摘要
目的对比研究18FDG PET/CT定位三维适形常规分割放疗食管癌的疗效、副反应及失败原因。方法对60例食管鳞癌患者用信封法随机分为18FDG 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组用PET/CT扫描定位,经PET/CT扫描后将扫描数据输入治疗计划系统,将PET图像和CT图像融合后进行靶区和重要脏器勾画、三维重建,制定治疗计划后进行常规分割三维适形放疗40 Gy左右,然后适当缩野针对残存肿瘤病灶放疗至总剂量60～70 Gy;普通CT组用普通CT定位设野,三维适形放疗至相同剂量。结果 PET/CT组的平均GTV体积、左肺照射体积、右肺照射体积、脊髓照射体积分别比普通CT组小(5.1±1.1)cm3、(27.7±24.6)cm3、(27.9±42.3)cm3、(0.4±0.4)cm3,两者差异均有显著性(P均<0.01);随访8～37个月,PET/CT组和普通CT组1,2,3年局部控制率分别为70.0%、56.7%、43.3%和66.7%、53.3%、36.7%,两者差异无显著性(χ2=0.65,P=0.421);PET/CT组的中位复发时间10.4个月,普通CT组的中位复发时间11.0个月,两者差异无显著性(t=0.41,P=0.682);PET/CT组和普通CT组1,2,3年生存率分别为76.7%、60.0%、46.7%和73.3%、56.7%、36.7%,两者差异无显著性(χ2=1.37,P=0.244);PET/CT组早期气管、食管、肺的Ⅰ、Ⅱ级副反应低于普通CT组(P均<0.05);晚期放射反应相近,两组差异无显著性。多因素分析表明,在年龄、性别、病变长度和部位等因素中,病变位于胸上段、髓质型和蕈伞型、病变长度≤5 cm、无淋巴结转移、T早分期病变预后较好(P均<0.01)。结论 PET/CT定位三维适形放疗食管癌可以优化放疗计划,减轻正常组织的早期放射副反应,胸上段以及髓质型或蕈伞型的早期病变预后好。
Objective To analyse the efficacy,side effect and cause of failure of 18FDG PET/CT positioning three-dimensional conformal radiotherapy（3DCRT） in treatment of esophageal carcinoma.Methods Sixty cases of esophageal squamous cell carcinoma were randomly divided into 18FDG PET/CT positioning 3DCRT group（PET/CT group）and the normal CT positioning three-dimensional conformal radiotherapy group（normal CT group）.The location of PET/CT group was determined by PET/CT and the data were transmitted to the treatment planning system（TPS）,the PET image and CT image were fused together;the target volume and critical organs were determined and the treatment plan was worked out by the fused image,then conventional fraction of 3DCRT（40 Gy or so） was followed to a total dose of radiotherapy 60Gy～70 Gy by reduced radiation field.The location of normal CT group cases was determined by normal CT and the data were transmitted to the TPS and were treated by 3DCRT to the same dose.Results The average GTV′s volume,left lung′s irradiated volume,right lung′s irradiated volume and spinal cord′s irradiated volume of the PET/CT group were smaller than those of the normal CT group（reduced by 5.1±1.1 cm3,27.7±24.6 cm3,27.9±42.3 cm3,0.4±0.4 cm3 respectively）,there was statistically significant difference（all P0.01） between the two groups.The follow-up time was 8～37 months.The 1,2,3-year local control rates of the PET/CT group and the normal CT group were 70.0%,56.7%,43.3% and 66.7%,53.3%,36.7% respectively,there was no significant difference between the two groups（χ2=0.65,P=0.421）.The median recurrence time was 10.4 months in the PET/CT group and 11.0 months in the normal CT group,there was no significant difference between the two groups（t= 0.41,P=0.682）.The 1,2,3-year survival rates of the PET/CT group and the normal CT group were 76.7%,60.0%,46.7% and 73.3%,56.7%,36.7% respectively,there was no significant difference between the two groups（χ2=1.37,P=0.244）.The early 1,2-grade adverse reactions of trachea,esophagus and lung in the PET/CT group were lower than those in normal CT group（P0.05）,but there was no significant difference of late radiation reactions between the two groups.Multivariate analysis showed that the prognosis of lesion located in the upper chest,medullary and mushroom umbrella type,lesion length ≤5 cm,no lymph node metastasis and early T stage lesions was better than that of others（all P0.01）.Conclusion PET/CT positioning 3DCRT can optimize the radiation treatment plan and reduce the early radiation side-effects of normal tissue,upper chest lesion and medullary or mushroom umbrella early type have better prognosis than that of others.
出处
《中国肿瘤临床与康复》
2010年第4期338-341,共4页
Chinese Journal of Clinical Oncology and Rehabilitation
关键词
食管肿瘤/放射疗法
正电子断层显像
三维适形放射治疗
预后
Esophageal neoplasms/radiotherapy
Tomography
positron emission
Three-dimensional conformal radiation therapy
Prognosis
