| 王中堂,李宝生,孙洪福,方永存,陈进琥,闫婧.肺灌注显像在Ⅲ期非小细胞肺癌调强放疗中对功能肺的保护[J].中华放射医学与防护杂志,2008,28(5):471-474 |
| 肺灌注显像在Ⅲ期非小细胞肺癌调强放疗中对功能肺的保护 |
| Using SPECT-guidance to protect functional lung with optimizing intensity modulated radiotherapy in stage Ⅲ non-small cell lung cancer patients |
| 投稿时间：2008-05-08 |
| DOI： |
| 中文关键词: 非小细胞肺癌 调强放疗 放射性核素显像 肺灌注 |
| 英文关键词:Non-small cell lung cancer Intensity-modulated radiotherapy Single photon emission computed tomography Lung perfusion |
| 基金项目: |
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| 中文摘要: |
| 目的 探讨肺灌注显像在Ⅲ期非小细胞肺癌(NSCLC)调强放疗(IMRT)保护功能肺的可行性。方法 选择拟行放疗的Ⅲ期NSCLC患者24例,分别行PET-CT和SPECT定位,图像传至治疗计划系统进行图像融合。根据SPECT图像确定功能肺(FL)和非功能肺(NFL),FL是指放射性计数为最大放射性计数的30%以上(包括30%)的区域,其他区域为NFL。肺灌注受损分为4级:0级,无灌注受损;1级,肿瘤及其周围局部肺灌注受损;2级,达1叶肺灌注受损;3级,超过1叶肺灌注受损。根据SPECT图像提供的肺功能信息制定IMRT计划进行优化,尽可能降低FL的照射体积剂量。采用配对t检验统计分析优化前后的IMRT计划的肺组织剂量参数变化。结果 患者均有不同程度的肺灌注缺损,其中肺灌注受损1级8例,2级6例,3级10例。根据SPECT提供的肺功能信息优化IMRT计划后WLV和FLV均有不同程度降低,而FLV降低程度更加明显。优化后WLV10、WLV15、WLV20、WLV25、WLV30和FLV10、FLV15、FLV20、FLV25、FLV30差异有统计学意义。结论 根据SPECT图像提供的肺功能信息优化IMRT计划以保护Ⅲ期NSCLC功能肺是可行的。 |
| 英文摘要: |
| Objective To explore the possibility of using lung perfusion single photon emission computed tomography (SPECT) scans to protect functional lung with optimizing intensity modulated radiotherapy (IMRT) plan in patients with stage Ⅲ non-small cell lung cancer(NSCLC). Methods Twenty_four patients with stage Ⅲ NSCLC who were candidated for radiotherapy were enrolled. All patients had PET-CT scans and SPECT scans. The two sets of images were accurately co-registered in the planning system. SPECT images were used to define a volume of functional lung (FL) and non-functional lung (NFL). The region of ≥30% maximum radioactive counts was FL and the other region was NFL. Then SPECT images were classified by comparing lung perfusion deficit with area of radiological abnormality. Grade 0: no lung perfusion deficit. Grade 1: the size of radiological abnormality was similar to the area of lung perfusion deficit. Grade 2: the area of lung perfusion was bigger than that of radiological abnormality, and extended to 1 pulmonary lobe. Grade 3: the area of lung perfusion deficit exceed 1 pulmonary lobe. The optimized IMRT objective was to minimize the dose to FL. the difference between the two sets of IMRT plans was studied. Results All patients had lung perfusion deficits, 8 patients with grade 1 damage, 6 patients with grade 2 damage, and 10 patient with grade 3 damage. After IMRT plan optimized, both the percentage of whole lung volume received dose (WLV) and the percentage of functional lung volume received dose (FLV) were decreased. However, the FLVs was decreased more significantly. There was significant difference in WLV10, WLV15, WLV20, WLV25, WLV30 and FLV10, FLV15, FLV20, FLV25, FLV30 between the two sets of IMRT plans(P<0.05). Conclusions It is conrenient to SPECT-guidance to protect functional lung with optimizing IMRT in stage Ⅲ NSCLC patients, potentially reducing lung toxicity. |
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