摘要
【目的】探讨18F-FDG PET/CT在非小细胞肺癌(NSCLC)三维适形放疗靶区勾画中的作用。【方法】对48例经病理学证实的NSCLC患者行18F-FDG PET/CT检查。由两位放疗科医师分别根据采集到的单纯CT和PET/CT融合图像勾画三维适形放疗靶区,利用Topslane治疗计划系统计算勾画靶区范围,分别称为CT-GTV1、PET-GTV1、CT-GTV2、PET-GTV2。比较四者异同。对PET/CT勾画的靶区进行计划设计并实施放疗,疗后进行随访。【结果】3例因发现远处转移而未采取根治性放疗,其余45例均完成放疗。平均CT-GTV1为179.3 cm3,平均CT-GTV2为197.0 cm3,利用配对t检验分析发现二者存在统计学差异(P=0.026)。平均PET-GTV1为161.7 cm3,平均PET-GTV2为162.2 cm3,未见统计学差异(P=0.496)。放疗医师1勾画结果中29例(64.4%)PET-GTV较CT-GTV小,平均减少45.3 cm3,其余16例(35.6%)PET-GTV较CT-GTV大,平均增大30.7 cm3。放疗医师2勾画结果中33例(73.3%)PET-GTV较CT-GTV小,平均减少58.4 cm3,其余12例(26.7%)PET-GTV较CT-GTV大,平均增大28.8 cm3。随访结果:肿瘤局部控制率为71.1%,11例出现了远处转移,8例出现了局部复发。1年生存率为66.6%。3例发生Ⅰ~Ⅱ级放射性肺损伤。【结论】PET/CT减少了由于勾画者不同而引起的靶区差异,使靶区勾画更为容易和准确。精确靶区放疗保证了肿瘤局控率的同时,有效的减少了正常组织受量,有着重要的临床意义。
[Objective] To investigate the effect of ^18F-fluoro-deoxy-2-glucose hybrid positron emission tomography images combined CT image （^18F-FDG PET/CT）on target volume delineation in patients with nonsmall-cell lung cancer （NSCLC）. [Methods]Forty eight patients with pathological defined NSCLC underwent FDG-PET/CT simulation procedures. The gross tumor volume（GTV） was delineated by two radiation oncologists （radiation oncologist 1 and radiation oncologists 2） independently based on single CT image, integrated PET and CT image （CT-GTV1, PET-GTV1, CT-GTV2, PET-GTV2）. The volume of each GTV was cumulated by Topslane treatment plan system. All the patients were treated by three-dimensional conformal radiotherapy （3DCRT） and then were followed up. [Results]PET/CT identified previously undetected distant metastatic disease in 3 patients and made them ineligible for radical conformal radiotherapy. Other 45 patients underwent completely radical conformal radiotherapy. The average of CT-GTV1 and CT-GTV2 were 179.3cm^3 and 197.0cm^3 respectively. There was significant difference between CT-GTV1 and CT-GTV2（ P=0. 026）. The average of PET-GTV1 and PET-GTV2 were 161.7cm^3 and 162.2cm^3 respectively. There was no significant difference between PET-GTV1 and PET-GTV2 （ P = 0. 496）. The GTV was decreased in 29（64.4%）patients, while increased in 16（35.6%）patients by PET/CT in radiation oncologist 1 . The GTV was decreased in 33 （73.3%）patients, while increased in 12（26.7%）patients by PET/CT in radiation oncologist 2 . PET- GTV and CT-GTV had obviously difference proved by statistic analysis. After radiotherapy, 11 patients underwent metastases , 8 patients underwent local recurrent and 3 patients underwent Ⅰ-Ⅲ grade radiation pneumonitis. Local control rate was 71.1% and one-year survival rate was 66.6%. [Conclusion] PET/CT allows accurate tumor delineation and reduces inter-observer variability. It makes delineation more easily and precisely. Precise radiotherapy to patients based on PET/CT can protect normal tissue effectively and increase local control rate.
出处
《医学临床研究》
CAS
2007年第12期2045-2048,共4页
Journal of Clinical Research
关键词
癌
非小细胞肺/放射疗法
体层摄影术
发射型计算机
单光子
carcinoma, non-small cell lung/RT
tomography, emission-computed, single-photon
tomography, X-ray computed
