鼻咽癌乏氧程度与放疗中期肿瘤退缩关系的初步研究

The relationship between tumor regression degree and its hypoxia degree in patients with nasopharyngeal carcinoma

目的探讨4，9-二氮-3，3，10，10-四甲基十二烷-2，11-二酮肟（^99mTc-HL91）乏氧显像评价鼻咽癌病灶的乏氧程度与放疗中期肿瘤退缩程度的关系。方法对接受根治性、连续性放疗的34例Ⅱ～Ⅳa期鼻咽癌初治患者在放疗前一周内进行头颈部^99mTc—HL91 SPECT及同机CT图像融合，分别计算原发病灶和颈淋巴结转移灶与大脑、颈部肌肉的平均放射性活度比值和测量放疗中期鼻咽癌原发病灶与颈部转移淋巴结的退缩程度。结果①乏氧阳性鼻咽癌病灶直径[（1．70±0．68）cm]与原发病灶／颈部肌肉和原发病灶／大脑的放射性比值呈正相关，相关系数分别为0．607和0．640，P值分别为0．001和0．000。②放疗中期鼻咽癌原发肿瘤退缩程度Ⅰ级和Ⅲ级的原发病灶／颈部肌肉和原发病灶／大脑的放射性比值差异有显著性，P值分别为0．001、0.004，Ⅰ级与Ⅱ级、Ⅱ级与Ⅲ级比值无显著性差异；放疗中期鼻咽癌原发灶退缩程度与原发病灶／颈部肌肉和原发病灶／大脑的放射性比值呈负相关，相关系数分别为-0．602和-0．643，P〈0．01。③^99mTc-HL91乏氧显像检出颈部转移淋巴结28处，淋巴结转移灶／颈部肌肉和淋巴结转移灶／大脑的放射性比值与其大小、中期放疗退缩程度无明显的线性趋势。结论鼻咽癌病灶越大，其乏氧程度越高，中期放疗退缩越小；颈部转移淋巴结乏氧程度与其直径、放疗中期退缩程度无明显关系。

Objectives To investigate the relationship between nasopharyngeal carcinoma hypoxia degree evaluated by imaging of the marker （99m）technetium -labeled 4, 9-diaza-3, 3, 10, 10 - tetramethyldodecan- 2,11-dione dioxime （^99mTc-HL91） and tumor regression in medium-term radiotherapy. Methods 34 patients with nasopharyngeal carcinoma staging from Ⅱ - Ⅳa underwent ^99mTc-HL91 SPECT imaging, integrated CT scan and its image fusion one week before receiving radical and continuous radiotherapy. Tumor/muscle, tumor /cerebra of the nasopharyngeal carcinoma and lymph node/muscle, lymph node/cerebra of the neck lymph node metastases were calculated, and lesion regression degree was measured in medium-term radiotherapy. Results （1）The diameter of nasopharyngeal carcinoma with positive hypoxia imaging was （1.70± 0.68）cm. There was a positive relationship with tumor/muscle and tumor/cerebra （ r was 0.607 and 0.640, P was 0.001 and 0.000）. （2） There was significant difference between tumor/muscle and tumor/cerebra （ P was 0.004 and 0.001 ） of nasopharyngeal carcinoma with grade Ⅰ and grade Ⅲ regression. The regression degree of nasopharyngeal carcinoma in medium-term radiotherapy was negative correlated to the hypoxic degree （tumor/muscle ： r = -0.602; tumor/cerebra： r =-0.643, P〈0.01）. （3）^99mTc-HL91 imaging detected 28 neck metastasis lymph nodes. There was no significant line trend between lymph node/muscle, lymph node/cerebra of lymph node metastases and its size, lesion regression degree in medium-term radiotherapy. Conclusions The larger the nasopharyngeal carcinoma, the higher the hypoxia degree of lesion, and the less regression in medium-term radiotherapy. There was no significant relationship between hypoxia of neck lymph node metastases and its size and medium-term regression.