摘要
目的探讨PET—CT检查对非小细胞肺癌（non—small—cell lung cancer，NSCLC）患者的分期与治疗方案的影响和PET／CT所确定的靶区（GTV）与病理学肿瘤大小的关系。方法2006年3月一2008年7月间37例接受手术或放疗的NSCLC患者，根据PET／CT检查结果，21例患者进入手术组（有手术指征），16例患者进入放疗组（无手术指征），手术组术前在PET／CT图像上确定肿瘤在冠状轴（x轴）、矢状轴（Y轴）、长轴（z轴）三维径线上的大小，术后病理检查，确定肿瘤在X、Y、Z轴上的大小；TNM分期分别用CT、PET／CT分期与病理学分期。放疗组分别在PET／CT和CT横断图像上勾画原发灶和纵隔淋巴结GTV，软件自动运算PET／CT和模拟定位增强CT所勾画靶区的体积。结果19例（51．4％）的TNM分期在PET／CT检查后发生改变；12例（37．8％）的治疗方案因而发生变化。CT、PET／CT、病理确定的原发灶大小在X、Y轴上无显著差异（P值〉0．05），Z轴上有显著差异（P值〈0．05）；放疗组16例患者中，PET／CT所勾画的GTVPET〉GTVCT者共4例，因为PET／CT发现不符合CT诊断标准的纵隔淋巴结转移灶。GTVPET〈GTVCT者共7例，主要是因为PET／CT排除了阻塞性肺炎和肺不张。结论PET／CT检查对分期与治疗方案的影响较大，PET／CT与病理学的肿瘤大小基本一致，PET／CT所确定的肿瘤大小可以作为病理学的GTV，勾画非小细胞肺癌放疗靶区PET／CT优于CT。
Objective To evaluate the influence to stage and the treatment planning in non -small cell lung cancer（NSCLC） by CT,PET/CT. To define the correlation of gross tumor volume（GTV） by PET/CT and pathology. Methods From March 2006 to July 2008,37 NSCLC patients were studied,21 cases received surgical resection and 16 cases received radiotherapy based on PET/CT. All patients had PET/CT scans of all body before surgery or radiotherapy and routine pathology examination after surgery. The tumor size at X（ lateral direction） ,Y （ventrodorsal direction）and Z（ craniocaudal direction）axes were measured on CT,PET/CT and pathology exami- nation, respectively. TNM stage change the treatment planning in a significant number of patients, both the CT and PET/CT images were transferred to the RT planning workstation for contouring. GTV, pathologic nodal and prima- ry tumor volumes were first defined in the conventional manner based on CT and PET/CT images. Results TNM stage was changed in 19 cases（51.4% ）and the treatment planning was changed in 12 cases（37.8% ）after PET/ CT. There was no significant difference in the tumor size at X , Y axes （ P 〉 0.05 ） ; and there was significant difference in the tumor size at Z axes. Of the 16 patients in radiotherapy group, the primary tumor GTV was increased in 4 cases by detecting additional nodal disease burden, and decreased GTV in 7 cases by differentiating atelectasis and postobstructive pneumonia from tumor. Conclusions PET/CT alter TNM stage and the treatment planning in NSCLC in a significant number of patients, there was almost total agreement on the gross tumor volume by PET/CT and pathology. GTV could be used for radiation therapy by PET/CT instead of the GTV by pathology. PET/CT is superior CT on delineation of the gross tumor volume for radiation planning.
出处
《实用肿瘤学杂志》
CAS
2011年第1期29-32,共4页
Practical Oncology Journal
基金
2006年佛山市科委课题项目（200608029）
关键词
肺肿瘤
非小细胞肺癌
病理学
正电子发射体层显像
靶区
Lung neoplasms
Non - small cell lung cancer
Pathology
18FFDG - PET/CT
Grosstumor volume
