CAJ | 학술논문

目的探讨肺灌注显像在Ⅲ期非小细胞肺癌(NSCLC)调强放疗(IMRT)保护功能肺的可行性.方法选择拟行放疗的Ⅲ期NSCLC患者24例,分别行PET-CT和SPECT定位,图像传至治疗计划系统进行图像融合.根据SPECT图像确定功能肺(FL)和非功能肺(NFL),FL是指放射性计数为最大放射性计数的30%以上(包括30%)的区域,其他区域为NFL.肺灌注受损分为4级:0级,无灌注受损;1级,肿瘤及其周围局部肺灌注受损;2级,达1叶肺灌注受损;3级,超过1叶肺灌注受损.根据SPECT图像提供的肺功能信息制定IMRT计划进行优化,尽可能降低FL的照射体积剂量.采用配对t检验统计分析优化前后的IMRT计划的肺组织剂量参数变化.结果患者均有不同程度的肺灌注缺损,其中肺灌注受损1级8例,2级6例,3级10例.根据SPECT提供的肺功能信息优化IMRT计划后WLV和FLV均有不同程度降低,而FLV降低程度更加明显.优化后WLV10、WLV15、WLV20、WLV25、WLV30和FLV10、FLV15、FLV20、FLV25、FLV30差异有统计学意义.结论根据SPECT图像提供的肺功能信息优化IMRT计划以保护Ⅲ期NSCLC功能肺是可行的.
목적 탐토폐관주현상재Ⅲ기비소세포폐암(NSCLC)조강방료(IMRT)보호공능폐적가행성.방법 선택의행방료적Ⅲ기NSCLC환자24례,분별행PET-CT화SPECT정위,도상전지치료계화계통진행도상융합.근거SPECT도상학정공능폐(FL)화비공능폐(NFL),FL시지방사성계수위최대방사성계수적30%이상(포괄30%)적구역,기타구역위NFL.폐관주수손분위4급:0급,무관주수손;1급,종류급기주위국부폐관주수손;2급,체1협폐관주수손;3급,초과1협폐관주수손.근거SPECT도상제공적폐공능신식제정IMRT계화진행우화,진가능강저FL적조사체적제량.채용배대t검험통계분석우화전후적IMRT계화적폐조직제량삼수변화.결과 환자균유불동정도적폐관주결손,기중폐관주수손1급8례,2급6례,3급10례.근거SPECT제공적폐공능신식우화IMRT계화후WLV화FLV균유불동정도강저,이FLV강저정도경가명현.우화후WLV10、WLV15、WLV20、WLV25、WLV30화FLV10、FLV15、FLV20、FLV25、FLV30차이유통계학의의.결론 근거SPECT도상제공적폐공능신식우화IMRT계화이보호Ⅲ기NSCLC공능폐시가행적.
Objective To explore the possibility of using lung parfusion single photon emission computed tomngraphy (SPECT) scans to protect functional lung with optimizing intensity modulated radiotherapy (IMRT) plan in patients with stage Ⅲ non-smaU cell lung cancer(NSCLG). Methods Twenty-four patients with stage Ⅲ NSCLC who were candidated for radiotherapy were enrolled. All patients had PET-CT scans and SPECT scans. The two sets of images were accurately co-registered in the planning system. SPECT images were used to define a volume of functional lung (FL) and non-functional lung (NFL). The region of≥30% maximum radioactive counts was FL and the other region was NFL. Then SPECT images were classified by comparing lung perfusion deficit with area of radiologicul abnormality. Grade 0: no lung perfusion deficit. Grade 1: the size of radiological abnormality was similar to the area of lung perfusion deficit. Grade 2 : the area of lung perfusion was bigger than that of radiological abnormality, and extended to 1 pulmonary lobe. Grade 3: the area of lung perfusion deficit exceed 1 pulmonary lobe. The optimized IMRT objective was to minimize the dose to FL. The difference between the two sets of IMRT plans was studied. Results All patients had lung perfusion deficits, 8 patients with grade 1 damage, 6 patients with grade 2 damage, and 10 patient with grade 3 damage. After IMRT plan optimized, both the percentage of whole lung volume received dose (WLV) and the percentage of functional lung volume received dose (FLV) were decreased. However, the FLVs was decreased more significantly. There was significant difference in WLV10, WLV15, WLV20, WLV25, WLV30 and FLV10, FLV15, FLV20, FLV25, FLV30 between the two sets of IMRT plans (P<0.05). Conclusions It is conrenient to SPECT-guidance to protect functional lung with optimizing IMRT in stage ≥ NSCLC patients, potentially reducing lung toxicity.