| 丁博月,王澜,韩春,刘丽虹,任雪姣,许立昂,刘树堂.磁共振在食管癌原发灶放化疗近期疗效评价中的应用[J].中华放射医学与防护杂志,2018,38(10):741-746 |
| 磁共振在食管癌原发灶放化疗近期疗效评价中的应用 |
| The investigation of using diffusion-weighted magnetic resonance imaging technologies to evaluate the therapeutic effect of esophageal primary carcinoma treatment with chemoradiotherapy |
| 投稿时间：2018-02-08 |
| DOI：10.3760/cma.j.issn.0254-5098.2018.10.004 |
| 中文关键词: 食管癌 放射治疗 磁共振弥散加权成像(DWI) 近期疗效 钡餐造影 |
| 英文关键词:Esophageal neoplasms Radiotherapy Diffusion-weighted magnetic resonance imaging(DWI) Short-term efficacy Esophagogram |
| 基金项目: |
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| 中文摘要: |
| 目的 根据食管癌放化疗前后磁共振扫描结果，结合临床疗效评估，对食管癌原发灶进行疗效判定，并结合原有CT及造影的评价标准，验证磁共振在食管癌放化疗近期疗效评价的可靠性。方法 2010年5月至2014年3月采用三维适形或调强放疗的83例食管癌患者，处方剂量50~64 Gy，中位剂量60 Gy，单次1.8~2.0 Gy，其中34例接受了FP或TP方案的同期化疗，放疗前后均行食管钡餐造影、胸及上腹CT、磁共振弥散加权成像（DWI）检查。依据1989版和2013版食管癌近期疗效评价标准进行疗效评价和比较，同时依据患者疗末病变区域DWI高信号表达情况进行疗效界定和亚组分析。结果 依据1989版及2013版近期疗效评价标准，全组完全缓解和部分缓解分别为：45例（54.2%）和38例（45.8%）；35例（42.2%）和48例（57.8%）。两种评价标准中完全缓解组1~5年的局部控制率和生存率均好于部分缓解组。治疗后病变区域DWI高信号完全消失者48例（将其界定为完全缓解），呈稍高信号表达者25例、高信号表达者10例（部分缓解），前者1~5年的局部控制率和生存率均好于后者（χ2=6.125、11.652，P<0.05）。与2013版近期疗效评价标准相比，一致性为中等（Kappa值=0.478）。依据钡餐造影、CT扫描、DWI检查综合评价，3项均达完全缓解标准者25例，部分缓解为58例，前者1~5年的局部控制率和生存率均高于后者（χ2=5.559、10.014，P<0.05）。结论 基于钡餐造影和CT扫描的近期疗效评价标准可较好地提示食管肿瘤局部控制情况；DWI可为食管癌治疗反应评价提供直观、量化的参考信息，疗末食管病变局部仍有高信号表达预示极高的复发风险。用3种影像学技术综合评价疗效更全面、客观、准确。 |
| 英文摘要: |
| Objective To determine the efficacy of primary tumor of esophageal cancer, according to the result of magnetic resonance imaging before and after chemoradiotherapy of esophageal cancer, combined with clinical efficacy evaluation, and to verify the reliable evaluation of the short-term curative effect of magnetic resonance on esophageal cancer, combined with the original CT and esophagogram evaluation criteria. Methods From May 2010 to March 2014, totally 83 patients with esophageal carcinoma treated with 3D-CRT or IMRT were enrolled. The prescribed doses were ranged from 50-64 Gy with median dose of 60Gy and 1.8-2.0 Gy per fraction, of which 34 of the patients received concurrent chemotherapy of FP or TP. All the patients performed the examinations of DWI, CT scan and esophagogram before and after radiotherapy. The treatment efficacy was evaluated by short-term therapeutic effect evaluation criterion of versions 1989 and 2013 and the hyperintense expression on DWI sequence. Results According to the short-term therapeutic effect evaluation criterion of versions 1989 and 2013 based on the examination of esophagogram and CT scan, 45 patients achieved complete remission(CR) after treatment(54.2%) and 38 achieved partly remission(PR)(45.8%) version 1989, while 35 patients achieved CR(42.2%) and 48 achieved PR(57.8%) version vesion 2013. In the two different criterions, the local control rate and survival rate of the complete remission group in 1 to 5 years were better than those in the partial remission group. According to the examination of DWI, 48 patients' hyperintense disappeared completely at the end of treatment (which was defined to CR), 25 patients had a slightly hyperintense expression and 10 patients still had hyperintense expression on DWI sequence (which two defined to PR), the local control and survival rates of the former group were superior to the latter groups (χ2=6.125, 11.652, P<0.05). The TE results evaluated by DWI and TE evaluation criterion of version 2013 were compared according to Kappa test, as a result, the Kappa coefficient 0.478. According to the examination of esophagogram, CT scan and DWI, 25 patients achieved CR and 58 achieved PR in all exams, and the local control and survival rates of the former group were superior to the latter group (χ2=5.559, 10.014,P<0.05). Conclusions The esophagogram and CT based TE evaluation criterion could well indicate local control status of esophageal cancer, and the examination of DWI could afford visualized and quantifying reference information about the TE of esophageal cancer. The expression of hyperintense at the end of treatment may indicate a high risk of recurrence and metastasis. The therapeutic effect evaluated by esophagogram, CT scan and DWI maybe more objective and more accurate. |
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