现代肿瘤医学
現代腫瘤醫學
현대종류의학
Journal of Modern Oncology
2015年
23期
3435-3439
,共5页
任宝志%周玉霞%张红%幸泽鲜%陶星
任寶誌%週玉霞%張紅%倖澤鮮%陶星
임보지%주옥하%장홍%행택선%도성
肺肿瘤%体层摄影术%正电子发射型%三维适形放疗
肺腫瘤%體層攝影術%正電子髮射型%三維適形放療
폐종류%체층섭영술%정전자발사형%삼유괄형방료
lung neoplasms%tomography%positron emission%three - dimensional conformal radiation therapy
目的：比较局限期小细胞肺癌普通 X 线模拟定位、CT 定位以及 PET/CT 定位三维适形放疗（3DCRT）协同化疗的疗效、不良反应和预后。方法：回顾性分析12年间局限期小细胞肺癌患者共148例，分别接受普通 X 线模拟定位（普放组）、CT 定位（适形组）和 PET/ CT 定位（PET/ CT 组）放疗。所有病例均用 EP 方案（顺铂40mg，d1～3；VP16100mg/ m2，d1～5）化疗4～6周期；随访并比较各种治疗方法的疗效、不良反应和预后。结果：PET/ CT 组的平均 GTV 与 PTV 体积均比适形组小，PET/ CT 组的左肺与右肺 V20、心脏、食管与脊髓 V40均比适形组小（P 均＜0.05）；近期总有效率差异无统计学意义（P ＞0.05）。普放组的早期与晚期放射反应均高于适形组与 PET/ CT 组；PET/ CT 组中 I、II 级肺和气管的早期与晚期放射损伤发生率低于适形组（P 均＜0.05）。PET/ CT 组的1、2、3年局部控制率与生存率均高于适形组（ P 均＜0.01）。PET/ CT 组纵隔淋巴结复发率低于适形组，放化疗后手术切除残存病灶者预后好；治疗失败的主要原因为远处转移。结论：PET/ CT 定位可以优化局限期小细胞肺癌的放疗设野计划，减少正常组织的照射体积与纵隔复发率。放化疗后手术切除残存病灶预后好，远处转移为主要失败原因。
目的：比較跼限期小細胞肺癌普通 X 線模擬定位、CT 定位以及 PET/CT 定位三維適形放療（3DCRT）協同化療的療效、不良反應和預後。方法：迴顧性分析12年間跼限期小細胞肺癌患者共148例，分彆接受普通 X 線模擬定位（普放組）、CT 定位（適形組）和 PET/ CT 定位（PET/ CT 組）放療。所有病例均用 EP 方案（順鉑40mg，d1～3；VP16100mg/ m2，d1～5）化療4～6週期；隨訪併比較各種治療方法的療效、不良反應和預後。結果：PET/ CT 組的平均 GTV 與 PTV 體積均比適形組小，PET/ CT 組的左肺與右肺 V20、心髒、食管與脊髓 V40均比適形組小（P 均＜0.05）；近期總有效率差異無統計學意義（P ＞0.05）。普放組的早期與晚期放射反應均高于適形組與 PET/ CT 組；PET/ CT 組中 I、II 級肺和氣管的早期與晚期放射損傷髮生率低于適形組（P 均＜0.05）。PET/ CT 組的1、2、3年跼部控製率與生存率均高于適形組（ P 均＜0.01）。PET/ CT 組縱隔淋巴結複髮率低于適形組，放化療後手術切除殘存病竈者預後好；治療失敗的主要原因為遠處轉移。結論：PET/ CT 定位可以優化跼限期小細胞肺癌的放療設野計劃，減少正常組織的照射體積與縱隔複髮率。放化療後手術切除殘存病竈預後好，遠處轉移為主要失敗原因。
목적：비교국한기소세포폐암보통 X 선모의정위、CT 정위이급 PET/CT 정위삼유괄형방료（3DCRT）협동화료적료효、불량반응화예후。방법：회고성분석12년간국한기소세포폐암환자공148례，분별접수보통 X 선모의정위（보방조）、CT 정위（괄형조）화 PET/ CT 정위（PET/ CT 조）방료。소유병례균용 EP 방안（순박40mg，d1～3；VP16100mg/ m2，d1～5）화료4～6주기；수방병비교각충치료방법적료효、불량반응화예후。결과：PET/ CT 조적평균 GTV 여 PTV 체적균비괄형조소，PET/ CT 조적좌폐여우폐 V20、심장、식관여척수 V40균비괄형조소（P 균＜0.05）；근기총유효솔차이무통계학의의（P ＞0.05）。보방조적조기여만기방사반응균고우괄형조여 PET/ CT 조；PET/ CT 조중 I、II 급폐화기관적조기여만기방사손상발생솔저우괄형조（P 균＜0.05）。PET/ CT 조적1、2、3년국부공제솔여생존솔균고우괄형조（ P 균＜0.01）。PET/ CT 조종격림파결복발솔저우괄형조，방화료후수술절제잔존병조자예후호；치료실패적주요원인위원처전이。결론：PET/ CT 정위가이우화국한기소세포폐암적방료설야계화，감소정상조직적조사체적여종격복발솔。방화료후수술절제잔존병조예후호，원처전이위주요실패원인。
Objective:To analyse the result and prognosis of concurrent chemotherapy and radiotherapy by ordina-ry X - based simulation,CT simulation,PET/ CT positioning three - dimensional conformal radiotherapy(3DCRT)for limited small cell lung cancer. Methods:To review 148 patients with limited small cell lung cancer by ordinary X ray simulator(normal group),CT localization(CRT group)and PET/ CT localization(PET/ CT group)radiotherapy. All cases were treated by EP program(VP16 100mg/ m2 ,d1 ~ 5;Cisplatin 40mg,d1 ~ 3 )chemotherapy for 4 ~ 6 cycles. Re-sults:The average volume of GTV and PTV of the PET/ CT group was smaller than that of the CRT group,the left lung and right lung V20 ,heart,sophagus and spinal cord V40 of the experimental group was smaller than that of the control group(all P < 0. 05). The short - term total effective rate of the three groups was not statistically significant(P >0. 05). The early and late radiation reactions of the normal group were higher than that of the CRT group and the PET/ CT group. The I,II - grade early and late radiation injury rate of the lung and trachea of the PET/ CT group was lower than that of the CRT group(all P < 0. 05). The 1,2,3 - year local control rates and survival rate of the PET/CT group were higher than that of the CRT group(all P < 0. 01). The mediastinal lymph node recurrence rate of the PET/ CT group was lower than that of the CRT group. The prognosis of post - chemotherapy residual tumor resection was good. The main reason for treatment failure was distant metastasis. Conclusion:Using PET/ CT to determine the target of limited small cell lung cancer can improve the radiation treatment plan,reduce the recurrence rate of medias-tinal,the prognosis of post - chemotherapy residual tumor resection is good. Distant metastasis was the main reason for failure.
