磁共振IVIM成像指导局部晚期NSCLC同步放化疗靶区勾画及剂量提升的疗效  

Efficacy of Magnetic Resonance IVIM Imaging in Guiding Target Delineation and Dose Escalation of Concurrent Radiochemotherapy on Locally Advanced NSCLC

作　　者：蔡婧[1,2] 熊强 魏建平[1,2] 刘安文 CAI Jing;XIONG Qiang;WEI Jianping;LIU Anwen(Department of Oncology,The Second Affiliated of Nanchang University,Nanchang 330006,China;Jiangxi Key Laboratory of Clinical Translational Cancer Research,Nanchang 330006,China)

机构地区：[1]南昌大学第二附属医院肿瘤科,南昌330006 [2]江西省肿瘤临床转化重点实验室,南昌330006

出　　处：《肿瘤防治研究》2020年第5期381-386,共6页Cancer Research on Prevention and Treatment

基　　金：江西省自然科学基金(20161BBG70210),江西省肿瘤临床转化重点实验室(20171BCD40022)。

摘　　要：目的明确磁共振IVIM成像指导局部晚期NSCLC同步放化疗靶区勾画及剂量提升的疗效及安全性。方法纳入2014年9月-2018年3月间确诊无法手术的局部晚期NSCLC患者60例,随机分为实验组和对照组。实验组采用4DCT结合IVIM成像行SIB-IMRT及放疗过程中缩野增量放疗,对照组行4DCT下SIB-IMRT放疗。比较两组患者的临床疗效及安全性,并分析IVIM各参数值与放化疗疗效的相关性。结果实验组有效率高于对照组(86.7% vs.60%,P=0.020);实验组3/4级放射性肺炎的发生率低于对照组(20% vs.46.7%,P=0.028);治疗过程中D值的变化与患者疗效相关(P<0.05),D值上升越多患者PFS越长(P=0.006)。结论 IVIM成像指导局部晚期NSCLC 同步放化疗有效率显著提高并可以降低3/4级放射性肺炎的发生率;放疗过程中IVIM成像参数D值的变化可能成为放化疗疗效的一个预测指标。Objective To clarify the efficacy and safety of magnetic resonance IVIM imaging in guiding target delineation and dose escalation of concurrent radiochemotherapy on locally advanced NSCLC.Methods From September 2014 to March 2018,60 patients with inoperable locally advanced NSCLC were randomly divided into the experimental group and the control group.In the experimental group,4DCT combined with IVIM imaging was used to guide the delineation of the target area of SIB-IMRT and dose escalation during radiotherapy.In the control group,4DCT simulation was used to delineate the target area of SIB-IMRT.The clinical efficacy and safety between the two groups were compared,and the correlation between IVIM parameters and chemoradiotherapy efficacy was analyzed.Results Compared with the control group,the overall response rate was higher(86.7%vs.60%,P=0.020)and the incidence of grade 3/4 radiation pneumonia was lower(20%vs.46.7%,P=0.028)in the experimental group.The change of D value during treatment was related to the overall response rate of patients(P<0.05).The more the D value increased,the longer PFS of patients was(P=0.006).Conclusion IVIM imaging guide could significantly increase the overall response rate of locally advanced NSCLC to concurrent chemoradiotherapy and reduce the incidence of grade 3/4 radiation pneumonia.The change of IVIM imaging parameter D value during radiotherapy is expected to be a predictor of chemoradiotherapy efficacy.

关 键 词：非小细胞肺癌 同步放化疗 IVIM 4DCT 疗效 

分 类 号：R734.2[医药卫生—肿瘤] R730.58[医药卫生—临床医学]