论文部分内容阅读
目的对比研究PET/CT定位三维适形常规分割放疗胰腺癌的疗效、副反应及失败原因。方法对48例胰腺癌患者用信封法随机分为18FDG 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(GTV与PTV)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40 Gy左右,然后适当缩野针对残存肿瘤病灶放疗至总剂量60~70 Gy;普通CT组用普通CT定位设野,三维适形放疗至相同剂量;两组疗中、疗后均配合口服卡莫氟治疗。结果 PET/CT组的平均GTV和PTV体积分别比普通CT组小(3.8±2.6)cm3和(53.2±16.4)cm3,胃、肝、左肾、右肾、脊髓平均照射体积分别比普通CT组小(1.3±2.7)cm3、(1.0±1.5)cm3、(0.9±1.7)cm3、(1.0±1.4)cm3、(0.7±1.5)cm3,两者差异均有显著性(P<0.05);两组近期疗效相近,差异无显著性(P>0.05);随访5~37个月,PET/CT组中位复发时间6.8个月,普通CT组中位复发时间6.5个月,两者差异无显著性(t=0.96,P=0.345);PET/CT组和普通CT组1,2,3年生存率分别为12.5%、12.5%、4.2%和16.7%、8.3%、4.2%,两者差异无显著性(χ2=0.041,P=0.840);PET/CT组早期胃肠道反应低于普通CT组(P<0.05);多因素分析表明,T分期和疗前GTV是独立的预后因子(P<0.01)。结论 PET/CT定位三维适形放疗胰腺癌可以优化放疗计划,减轻正常组织的早期放射副反应,分期早的病变预后好。
Objective To compare the curative effect, side effects and failure causes of PET / CT in three-dimensional conformal radiotherapy for pancreatic cancer. Methods Forty-eight patients with pancreatic cancer were randomly divided into three-dimensional conformal radiotherapy (PET / CT) group with 18FDG PET / CT and three-dimensional conformal radiotherapy group with CT (conventional CT group). The PET / CT scan was performed with PET / CT scanning. After the PET / CT scan, the scan data was input into the treatment planning system. The PET images and CT images were fused and the target areas (GTV and PTV) and important organs were outlined and reconstructed. After the treatment plan was established, the conventional three-dimensional conformal radiotherapy of about 40 Gy was performed, and then the appropriate tumor was radiated to the total dose of 60-70 Gy. The common CT group was treated with common CT and the three-dimensional conformal radiotherapy to the same dose. Two groups of treatment, after treatment with oral carbofuran treatment. Results The mean volumes of GTV and PTV in the PET / CT group were (3.8 ± 2.6) cm3 and (53.2 ± 16.4) cm3 respectively, and those in the stomach, liver, left kidney, right kidney and spinal cord were respectively smaller than those in the normal CT group (1.3 ± 2.7) cm3, (1.0 ± 1.5) cm3, (0.9 ± 1.7) cm3, (1.0 ± 1.4) cm3 and (0.7 ± 1.5) cm3, respectively; There was no significant difference between the two groups (P> 0.05). After a median follow-up of 5 to 37 months, the median time to recurrence was 6.8 months in the PET / CT group and 6.5 months in the CT group (T = 0.96, P = 0.345). The 1, 2, 3 year survival rates of PET / CT group and conventional CT group were 12.5%, 12.5%, 4.2% and 16.7%, 8.3% and 4.2% (Χ2 = 0.041, P = 0.840). The early gastrointestinal reaction in PET / CT group was lower than that in CT group (P <0.05). Multivariate analysis showed that T stage and pretreatment GTV were independent prognostic factors P <0.01). Conclusion PET / CT mapping of three-dimensional conformal radiotherapy of pancreatic cancer can optimize the radiotherapy plan and reduce the early radioactive side effects of normal tissue, and the prognosis of early stage staging is good.