CT影像对肿瘤热疗加放射治疗的疗效评价  

CT scan evaluation of tumor response to thermoradiation therapy

作　　者：孙庆选[1] 夏廷毅[1] 史小丽[1] 王佐仁[1] 崔纪青[1] 

机构地区：[1]中国人民解放军空军总医院肿瘤放射治疗科,北京100036

出　　处：《中华放射肿瘤学杂志》2003年第4期270-272,共3页Chinese Journal of Radiation Oncology

摘　　要：目的　探讨采用CT影像对肿瘤热疗加放射治疗疗效评价的价值。方法　采用热疗结合放射治疗 134例晚期恶性肿瘤 ,对其中 2 3例治疗后瘤体变化不大 ,但瘤体出现明显液化坏死的病例通过增强CT扫描随访观察 ,按瘤体内低密度区范围和瘤体内有无增强评价疗效。结果　治疗后按实体瘤消退程度评价疗效的 111例中 ,完全缓解 (CR) 32例 ,部分缓解 (PR)加无变化 (NC) 79例。按CT影像上低密度区域占肿瘤的百分比评价疗效的 2 3例中 ,完全缓解 (CR ,低密度区域占瘤体 >80 % )10例 ,部分缓解 (PR ,低密度区占瘤体的 5 0 %～ 80 % ) 10例 ;无变化 (NC ,低密度区占瘤体 <5 0 % ) 3例。按CT影像评价为CR的 10例治疗后病灶稳定 ,12～ 2 4个月未见复发 ,对其中 3例行瘤体穿刺活检、1例行肿块切除 ,病理结果均为凝固性坏死 ,未查到肿瘤细胞。按CT影像评价为PR的 10例中 8例在治疗后 12个月内局部复发。按CT影像评价为NC的 3例均在 6个月内局部复发。用实体瘤消退程度判定的 111例患者与按CT图像判定的 2 3例患者间 1年局部控制率和 1年生存率差异无显著性意义 (P >0 .0 5 )。结论　对热疗结合放射治疗后的局部肿瘤的疗效评价 ,需结合瘤体大小变化和CT影像上肿瘤内的低密度区变化综合评价。Objective To investigate the value of CT scan to evaluate the tumor response to thermoradiation therapy. Methods Combined ultrasound hyperthermia and radiotherapy was used in 134 patients with advanced malignancies, of whom 23 showing little change in mass size but obvious liquefaction and necrosis after treatment, were followed up with enhanced CT scan for 3-24 months. The effects were evaluated by percentage of low density area and level of enhancement in tumor on CT scan. The remaining 111 patients were evaluated by the WHO criteria. Results In 111 patients evaluated by the WHO evaluation of tumor response, 32 showed CR and 79 PR+NC. In 23 patients evaluated by percentage of low density area on CT scan, 10 showed CR(>80% of low density area in tumor), 10 PR(50%-80%) and 3 NC(<50%). All the 10 CR patients evaluated by CT scan were stable and did not develop recurrence in 12-24 months after treatment. Three of 10 CR patients were punctured and 1 was resected for biopsy, with pathology showing coagulation necrosis without any tumor cells. Of the 10 PR patients evaluated by CT scan, the lesion of 8 recurred locally in 12 months. All the 3 NC patients by CT scan recurred locally in 6 months. There were no significant differences in the 1-year local control and 1-year overall survival rates between the 111 patients evaluated by the WHO criteria and 23 evaluated by CT scan (P>0.05). Conclusion For tumor treated with hyperthermia plus radiotherapy, the response evaluation should be based on both the change in the mass size and the percentage of low density area in the tumor.

关 键 词：CT影像 肿瘤 热疗 放射治疗 疗效评价 

分 类 号：R730.5[医药卫生—肿瘤]