术后复发性食管癌^(18)FDG PET/CT定位三维适形放疗的疗效分析

Result of ^(18)FDG PET/CT positioning three-dimensional conformal radiotherapy for recurrent esophageal carcinoma

目的:对比研究18FDG PET/CT定位三维适形常规分割放疗术后复发性食管癌的疗效、副反应及失败原因。方法:对58例术后复发性食管鳞癌患者用信封法随机分为18 FDG 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40Gy左右,然后适当缩野针对残存肿瘤病灶放疗至总剂量60Gy-70Gy;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与PTV体积、左肺、右肺、心脏、胸胃、脊髓照射体积均比普通CT组小(P均<0.05);PET/CT组和普通CT组的1、2、3年生存率分别为93.0%、59.9%、20.4%和86.7%、54.6%、20.9%(P均<0.01);PET/CT组早期气管、食管、胃肠道、肺的1、2级副反应均低于普通CT组(P均<0.05);卡氏评分高、进食情况良好、病变长度≤5cm、标准摄入值低的病变预后较好。结论:PET/CT定位三维适形放疗术后复发性食管癌可以优化放疗计划,减轻正常组织的放射副反应,早期病变预后好。

Objective： To analyse the result of 18^FDG PET/CT positioning three-dimensional conformal radiotherapy（3DCRT） for recurrent esophageal carcinoma.Methods： Fifty eight cases of recurrent esophageal squamous cell carcinoma patients were randomly divided into 18^FDG PET/CT positioning 3DCRT group（PET/CT group）and the general CT dimensional conformal radiotherapy group（normal CT group）.The location of PET/CT group＇s cases was determined by PET/CT and the date was transmitted to the treatment planning system（TPS）,the PET image and CT image were fused together;Target volume and critical organs were determined and the treatment plan was worked out by the fused image,then conventional fraction＇s 3DCRT（40Gy or so） was followed to a total dose of radiotherapy 60Gy-70Gy by reduced radiation field.The location of normal CT group＇s cases was determined by normal CT and the date was transmitted to the TPS and were treated by 3DCRT to the same dose.Results： The average GTV＇s and PTV volume,left lung and right lung irradiated volume,heart irradiated volume,thoracostomach irradiated volume,spinal cord irradiated volume of the PET/CT group were smaller than that of the normal CT group（all P〈0.05）;The 1,2,3-year survival rates of PET/CT group and normal CT group were 93.0%,59.9%,20.4% and 86.7%,54.6%,20.9% respectively（all P〈0.01）;The early trachea,esophagus and lung 1,2-grade adverse reactions of the PET/CT group were lower than that of normal CT group（P〈0.05）.Multivariate analysis showed that Karnofsky high score,eating well,lesion length ≤ 5cm,low standard uptake value of the lesion were with good prognosis.Conclusion： PET/CT positioning 3DCRT for recurrence of esophageal carcinoma can optimize the radiation treatment planning,reduce the early radiation side-effects of normal tissue,early type have better prognosis than that of others.