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目的探讨鼻咽癌放疗后复发采用18FDG PET-CT定位再程三维适形放疗的疗效、不良反应及失败原因。方法对56例鼻咽癌放疗后复发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),每组各28例。PET-CT组采用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(大体肿瘤体积和计划靶体积)和重要脏器勾画、三维重建,制定治疗计划后常规分割三维适形放疗40 Gy左右,然后适当缩野放疗至总剂量50～60Gy。普通CT组采用普通CT定位设野,三维适形放疗至相同剂量。两组放疗后均用TP方案(紫杉醇135～175mg/m2,d1;顺铂40mg,d2～4)辅助化疗4～6周期。结果 PET-CT组大体肿瘤体积和计划靶体积均小于普通CT组,两者差异有统计学意义(均P<0.05)。PET-CT组再次局部复发17例,中位复发时间11.7个月,普通CT组再次局部复发19例,中位复发时间10.3个月,两者差异有统计学意义(P<0.01)。多因素分析表明,在年龄、性别、卡氏评分、T分期和疗前大体肿瘤体积等因素中,只有T分期和疗前大体肿瘤体积是独立的预后因子,T分期早和疗前大体肿瘤体积≤100cm3者预后好,P值均<0.01。结论鼻咽癌放疗后复发用PET-CT定位三维适形再程放疗可以优化放疗计划,延长中位复发时间,分期早的病变预后好。
Objective To investigate the curative effect, adverse reactions and causes of failure of nasopharyngeal carcinoma (NPC) treated with 18FDG PET-CT after radiotherapy and relapse. Methods Fifty-six patients with recurrent nasopharyngeal carcinoma after radiotherapy were randomly divided into three-dimensional conformal radiotherapy group (PET-CT group) and conventional CT stereotactic radiotherapy group (normal CT group) by 18FDG PET-CT. Each group 28 cases each. The PET-CT group was scanned by PET-CT. 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 (gross tumor volume and planned target volume) and vital organs were outlined , Three-dimensional reconstruction, the treatment plan after the conventional segmentation of three-dimensional conformal radiotherapy about 40 Gy, and then appropriate shrinkage radiotherapy to a total dose of 50 ~ 60Gy. General CT group using ordinary CT positioning field, three-dimensional conformal radiotherapy to the same dose. After the two groups were treated with TP TP regimen (paclitaxel 135 ~ 175mg / m2, d1; cisplatin 40mg, d2 ~ 4) adjuvant chemotherapy 4 to 6 cycles. Results The gross tumor volume and planned target volume in PET-CT group were less than those in normal CT group, both of which had statistical significance (all P <0.05). In the PET-CT group, there were 17 cases with local recurrence, with a median recurrence time of 11.7 months. There were 19 cases of recurrence in the CT group and 10.3 months in the CT group. The difference was statistically significant (P <0.01). Multivariate analysis showed that among the factors of age, sex, Karnofsky score, T-staging, and general tumor volume before treatment, only T-stage and pre-treatment gross tumor volume were independent prognostic factors. T-staging was earlier and pretreatment gross tumor volume ≤ 100cm3 good prognosis, P values were <0.01. Conclusions The recurrence of nasopharyngeal carcinoma after radiotherapy with PET-CT positioning three-dimensional conformal reradiation can optimize the radiotherapy plan to extend the median recurrence time, early stage of the disease prognosis is good.