中华放射肿瘤学杂志
中華放射腫瘤學雜誌
중화방사종류학잡지
CHINESE JOURNAL OF RADIATION ONCOLOGY
2010年
6期
500-503
,共4页
任宝志%钟立松%张仟仕%袁建军%陶星
任寶誌%鐘立鬆%張仟仕%袁建軍%陶星
임보지%종립송%장천사%원건군%도성
肺肿瘤/三维适形放射疗法%定位,体层摄影术,正电子发射型%定位,体层摄影术,X线计算机%预后
肺腫瘤/三維適形放射療法%定位,體層攝影術,正電子髮射型%定位,體層攝影術,X線計算機%預後
폐종류/삼유괄형방사요법%정위,체층섭영술,정전자발사형%정위,체층섭영술,X선계산궤%예후
Lung neoplasms/three-dimensional conformal radiotherapy%Positioning,tomography,positron emission%Positioning,tomography,X-ray computed%Prognosis
目的 观察Ⅲ期非小细胞肺癌(NSCLC)经氟标记脱氧葡萄糖(18FDG)PET-CT定位后行三维适形放疗的疗效、副反应及失败原因.方法 64例Ⅲ期NSCLC(临床Ⅲa、Ⅲb期)患者用信封法随机分为PET-CT定位三维适形放疗(3DCRT)组(PET-CT组)和普通CT定位3DCRT组(普通CT组).PET-CT组将PET和CT图像融合后进行靶区和重要脏器勾画,制定治疗计划后进行常规分割3DCRT 40 Gy左右,然后适当缩野针对残存肿瘤病灶放疗至总剂量65 Gy左右.普通CT组用普通CT定位设野,3DCRT至相同剂最.所有病例均用TP方案(紫杉醇175 mg/m2第1天,顺铂40 mg第2～4天)辅助化疗6个周期.结果 随访率100%.随访满1、2、3年者分别为40、20、11例,PET-CT组和CT组分别为23和17例、11和9例、7和4例.PET-CT组中13例靶区有改变.PET-CT组和普通CT组完全缓解、部分缓解率分别为13%、66%和19%、53%(x2=0.33,P=0.564),1、2、3年局部控制率分别为84%、66%、53%和72%、59%、44%(x2=2.36,P=0.124),1、2、3年生存率分别为72%、34%、22%和53%、28%、13%(x2=2.46,P=0.117).PET-CT组1、2级肺晚期放射损伤发生率低于普通CT组,分别为28%、53%(x2=4.14,P=0.042).PET-CT组肺门、纵隔淋巴结复发率低于普通CT组,分别为3%和25%(P=0.026)、6%和28%(P=0.043);治疗失败主要原因相似均为远处转移,分别为56%和47%(x2=0.56,P=0.453).结论 PET-CT定位可以优化Ⅲ期NSCLC放疗设野计划,减少肺门和纵隔复发率,但远期生存率无明显提高,远处转移为主要失败原因.
目的 觀察Ⅲ期非小細胞肺癌(NSCLC)經氟標記脫氧葡萄糖(18FDG)PET-CT定位後行三維適形放療的療效、副反應及失敗原因.方法 64例Ⅲ期NSCLC(臨床Ⅲa、Ⅲb期)患者用信封法隨機分為PET-CT定位三維適形放療(3DCRT)組(PET-CT組)和普通CT定位3DCRT組(普通CT組).PET-CT組將PET和CT圖像融閤後進行靶區和重要髒器勾畫,製定治療計劃後進行常規分割3DCRT 40 Gy左右,然後適噹縮野針對殘存腫瘤病竈放療至總劑量65 Gy左右.普通CT組用普通CT定位設野,3DCRT至相同劑最.所有病例均用TP方案(紫杉醇175 mg/m2第1天,順鉑40 mg第2～4天)輔助化療6箇週期.結果 隨訪率100%.隨訪滿1、2、3年者分彆為40、20、11例,PET-CT組和CT組分彆為23和17例、11和9例、7和4例.PET-CT組中13例靶區有改變.PET-CT組和普通CT組完全緩解、部分緩解率分彆為13%、66%和19%、53%(x2=0.33,P=0.564),1、2、3年跼部控製率分彆為84%、66%、53%和72%、59%、44%(x2=2.36,P=0.124),1、2、3年生存率分彆為72%、34%、22%和53%、28%、13%(x2=2.46,P=0.117).PET-CT組1、2級肺晚期放射損傷髮生率低于普通CT組,分彆為28%、53%(x2=4.14,P=0.042).PET-CT組肺門、縱隔淋巴結複髮率低于普通CT組,分彆為3%和25%(P=0.026)、6%和28%(P=0.043);治療失敗主要原因相似均為遠處轉移,分彆為56%和47%(x2=0.56,P=0.453).結論 PET-CT定位可以優化Ⅲ期NSCLC放療設野計劃,減少肺門和縱隔複髮率,但遠期生存率無明顯提高,遠處轉移為主要失敗原因.
목적 관찰Ⅲ기비소세포폐암(NSCLC)경불표기탈양포도당(18FDG)PET-CT정위후행삼유괄형방료적료효、부반응급실패원인.방법 64례Ⅲ기NSCLC(림상Ⅲa、Ⅲb기)환자용신봉법수궤분위PET-CT정위삼유괄형방료(3DCRT)조(PET-CT조)화보통CT정위3DCRT조(보통CT조).PET-CT조장PET화CT도상융합후진행파구화중요장기구화,제정치료계화후진행상규분할3DCRT 40 Gy좌우,연후괄당축야침대잔존종류병조방료지총제량65 Gy좌우.보통CT조용보통CT정위설야,3DCRT지상동제최.소유병례균용TP방안(자삼순175 mg/m2제1천,순박40 mg제2～4천)보조화료6개주기.결과 수방솔100%.수방만1、2、3년자분별위40、20、11례,PET-CT조화CT조분별위23화17례、11화9례、7화4례.PET-CT조중13례파구유개변.PET-CT조화보통CT조완전완해、부분완해솔분별위13%、66%화19%、53%(x2=0.33,P=0.564),1、2、3년국부공제솔분별위84%、66%、53%화72%、59%、44%(x2=2.36,P=0.124),1、2、3년생존솔분별위72%、34%、22%화53%、28%、13%(x2=2.46,P=0.117).PET-CT조1、2급폐만기방사손상발생솔저우보통CT조,분별위28%、53%(x2=4.14,P=0.042).PET-CT조폐문、종격림파결복발솔저우보통CT조,분별위3%화25%(P=0.026)、6%화28%(P=0.043);치료실패주요원인상사균위원처전이,분별위56%화47%(x2=0.56,P=0.453).결론 PET-CT정위가이우화Ⅲ기NSCLC방료설야계화,감소폐문화종격복발솔,단원기생존솔무명현제고,원처전이위주요실패원인.
Objective To analyse the long-term result and prognosis of 18 FDG PET/CT positioning three - dimensional conformal radiotherapy ( 3 DCRT ) for stage Ⅲ non - small cell lung cancer. Methods Sixty-four cases with stage Ⅲ non-small cell lung cancer (clinical stage Ⅲa- Ⅲb ) were randomly divided into two groups: PET/CT positioning three-dimensional conformal radiotherapy group (PET/CT group) and the conventional CT positioning three-dimensional conformal radiotherapy group (conventional CT group). In the PET/CT group, the target volume and critical organs were sketched according to PET/CT after fusion of the PET and the CT images; the treatment plan was worked out, then conventional fractionated 3DCRT ( total
dosage around 40 Gy) followed by field-shrinked radiotherapy to a total dose of 65 Gy or sowas performed ;in the conventional CT group, the target volume and critical organs were sketched according to CT and 3DCRT were performed to the same total dose; All cases were treated with the TP scheme (paclitaxel 175 mg/m2,d1 ,cisplatin 40 mg,d2-4) adjuvant chemotherapy for 6 cycles after the radiotherapy. Results The followup rate was 100%. The number of patients who completed the 1-,2-and 5-year follow-up were 40,20 and 11 respectively ;The number of patients of the PET/CT group and conventional CT group were 23 and 17,11 and 9,7 and 4 respectively. Target volumes of 13 cases in the PET/CT group were changed. The complete remission and partial remission rates of the two groups were 13% 、66% and 19% 、53% (x2 = 0. 33, P =0. 564), respectively. The 1-,2-and 3-year local control rates of the PET/CT group and conventional CT group were84 % 、66% 、53 % an d72% 、59% 、44% ( x2 = 2.36, P = 0. 124 ) respectively. The1 -, 2-and 3-year survival rates were 72% 、34% 、22% and 53% 、28% 、13% (x2 =2. 46,P =0. 117) respectively. The level-1 and level-2 lungs' and trachea's late radiation injury of the PET/CT group and the conventional CT group were 28% and 53% ( x2 = 4. 14, P = 0. 042 ), respectively. The hilar and mediastinal lymph node recurrence rates of the PET/CT group were lower than those of the conventional CT group, were 3% ,25%(P = 0. 026) and 6%, 28% ( P = 0. 042 ), respectively. The main reason for treatment failure was distant
metastasis both in the PET/CT group and conventional CT group,56% and 47% (x2 = 0. 56,P = 0. 453 ),respectively. Conclusions PET/CT, as a method of sketching the target of stage Ⅲ non-small cell lung cancer, can improve the radiation treatment plan, reduce the recurrence rate of hilar and mediastinal lymph nodes, meanwhile it can not improve the long-term survival rate; Distant metastasis was the main reason of failure.
