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目的探讨~(18)F-FDG PET/CT在晚期非小细胞肺癌(NSCLC)三维适形放疗(3DCRT)的靶区勾画中的价值及对短期疗效评价和1年生存率的影响。方法将56例NSCLC临床Ⅲ期的患者分为PET/CT引导定位组(PET/CT组,26例)和普通CT定位组(CT组30例)。PET/CT组将PET和CT图像融合后进行靶区和重要脏器勾画,制定治疗计划后进行相应3DCRT治疗。CT组用普通CT定位,治疗同上。所有病例均用TP方案辅助化疗6个周期。结果随访率100%。随访满1年者共计39例,PET-CT组和CT组分别为19和20例。治疗计划显示应用PET/CT勾画大体肿瘤体积(GTV)与计划靶区体积(PTV)均小于CT勾画的靶区(t=3.712,P<0.05;t=9.430,P<0.05)。PET//CT组和CT组短期疗效有效率分别为80.7%vs.70.0%(P=0.537),1年局部控制率分别为69.2%vs.56.7%(P=0.412),1年生存率分别为73.1%vs.66.7%(P=0.772)。PET-CT组肺门、纵隔淋巴结复发率(1年内)低于CT组,分别为11.5%vs.36.7%(P=0.036);治疗失败主要原因均为远处转移,分别为42.3%vs.53.3%(P=0.436)。结论与CT相比,PET/CT引导定位可以优化晚期NSCLC放疗设野计划,略微提高短期疗效,明显降低肺门、纵隔淋巴结复发率,而1年期生存率无明显提高。
Objective To investigate the value of ~ (18) F-FDG PET / CT in delineating the target volume of 3DCRT in patients with advanced non-small cell lung cancer (NSCLC) and to evaluate the short-term efficacy and 1-year survival rate. Methods Fifty-six patients with stage Ⅲ NSCLC were divided into PET / CT group (26 cases) and CT group (30 cases). PET / CT group will be PET and CT image fusion target area and important organs outlined, the treatment plan developed after the corresponding 3DCRT treatment. CT group with ordinary CT positioning, treatment ibid. TP cases in all cases were adjuvant chemotherapy for 6 cycles. Results The follow-up rate was 100%. A total of 39 cases were followed up for 1 year, 19 and 20 cases were PET-CT group and CT group respectively. The treatment plans showed that the gross tumor volume (GTV) and projected target volume (PTV) were less than those of CT sketched by PET / CT (t = 3.712, P <0.05; t = 9.430, P <0.05). The short-term effective rates of PET // CT group and CT group were 80.7% vs.70.0% (P = 0.537), respectively. The 1-year local control rates were 69.2% vs.56.7% (P = 0.412) 73.1% vs.66.7% (P = 0.772). The recurrence rates of hilar and mediastinal lymph nodes in PET-CT group were lower than those in CT group (11.5% vs.36.7%, P = 0.036 respectively). The main reasons for the failure were distant metastasis, which were 42.3% vs. 53.3% (P = 0.436). Conclusion Compared with CT, PET / CT guided positioning can optimize the radiotherapy field planning for advanced NSCLC, slightly improve the short-term curative effect, significantly reduce the recurrence rate of hilar and mediastinal lymph nodes, but the 1-year survival rate did not increase significantly.