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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食管癌的疗效、副反应及失败原因。方法对60例食管鳞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。结果 PET/CT组的平均GTV体积、左肺照射体积、右肺照射体积、脊髓照射体积分别比普通CT组小(5.1±1.1)cm3、(27.7±24.6)cm3、(27.9±42.3)cm3、(0.4±0.4)cm3,两者差异均有显著性(P均<0.01);随访8～37个月,PET/CT组和普通CT组1,2,3年局部控制率分别为70.0%、56.7%、43.3%和66.7%、53.3%、36.7%,两者差异无显著性(χ2=0.65,P=0.421);PET/CT组的中位复发时间10.4个月,普通CT组的中位复发时间11.0个月,两者差异无显著性(t=0.41,P=0.682);PET/CT组和普通CT组1,2,3年生存率分别为76.7%、60.0%、46.7%和73.3%、56.7%、36.7%,两者差异无显著性(χ2=1.37,P=0.244);PET/CT组早期气管、食管、肺的Ⅰ、Ⅱ级副反应低于普通CT组(P均<0.05);晚期放射反应相近,两组差异无显著性。多因素分析表明,在年龄、性别、病变长度和部位等因素中,病变位于胸上段、髓质型和蕈伞型、病变长度≤5 cm、无淋巴结转移、T早分期病变预后较好(P均<0.01)。结论 PET/CT定位三维适形放疗食管癌可以优化放疗计划,减轻正常组织的早期放射副反应,胸上段以及髓质型或蕈伞型的早期病变预后好。
Objective To compare the curative effect, side effects and failure causes of 18FDG PET / CT in three-dimensional conformal radiotherapy for esophageal cancer. Methods Sixty esophageal squamous cell carcinoma patients were randomly divided into three-dimensional conformal radiotherapy group (PET / CT group) and conventional CT stereotactic radiotherapy group (conventional CT group) by 18FDG PET / CT. 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 image and the CT image were fused and the target area and important organs were outlined and reconstructed. The treatment plan was made Conventional three-dimensional conformal radiotherapy 40 Gy conformal radiotherapy, and then appropriate shrinkage for the residual tumor lesions radiotherapy to a total dose of 60 ~ 70 Gy; ordinary CT group using ordinary CT positioning field, three-dimensional conformal radiotherapy to the same dose. Results The mean GTV volume, left lung volume, right lung volume and spinal cord volume in PET / CT group were (5.1 ± 1.1) cm3, (27.7 ± 24.6) cm3, (27.9 ± 42.3) cm3, (0.4 ± 0.4) cm3, respectively (all P <0.01). After 8 to 37 months of follow-up, the local control rates at 1, 2 and 3 years in PET / CT group and normal CT group were 70.0% 56.7%, 43.3% and 66.7%, 53.3% and 36.7%, respectively (χ2 = 0.65, P = 0.421). The median time to recurrence in PET / CT group was 10.4 months The 1-year, 2-year and 3-year survival rates were 76.7%, 60.0%, 46.7% and 73.3% respectively in the PET / CT group and the conventional CT group, with a mean of 11.0 months of recurrence (t = 0.41, P = 0.682) %, 56.7% and 36.7%, respectively (χ2 = 1.37, P = 0.244). The grade Ⅰ and Ⅱ side effects of early tracheal, esophageal and pulmonary in PET / CT group were lower than those in normal CT group (P < 0.05). The late radiation reaction was similar with no significant difference between the two groups. Multivariate analysis showed that the lesions were located in the upper thoracic segment, medulla oblongata and mycotoxins in the age, gender, length of lesion and other factors, the length of the lesion was ≤5 cm, no lymph node metastasis, and the prognosis of early stage T was better (P All <0.01). Conclusions PET / CT localization of three-dimensional conformal radiotherapy for esophageal cancer can optimize the radiotherapy plan and reduce the early radioactive side effects of normal tissues. The prognosis of upper thoracic and medullary or muscarinic early lesions is good.