PET-CT模拟定位下三维适形放射治疗Ⅲ期非小细胞肺癌的疗效观察

Observation of clinical effect of three-dimensional conformal radiotherapy in the treatment of patients with non-small cell lung cancer at stage Ⅲ analogue positioned by PET-CT

目的探讨PET-CT定位下行三维适形放疗对Ⅲ期非小细胞肺癌的临床疗效和毒副反应。方法 54例ⅢA、ⅢB期NSCLC患者,随机分为PET-CT定位3DCRT组(A)27例和普通CT定位3DCRT组(B)27例,先常规分割3DCRT 40Gy/20次,后缩野瘤灶加量至60～66 Gy,同步予TP方案化疗。结果 A组PET-CT融合图像下GTV平均体积为102.52 cm3,而普通CT图像下GTV平均体积为136.52 cm3,差异有统计学意义(P<0.05)。A、B组总有效率分别为77.8%、62.9%,差异无统计学意义(P>0.05)。两组均未出现Ⅲ、Ⅳ度急性毒副反应,A组急性放射性肺炎、食管炎发生率分别为14.8%、18.5%,明显低于B组的40.7%、55.6%(P<0.05)。A、B组的1、2、3年局部控制率分别为83.2%、62.5%、50.3%和70.1%、58.6%、40.3%,1、2、3年生存率分别为69.5%、32.3%、20.1%和51.3%、27.5%、13.6%,均无统计学意义(P>0.05)。结论 PET-CT定位下3DCRT治疗Ⅲ期NSCLC,能精确指导靶区勾画,降低急性毒副反应。

Objective To observe the clinical efficacy and acute toxic effect of three-dimensional conformal radiotherapy in the treatment of patients with non-small cell lung cancer at stage Ⅲ analogue positioned by PET-CT. Methods 54 NSCLC patients at stage m A and In B were randomly divided into two groups ： the group A positioned by PET-CT （ n = 27 ） and the group B positioned by conventional CT （n = 27 ）. All patients were conventional fractionated by 3DCRT （DT40 Gy/20fx）, followed by field-shrunk radiotherapy to a total dose of 60 - 66Gy. Both groups received concurrent TP chemotherapy. Results The average volume of GTV was 102.52 cm3 in the group A and 136. 52 cm3 in the group B with significant statistical difference （ P 〈 0. 05 ）. The total effective rate was 77.8% and 62.9% respectively in the group A and B （ P 〉 0.05 ）. Neither groups had the Ⅲ and IV degree acute toxic effect. The incidence of acute radiation pneumonitis and radiation esophagitis was 14. 8% and 18.5% respectively in the group A, which was obviously lower than those in the group B （40. 7% and 55.6% ） （ P 〈 0. 05 ）. The local control rates of the 1 st, 2nd, and 3rd years were 83.2% , 62. 5% , and 50. 3 % in the group A and 70. 1%, 58.6%, and 40. 3 % in the group B. The survival rates of the 1 st, 2nd, and 3 rd years were 69.5 %, 32.3%, and20.1% inthegroup Aand51.3%, 27.5%, and 13.6% in the group B （P〉0. 05）. Conclusion Three-dimensional conformal radiotherapy positioned by PET-CT can accurately delineate target volume and reduce the acute toxic effect in the treatment of patients with non-small cell lung cancer at stage Ⅲ.