01）。PET—CT组纵膈淋巴结复发率低于普通CT组，放化疗后手术切除残存病灶者预后好。治疗失败的主要原因为远处转移。结论PET—CT定位可以优化局限期小细胞肺癌的放疗设野计划，减少正常组织的照射体积与纵膈复发率，放化疗后手术切除残存病灶预后好，远处转移为主要失败原因。Objective To analyse the result and prognosis of 18F-FDG PET-CT positioning three- dimensional eonformal radiotherapy （3DCRT） for limited small cell lung cancer. Methods To retrospect 58 cases with limited small cell lung cancer;The location of experimental 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 （40Gy or so） was followed to a total dose of 50 -60Gy by reduced radiation field;The location of the control group＇s cases was determined by CT and were treated by 3DCRT to the same dose;All cases were treated by the EP program（ Vpl6 100mg/m^2,d1- 5 ; Cisplatin 40mg, d2 - 4） chemotherapy for 4-6 cycles. Results The average GTV and PTV volume of the experimental group was smaller than that of the control group, the left lung and right lung V20 ,heart, esoph- agus and spinal cord V40 of the experimental group was smaller than that of the control group （ all P 〈 0. 05 ） ; The short-term total effective rate of the two groups was not statistically significant （ P 〉 0. 05 ） ; The 1,2-grade early and late radiation injury rate of the lung and trachea of the experimental group was lower than that of the control group （ all P 〈 0. 05） ; The 1,2,3-year local control rate and survival rate of the experimental group was higher than that of the control group （ all P 〈 0. 01 ） ;The mediastinal lymph node recurrence rate of the experimental group was lower than that of the control group, the prognosis of post-chem-otherapy residual tumor resection was good;The main reason for treatment failure was distant metastasis. Conclusion Using PET-CT to determine the target of limited small cell lung cancer can improve the radiation treatment plan, reduce the recurrence rate of mediastinal, the prognosis of post-chemotherapy residual tumor resect

关 键 词：肺肿瘤 体层摄影术 正电子发射型 三维适形放疗 预后 

分 类 号：R739.6[医药卫生—肿瘤]