PET-CT引导在放射性粒子植入治疗肺癌中的价值

Evaluation of radioactive seeds implantation under PET-CT guidance for the treatment of central lung cancer with obstructive atelectasis

目的探讨PET-CT引导靶区定位技术,在经皮穿刺种植放射性125Ⅰ粒子治疗中心型肺癌并发阻塞性肺不张中的应用价值。方法选择30例术前胸部X线检查可疑为中心型肺癌导致阻塞性肺不张,但不能分辨肺不张和肿瘤边界的患者,行胸部CT检查仍无法区别者,行PET-CT检查。确定肿瘤靶区后,在行PET-CT引导下经皮穿刺植入放射性125Ⅰ粒子。结果 21例经PET-CT检查可以清晰显示肿块与肺不张的界限,肿瘤靶区体积平均约为26cm3,行粒子植入。而CT检查的靶区体积平均约为37cm3。粒子植入后6个月复查胸CT显示有效率为93.0%(28/30)。1年生存率100%。粒子植入并发气胸9例(30%),少量咯血13例(43.3%),发热2例。无粒子移位、游走。结论 PET-CT对于确定中心型肺癌并发阻塞性肺不张的肿瘤靶区方面的价值明显优于CT检查,有利于放射性粒子植入治疗。

Objective To evaluate percutaneous puncturing 125Ⅰ seed implantation by using PET-CT guided target localization technique in treating central lung cancer complicated by obstructive pulmonary atelectasis. Methods A total of 30 patients with suspected central lung cancer complicated by obstructive pulmonary atelectasis on preoperative chest films were enrolled in this study. As no clear distinction existed between the tumor and the atelectatic consolidation shadow on plain chest films, CT scanning was carried out in all patients. If CT scan was still not able to determine the margin of the tumor, an additional PET-CT scanning was adopted. After ascertaining the location of the lung cancer, percutaneous puncturing implantation of 125Ⅰ seeds under PET-CT guidance was performed. The clinical data and the therapeutic results were evaluated. Results A sharp distinction between the tumor and the atelectatic consolidation shadow was demonstrated on PET-CT scans in 21 cases. The mean volume of the targeted lesion reckoned from PET-CT scans was 26 cm^3, and the 125Ⅰ seeds were implanted. The mean volume of the targeted lesion calculated on CT scans was 37 cm^3. Six months after the treatment, the follow-up CT exam showed that the effective rate was 93% （28 / 30）. The one-year survival rate was 100% . The complications included pneumothorax （n = 8）, small amount of hemoptysis （n = 12） and fever （n = 2）. No displacement or immigration of the implanted seeds occurred. Conclusion PET-CT scanning is far superior to conventional CT scanning in determining the target area of the tumor in patients with central lung cancer complicated by obstructive pulmonary atelectasis.