^(99m)Tc-HL91 SPECT肺癌乏氧显像与放疗疗效关系的初步研究

^(99m)Tc-HL91 SPECT detects the relation between hypoxic changes and radiotherapy response of lung cancer

目的利用99 mTc-HL91 SPECT乏氧显像,确定非小细胞肺癌放疗中乏氧程度及乏氧变化与放疗疗效的相关性。方法拟接受三维适形放疗的非小细胞肺癌患者35例,于放疗前1~2 d行99 mTc-HL91 SPECT检查,其中20例还分别于放疗过程中(接受30~40 Gy照射后)及放疗后1~2 d行99 mTc-HL91 SPECT检查。利用感兴趣区(ROI)技术计算T/N(靶与非靶)比值。分析放疗前T/N及放疗前后T/N变化与放疗疗效的关系。放疗后3~6个月,利用WHO实体瘤疗效评价标准评价其放疗疗效。结果放疗前、放疗中和放疗后影像的T/N比值分别为1.56±0.19,1.40±0.12和1.29±0.13(P=0.010)。放疗前T/N较低组放疗有效率高于T/N较高组(P=0.040)。放疗前后T/N变化较大组放疗有效率高于变化较小组,但差异无统计学意义。结论HL91 SPECT显像可观测到肺癌放疗前乏氧状态及放疗中动态变化,乏氧显像对放疗疗效的预测有一定的意义。

Objective To evaluate＇relation between hypoxia, hypoxic changes detected by ^99mTc-HL 91 SPECT and the response to radiotherapy. Methods Thirty-five patients with pathologically proven non-small cell lung cancer（NSCLC） treated by three-dimensional confomml radiotherapy were entered into the study. All patients were examined by examined by ^99mTc-HL 91 SPECT imaging one or two days before radiotherapy. Twenty patients were monitored during radiotherapy（30-40 Gy） and one or two days after radiotherapy. Anterior, posterior and lateral planar images were collected 2 hours, 4 hours and 6 hours after intravenous injection approximately 740 MBq ^99mTc-HL 91 SPECT. Regions of interest（ROIs） were drawn in the tumor and contralateral position and the radioactivity raflus of tumor to nomml（T/N） were calculated. The response to radiotherapy was evaluated by solid tumor＇s effect evaluation criterion （WHO） 3-6 months after radiotherapy. The correlations between T/N before radiotherapy, the T/N changes during radiotherapy and the response to radiotherapy were analyzed. Results The T/N value gradually decreased before, during and after radiotherapy. The average T/N value before, during and after radiotherapy was 1.56±0.19, 1.40±0.12 and 1.29±0.13, respectively（ F= 10.13,P=0.010）. The lower T/N ratio before radiotherapy, the higher the response rate of radiotherapy（ P =0.040）. The larger change of T/N ratio before and after radiotherapy resulted in higher radiotherapy response, but with no statistical significance（ P 〉 0.05）. Conclusions The hypoxia status and hypoxic changes can be observed by HL91 SPECT imaging during radiotherapy which can predict the response to radiotherapy.