| 邓红彬,巩贯忠,陈进琥,段敬豪,尹勇.18F-FDG PET/CT引导局部晚期非小细胞肺癌靶区剂量提升的可行性研究[J].中华放射医学与防护杂志,2017,37(10):747-751 |
| 18F-FDG PET/CT引导局部晚期非小细胞肺癌靶区剂量提升的可行性研究 |
| The study of the feasibility of dose escalation guided by 18F-FDG PET/CT for high metabolic region in radiotherapy of locally advanced non-small cell lung cancer |
| 投稿时间：2017-04-01 |
| DOI：10.3760/cma.j.issn.0254-5098.2017.10.005 |
| 中文关键词: 剂量提升 非小细胞肺癌 亚区域 18F-FDG PET/CT 放射治疗 |
| 英文关键词:Dose escalation Non-small cell lung cancer Sub-volume 18F-FDG PET/CT Radiotherapy |
| 基金项目:国家自然科学基金（81301936，81472811）；山东省科技发展计划项目（2014GGC03038） |
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| 中文摘要: |
| 目的 研究基于放疗前正电子发射计算机断层显像（PET/CT）的标准摄取值（SUV）梯度引导局部晚期非小细胞肺癌（NSCLC）患者靶向剂量提升的可行性及剂量学特点。方法 收集29例NSCLC患者的放疗前PET/CT图像，在PET/CT图像上勾画大体肿瘤靶区（GTV），以最大SUV值（SUVmax）的50%和75%为阈值将GTV分割为3个代谢活性亚区域，低于50%SUVmax的区域为GTV1，50%SUVmax到75%SUVmax的区域为GTV2，高于75%SUVmax的区域为GTV3。计划靶区（PTV）、PTV1、PTV2、PTV3分别由GTV、GTV1、GTV2及GTV3外放适当边界得到。计划1：在PTV上照射均匀60 Gy处方剂量。计划2：将PTV1、PTV2和PTV3的处方剂量分别设置为60~66 Gy、66~72 Gy和≥72 Gy。比较两种治疗计划靶区和危及器官（OAR）的剂量学差异。结果 相对于计划1，计划2将2%的PTV体积接受的剂量（D2）由66.5 Gy提升至78.5 Gy，剂量提升约20%；PTV的平均剂量提升了8.9%（63.2~68.8 Gy）、PTV1，PTV2、PTV3的平均剂量分别提升了2.8%（62.7~64.4 Gy）、10.3%（63.5~70.0 Gy）、18.7%（63.8~75.8 Gy）。各亚区域剂量均得到有效提升。计划1与计划2 中PTV的60 Gy剂量线靶区覆盖度基本相当，差异无统计学意义（P>0.05），均匀性指数（HI）的差异有统计学意义（t=23.3， P<0.05），计划2中随着最大剂量的提升，HI下降显著。肺、心脏和脊髓的受照剂量在两个治疗计划中基本相当，差异均无统计学意义（P>0.05）。结论 对不同代谢活性梯度实施差异化的放疗剂量，在不增加危及器官辐射剂量的前提下，可对代谢活性高的亚区域进行靶向剂量提升，具有提高肿瘤局部控制的潜能。 |
| 英文摘要: |
| Objective To investigate dose escalation by metabolic sub-volume based on standard uptake values (SUV) gradient of pre-treatment positron emission tomography/computed tomography (PET/CT) for locally advanced non-small cell lung cancer (NSCLC) radiotherapy.Methods The pre-treatment 18F-FDG PET/CT images of 29 patients with locally advanced NSCLC were analyzed retrospectively. Gross tumor volume (GTV) was delineated on the PET/CT fusion images. Tumor metabolic sub-volume was segmented according to the threshold of 50% and 75% maximum standard uptake values (SUVmax). The region that under 50% SUVmax was defined as GTV1. From 50% to 75% SUVmax was defined as GTV2,and over 75% SUVmax was defined as GTV3. PTV (planning target volume), PTV1, PTV2 and PTV3 were extended from GTV, GTV1, GTV2 and GTV3, and different plans were designed subsequently. Plan 1 was designed for PTV with prescription dose 60 Gy, and Plan 2 was designed for PTV1, PTV2 and PTV3 with prescription dose 60-66 Gy, 66-72 Gy and ≥ 72 Gy, respectively. The dosimetric parameters between tumor target and organs at risk (OARs) were compared.Results Compared to Plan 1, the absorbed dose in Plan 2 that covers 2% volume of the PTV (D2) was increased from 66.5 Gy to 78.5 Gy and the dose was escalated by about 23.2%. The average dose of PTV1, PTV2 and PTV3 increased by 2.8% (62.7-64.4 Gy), 10.3% (63.5-70.0 Gy), 18.7% (63.8-75.8 Gy), and the average dose of PTV increased by 8.9% (63.2-68.8 Gy). The sub-regional dose had been effectively improved. There was no significant difference in target coverage between Plan 1 and Plan 2 (P>0.05). Homogeneity index(HI) was decreased with the escalation of maximum dose for Plan 2(t=23.3, P<0.05). There was no statistically significant difference in radiation dose of OARs between two plans(P>0.05).Conclusions Dose escalation based on metabolic sub-volume from 18F-FDG PET/CT was feasible, and radiation dose escalation of sub-volume with high metabolic activity can be achieved without increasing the OARs dose. |
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