非小细胞肺癌PET-CT定位调强放射治疗的临床研究

A clinical research on PET-CT positioned IMRT for NSCLC

目的 评价PET-CT定位调强放射治疗（IMRT）对非小细胞肺癌（NSCLC）靶区勾画、近期疗效及急性毒副反应的影响.方法 ⅢA、ⅢB期NSCLC患者46例,其中行PET-CT定位IMRT 23例（A组）、行CT定位三维适形放疗（3D-CRT）23例（B组）.2组均采用6 MV-X线：A组,临床靶区（CTV）50 Gy/28次/38～40天（1.8 Gy/次）,肿瘤区（GTV） 64.4 Gy/28次/38～40天（2.3 Gy/次）; B组,CTV 50 Gy/25次/35～37天（2.0 Gy/次）,后缩野至GTV 14 Gy/7次/9～11天（2.0 Gy/次）.2组均同步TP方案化疗.放化疗2个月后复查CT,比较2组近期疗效及急性毒副反应的差异.结果 ①A组PET-CT融合图像下GTV平均体积为103.69 cm3,CT图像下GTV平均体积为132.64 cm3,差异有统计学意义（P〈0.05）.②A组近期有效率为78.3%,B组近期有效率为65.2%,2组间差异无统计学意义 （P〉0.05）.③2组均未出现Ⅳ度急性毒副反应.A组急性放射性肺炎、放射性食管炎发生率分别为13.0%、21.7%,明显低于B组的39.0%、56.5%（P＜0.05）.结论 PET-CT定位IMRT治疗NSCLC能精确指导靶区勾画,减少GTV体积,降低急性毒副反应.

Objective To evaluate the influence of positron emission tomography - computed tomography （ PET - CT） positioned intensity- modulated radiation therapy （IMRT） on nonsmall cell lung cancer （NSCLC） in target volume delineation, short term effect and acute toxic and side effect. Methods 46 Ⅲ A and Ⅲ B NSCLC patients were selected. Group A （ n = 23 ） were treated by PET - CT positioned IMRT, group B （ n = 23 ） were treated by CT positioned three -dimensional conformal radiotherapy （3D -CRT）. 6 MV- X ray was adopted in both groups. Group A was given clinical target volume （ CTV ） ： 50 Gy/28 f/38 - 40 d （ 1.8 Gy per fraction） and simultaneously gross traget volume （GTV） ： 64.4 Gy/28 f/38 -40 d （2.3 Gy per fraction）. Group B was first given CTV： 50 Gy/25 f/35 -37 d （2.0 Gy per fraction）, and then GTV： 14 Gy/7 f/9 -11 d （2.0 Gy per fraction）. Both groups received concurrent TP chemo- therapy. After 2 months＇ radiotherapy, the condition of the tumor was evaluated by CT. The short term effect and acute toxic and side effect between the 2 groups were compared. Results （~Group A ： The average GTV based on PET - CT image fusion was 103.69 cm3 , while the average GTV based on CT image was 132.64 cm3 , with significant statistical difference （P 〈 0.05 ）. （2）The short term effect was 78.3% in group A and 65.2% in group B, with no statistical differ- ence （ P 〉 0.05 ）. （3） Neither groups had IV - degree acute toxic and side effect. The incidences of acute radiation pneu- monitis and radiation esophagitis in group A （ 13.0%, 21.7% ） were lower than those in group B （39.0%, 56.5% ） （P 〈 0.05 ）. Conclusion The scheme of PET - CT positioned IMRT on NSCLC can delineate targ：et volume accurately, reduce GTV and cut down the acute toxic and side effect.