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目的对比研究18FDG PET/CT定位三维适形常规分割放疗贲门癌的疗效、副反应及失败原因。方法对46例贲门癌患者采用信封法随机分为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,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组采用普通CT定位设野,三维适形放疗至相同剂量。结果PET/CT组的平均大体肿瘤靶区(GTV)和计划治疗靶区(PTV)体积、左肺、右肺、左肾与右肾V20、胃、心脏、食管与脊髓V40均比普通CT组小(均P<0.05);PET/CT组的局部控制率和1、2、3年生存率均比普通CT组高(均P<0.01);PET/CT组早期气管、食管、胃肠道、肺的1、2级不良反应均低于普通CT组(均P<0.05)。多因素分析表明,年轻、病变长度≤5 cm、病变T分期早是影响预后的主要因素(均P<0.01)。结论 PET/CT定位三维适形放疗贲门癌可以优化放疗计划,减轻正常组织的早期放射不良反应,年轻、病变分期早的患者预后较好。
Objective To compare the curative effect, side effects and failure causes of 18FDG PET / CT in three-dimensional conformal radiotherapy and cardia cancer. Methods Forty-six patients with cardia cancer were randomly divided into three-dimensional conformal radiotherapy (PET / CT group) and PET (three-dimensional conformal radiotherapy 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 and CT images were fused and the target area and important organs were outlined and reconstructed. The treatment plan Routine segmentation of three-dimensional conformal radiotherapy 40 Gy, and then appropriate reduction for the remaining tumor lesions radiotherapy to a total dose of 60 ~ 70 Gy. General CT group using ordinary CT positioning field, three-dimensional conformal radiotherapy to the same dose. Results The average gross tumor target (GTV) and planned target volume (PTV) volume in the PET / CT group were significantly lower than those in the normal CT group in the left lung, right lung, left kidney and right kidney V20, stomach, heart, esophagus and spinal cord (Both P <0.05). The local control rate and the 1, 2 and 3 year survival rates in PET / CT group were higher than those in normal CT group (all P <0.01). The early tracheal, esophageal and gastrointestinal , Grade 1 and 2 lung adverse reactions were lower than the normal CT group (all P <0.05). Multivariate analysis showed that young, lesion length ≤ 5 cm, T stage of the lesion is the main factor affecting the prognosis (all P <0.01). Conclusions PET / CT localization of three-dimensional conformal radiotherapy and cardia cancer can optimize the radiotherapy plan and reduce the early adverse reactions of normal tissue. The prognosis of young patients with early stage of disease is better.