局限期小细胞肺癌PET-CT定位适形放疗联合化疗的疗效分析

Efficacy analysis of PET-CT positioning three-dimensional conformal radiotherapy for limited small cell lung cancer

目的探讨局限期小细胞肺癌PET-CT定位适形放疗联合化疗的疗效。方法回顾性分析局限期小细胞肺癌58例,其中28例经PET-CT扫描(PET-CT组),30例采用普通CT定位(普通CT组),所有患者均用相同剂量适形放疗联合EP方案化疗,观察两组患者的疗效、不良反应及失败原因。结果 PET-CT组的平均GTV与PTV体积均小于普通CT组,PET-CT组的左肺与右肺V20、心脏、食管与脊髓V40均小于普通CT组(P<0.05)。两组近期总有效率差异无统计学意义(P>0.05)。PET-CT组中,1、2级肺和气管的早期与晚期放射损伤发生率低于普通CT组(P均<0.05)。PET-CT组的1、2、3年局部控制率和生存率均高于普通CT组(P<0.01)。PET-CT组纵膈淋巴结复发率低于普通CT组,放化疗后手术切除残存病灶者预后好。治疗失败的主要原因为远处转移。结论PET-CT定位可以优化局限期小细胞肺癌的放疗设野计划,减少正常组织的照射体积与纵膈复发率,放化疗后手术切除残存病灶预后好,远处转移为主要失败原因。

Objective To analyze efficacy of PET-CT positioning three-dimensional conformal ra- diotherapy for limited small cell lung cancer. Methods 58 cases with limited small cell lung cancer were analyzed retrospectively. 28 cases were determined by PET-CT （ the PET-CT group）, and 30 cases by CT （CT group）. Both groups were treated by three-dimensional conformal radiation therapy with same dose and the EP program. Clinical efficacy, adverse reactions and failure reasons were observed. Results The aver- age GTV and PTV volume of the PET-CT group was smaller than those of the CT group, the left lung and right lung V20,heart,esophagus and spinal cord V40 of the PET-CT group was smaller than those of the CT group （ P 〈 0. 05 ） ; The short-term total effective rate of the two groups was not statistically significant （ P 〉 0.05） ;The 1,2-grade early and late radiation injury rate of the lung and trachea of the PET-CT group was lower than that of the CT group （ P 〈 0.05 ） ; The 1,2,3-year local control rates and survival rates of the PET-CT group were higher than those of the CT group （P 〈 0.01 ） ;The mediastinal lymph node recurrence rate of the PET-CT group was lower than that of the CT group, the prognosis of post-chemotherapy residual tumor resection was satisfying;The main reason for treatment failure was distant metastasis. Conclusion Using PET-CT to determine the target of limited small cell lung cancer can improve the radiation treatment plan, reduce the recurrence rate of mediastinal, the prognosis of post-chemotherapy residual tumor resection is good;Distant metastasis is the main reason for failure.