SPECT肺灌注显像优化肺癌放疗计划对肺功能保护价值的研究

Study of the value of SPECT lung perfusion imaging in optimizing lung cancer radiotherapy plan for lung function protection

目的探讨SPECT肺灌注显像在Ⅲ期不可切除非小细胞肺癌放疗中指导放疗路径、优化放疗计划及保护肺功能方面的应用价值。方法本研究纳入84例Ⅲ期不可切除非小细胞肺癌患者,随机分为对照组(44例)及观察组(40例)。对照组依据常规CT图像制定放疗计划,观察组依据常规CT及SPECT肺灌注显像提示的肺功能信息制定P1、P2计划,但最终均按P2计划进行治疗。比较两组患者放射性肺炎发生率、放疗前后肺功能变化,并对比观察组P1、P2计划的剂量体积参数情况。结果计划优化后观察组放射性肺炎发生率降低,肺功能下降情况得以改善(均P≤0.001);P2计划在功能剂量参数上有明显改善(P<0.05),且危及器官受量变化不大(P>0.05)。结论SPECT肺灌注显像优化调强放疗计划能够在不增加其他危及器官受量条件下,降低功能肺受量,提高肿瘤放疗剂量,对患者的肺功能有保护作用。

Objective To evaluate the application value of SPECT lung perfusion imaging in guiding radiotherapy path,optimizing the radiotherapy plan for lung cancer and protecting lung function during radiotherapy for locally advanced non-small cell lung cancer.Methods In this study,84 patients with stageⅢnon-resectable non-small cell lung cancer were randomly divided into the control group(n=44)and observation group(n=40).In the control group,radiotherapy plan based on conventional CT images was delivered,and two plans based on the lung function information suggested by conventional CT and SPECT lung perfusion imaging:P1 and P2 were given in the observation group.All patients in the observation group were finally treated according to the P2 plan.The incidence of radiation pneumonitis,and changes in lung function before and after radiotherapy were statistically compared between two groups.The dose-volume parameters of P1 and P2 were statistically compared.Results After the plan was optimized,the incidence of radiation pneumonitis in the observation group was significantly reduced and the decline of lung function was significantly improved(bothP≤0.001).The functional dose parameters were significantly improved in the P2 plans(bothP<0.05),whereas the irradiation dose of organs at risk did not significantly change(P>0.05).Conclusion SPECT lung perfusion imaging optimizes the intensity-modulated radiotherapy plan,which can reduce the functional lung dose and increase the tumor radiotherapy dose without increasing the irradiation dose of other organs at risk.