肿瘤研究与临床
腫瘤研究與臨床
종류연구여림상
CANCER RESEARCH AND CLINIC
2013年
4期
253-256
,共4页
周军涛%李险峰%李功祥%黎妲
週軍濤%李險峰%李功祥%黎妲
주군도%리험봉%리공상%려달
肺肿瘤%放射性肺炎%肺灌注显像%剂量体积直方图
肺腫瘤%放射性肺炎%肺灌註顯像%劑量體積直方圖
폐종류%방사성폐염%폐관주현상%제량체적직방도
Lung neoplasms%Radiation pneumonitis%Pulmonary perfusion imaging%Dose-volume histogram
目的 观察接受三维适形或调强放疗的肺癌患者放疗前后肺灌注显像的变化、肺受照射的剂量体积直方图(DVH)参数等,并结合临床因素,探讨其与放射性肺炎发生的相关性.方法 18例接受三维适形或调强放疗的肺癌患者放疗前后行肺灌注显像检查,比较照射前后肺灌注显像的变化.放射性肺炎的评价按美国肿瘤放疗协作组(RTOG)急性放射性肺炎标准评定.获得的CT与单光子发射CT(SPECT)肺灌注图像融合后,将等剂量曲线投影到SPECT图像,将传统的DVH转换成f-DVH.将f-DVH曲线中每例患者的V5、V10和V20所对应的灵敏度与特异度相加,取其最大值,寻找到曲线的界值.分析放疗前后肺灌注显像变化及肺受照射的DVH与放射性肺炎发生的相关性.结果 18例患者中,33.3％(6/18)发生了2级以上放射性肺炎.放疗前后肺灌注受损加重者2级以上放射性肺炎发生率为62.5％(5/8),肺灌注受损改善者发生率为10.0％(1/10).f-DVH图曲线中V5、V10和V20的界值分别为53％、41％和27％,以V5对中重度急性放射性肺炎的预测准确度最高.放疗前后肺灌注显像的变化联合全肺DVH参数V5是放射性肺炎最强的预测因素.结论 肺癌患者放疗前后肺灌注显像能反映患侧肺灌注功能的变化.放疗前后肺灌注显像的变化联合DVH参数V5有望作为预测放射性肺炎发生的指标.
目的 觀察接受三維適形或調彊放療的肺癌患者放療前後肺灌註顯像的變化、肺受照射的劑量體積直方圖(DVH)參數等,併結閤臨床因素,探討其與放射性肺炎髮生的相關性.方法 18例接受三維適形或調彊放療的肺癌患者放療前後行肺灌註顯像檢查,比較照射前後肺灌註顯像的變化.放射性肺炎的評價按美國腫瘤放療協作組(RTOG)急性放射性肺炎標準評定.穫得的CT與單光子髮射CT(SPECT)肺灌註圖像融閤後,將等劑量麯線投影到SPECT圖像,將傳統的DVH轉換成f-DVH.將f-DVH麯線中每例患者的V5、V10和V20所對應的靈敏度與特異度相加,取其最大值,尋找到麯線的界值.分析放療前後肺灌註顯像變化及肺受照射的DVH與放射性肺炎髮生的相關性.結果 18例患者中,33.3％(6/18)髮生瞭2級以上放射性肺炎.放療前後肺灌註受損加重者2級以上放射性肺炎髮生率為62.5％(5/8),肺灌註受損改善者髮生率為10.0％(1/10).f-DVH圖麯線中V5、V10和V20的界值分彆為53％、41％和27％,以V5對中重度急性放射性肺炎的預測準確度最高.放療前後肺灌註顯像的變化聯閤全肺DVH參數V5是放射性肺炎最彊的預測因素.結論 肺癌患者放療前後肺灌註顯像能反映患側肺灌註功能的變化.放療前後肺灌註顯像的變化聯閤DVH參數V5有望作為預測放射性肺炎髮生的指標.
목적 관찰접수삼유괄형혹조강방료적폐암환자방료전후폐관주현상적변화、폐수조사적제량체적직방도(DVH)삼수등,병결합림상인소,탐토기여방사성폐염발생적상관성.방법 18례접수삼유괄형혹조강방료적폐암환자방료전후행폐관주현상검사,비교조사전후폐관주현상적변화.방사성폐염적평개안미국종류방료협작조(RTOG)급성방사성폐염표준평정.획득적CT여단광자발사CT(SPECT)폐관주도상융합후,장등제량곡선투영도SPECT도상,장전통적DVH전환성f-DVH.장f-DVH곡선중매례환자적V5、V10화V20소대응적령민도여특이도상가,취기최대치,심조도곡선적계치.분석방료전후폐관주현상변화급폐수조사적DVH여방사성폐염발생적상관성.결과 18례환자중,33.3％(6/18)발생료2급이상방사성폐염.방료전후폐관주수손가중자2급이상방사성폐염발생솔위62.5％(5/8),폐관주수손개선자발생솔위10.0％(1/10).f-DVH도곡선중V5、V10화V20적계치분별위53％、41％화27％,이V5대중중도급성방사성폐염적예측준학도최고.방료전후폐관주현상적변화연합전폐DVH삼수V5시방사성폐염최강적예측인소.결론 폐암환자방료전후폐관주현상능반영환측폐관주공능적변화.방료전후폐관주현상적변화연합DVH삼수V5유망작위예측방사성폐염발생적지표.
Objective To evaluate the lung exposure dose-volume (DVH) parameters and other indicators of lung perfusion imaging before and after three-dimensional conformal or intensity modulated radiation therapy for lung cancer patients,and combined with clinical factors,to explore relationship with radiation pneumonitis occurred.Methods 18 patients were selected for data analysis.Lung perfusion scintigraphy was detected before and after three-dimensional conformal or intensity modulated radiation therapy for lung cancer.Lung perfusion changes were compared before and after irradiation.Evaluation of radiation pneumonitis was assessed by the Radiation Therapy Oncology Group (RTOG) acute radiation pneumonitis standard.After the CT and SPECT lung perfusion images were transferred to Varian,the Eclipse 3D treatment planning system,image fusion after dose curve projected onto the SPECT images,and the DVH was converted into a f-DVH diagram.Analysis of pulmonary perfusion imaging changes before and after radiotherapy combined with lung irradiation dose volume parameters and radiation pneumonitis.Results In the whole group,33.3 ％ (6/18) cases occurred more than 2 radiation pneumonitis.Before and after radiotherapy,the damage to the lung perfusion was more than 2 radiation pneumonitis incidence [62.5 ％ (5/8)],and impaired pulmonary perfusion improvement was 10.0 ％ (1/10).DVH parameters to V5 severe RP forecasted high accuracy.In curve for each patient,boundary values of V5,V10 and V20 were 53 ％,41％ and 27 ％.Before and after radiotherapy it was found that lung perfusion changes and the whole lung V5 portfolio were the strongest predictors for radiation pneumonitis after radiotherapy.Conclusion Pulmonary perfusion imaging in patients with lung cancer is able to reflect changes in the function of ipsilateral lung perfusion before and after radiotherapy.Changes in the ipsilateral lung perfusion detected before and after radiotherapy combined with V5 are expected to serve as indicators to predict radiation pneumonitis.
