摘要
目的:观察Ⅲ期肺鳞癌患者经PET/CT定位进行后加速超分割三维适形放射治疗的临床疗效。方法:对56例Ⅲ期肺鳞癌(Ⅲa期～Ⅲb期),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18FDG PET/CT扫描后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,制定计划后前2/3疗程行常规分割三维适形放疗40Gy左右,后1/3疗程缩野针对残存肿瘤病灶行后加速超分割放疗,1.5Gy/次,2次/d,共21Gy～30Gy,总剂量为61Gy～70Gy;普通CT组经CT定位后同样分割方式三维适形放疗至相同剂量;所有病例均用TP方案辅助化疗4周期～6周期。结果:PET/CT组中11例靶区有改变(8例照射野较CT片小、3例照射野较CT片大)。所有患者均随访8个月～39个月;PET/CT组与普通CT组的完全缓解(CR)率和部分缓解(PR)率分别为14.3%、64.3%和17.9%、53.6%;总有效率(CR+PR)分别为78.6%、71.4%,差异无统计学意义(x^2=0.67,P=0.715);PET/CT组1、2级肺和气管的晚期放射损伤发生率低于普通CT组,差异有统计学意义(P=0.029);PET/CT组与普通CT组的1、2、3年局部控制率分别为85.7%、64.2%、53.6%和71.4%、60.7%、42.9%;PET/CT组的局部控制率高于普通CT组,但无统计学意义(x^2=1.30,P=0.254);PET/CT组与普通CT组的1、2、3年生存率分别为71.4%、35.7%、21.4%和53.6%、28.6%、14.3%,差异无统计学意义(x^2=1.38,P=0.240);PET/CT组肺门和纵膈淋巴结复发率低于普通CT组(P均<0.05);治疗失败的主要原因为远处转移。结论:PET/CT定位可以优化Ⅲ期肺鳞癌的放疗设野计划,降低1、2级肺和气管的晚期放射损伤发生率,减少肺门和纵膈复发率,但远期生存率无提高,远处转移为主要失败原因。
Objective： To analysis the clinical efficacy of 18FDG PET/CT positioning late-course accelerated hyperfractionated and three-dimensional conformal radiotherapy （3DCRT） for stage Ⅲ lung squamous cell carcinoma. Methods： 56 cases with stage Ⅲ lung squamous cell carcinoma（ Ⅲa - Ⅲb） 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） ;Locations of PET/CT group were determined by PET/CT and the data were 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 fractioned 3DCRT （40Gy or so） was followed by a planning of 21Gy - 30Gy in 9 - 14days, 1.5Gy per fraction, twice a day in reduced radiation field. The total dose was 61Gy- 70Gy. Locations of normal CT group were determined by CT and the data were transmitted to the TPS and the patients were treated by 3DCRT to the same dose. All cases were treated by the rip adjuvant chemotherapy for 4 - 6 cycles later. Results：Target volume of 11 cases in the PET/CT group was changed（ radiation field of 8cases got smaller and 3 cases got larger eamparing with the CT imaging）. The follow-up time was 8 -39 months. The complete remission （CR） and partial remission （PR） rates of the PET/CT group and the normal CT group were 14. 3% ,64. 3% and 17.9% ,53.6% respectively; The overall response rates （ CR ＋ PR） were 78.6% ,71.4% respectively, there was no significant difference in the total effective rates（χ^2 =0. 67,P =0. 715）. The rate of grade 1 -2 late radiation injury of lung and trachea in PET/CT group was lower than that of normal CT group（P =0. 029）. The 1,2,3-year local control rates of the PET/CT group and normal CT group were 85.7% ,64. 2% ,53. 6% and 71.4% ,60.7% ,42.9% respectively,there was no significant difference in the two groups（χ^2 = 1.30 ,P = 0. 254）. The 1,2,3-year survival rates were 71.4% ,35.7% ,21.4% and 53.6% ,28. 6% , 14. 3% respectively, there was no significant difference in the two groups（χ^2 = 1.38 ,P = 0. 240）. The recurrent rate of hilar and mediastinal lymph node in PET/CT group was lower than that of the normal CT group（ P 〈 0. 05 ）. The main reason for failure was distant metastasis. Conclusion： Using PET/CT to determine the target of stage Ⅲ lung squamous cell carcinoma can improve the radiation treatment plan, reduce the recurrent rate of hilar and mediastinum, but can＇ t improve the long-term survival rate. Distant metastasis is the main reason for failure.
出处
《肿瘤预防与治疗》
2010年第5期389-392,共4页
Journal of Cancer Control And Treatment
关键词
肺肿瘤
体层摄影术
正电子发射型
后加速放疗
三维适形放疗
预后
Lung Neoplasms
Tomography
Positron Emission
Late Course Accelerated Fraetionated Radiotherapy
Three-dimensional Conformal Radiation Therapy
Prognosis
