陈杉 黄杰

[摘要] 目的 研究氟脱氧葡萄糖 F18（18F-FDG）PET/CT与增强CT应用于非小细胞肺癌（NSCLC）放射治疗靶区勾画中的价值及对患者无进展生存时间（PFS）、总生存时间（OS）的影响。 方法 以武汉大学人民医院（以下简称“我院”）2013年1～12月采取增强CT勾画放疗靶区治疗的78例NSCLC患者作为增强CT组，以我院2014年1～12月采取18F-FDG PET/CT勾画放疗靶区治疗的78例NSCLC患者作为PET/CT组；保存PET/CT组患者增强CT靶区勾画资料并与PET/CT靶区勾画结果进行比较；比较两组患者放疗后情况、不良反应发生率；随访3年，比较两组患者生活质量，以生存函数分析比较两组无进展生存期（PFS）、总生存期（OS）。 结果 PET/CT组总有效率为32.05%，增强CT组总有效率为14.10%，PET/CT组高于对照组（P < 0.01）；PET/CT组不良反应发生率及程度均低于增强CT组（P < 0.05）。PET/CT组双肺V5、V20、V30均優于对照组（P < 0.05）；随访3年，PET/CT组患者生存质量优于增强CT组（P < 0.01）；PET/CT组患者PFS、OS均长于增强CT组（P < 0.05）。PET/CT组患者行增强CT扫描病灶检出率低于PET/CT扫描（P < 0.05）；并且PET/CT勾画GTV、SUVmax均小于增强CT组（P < 0.05）。 结论 PET/CT能够更加精准地勾画放疗靶区，提高治疗精准性与减少局部放射量，降低不良反应发生程度，改善患者预后，延长患者无病情进展生存时间与总生存时间。

[关键词] 非小细胞肺癌；放射治疗；氟脱氧葡萄糖F18；正电子发射断层显像术

[中图分类号] R734 [文献标识码] A [文章编号] 1673-7210（2018）09（a）-0132-05

[Abstract] Objective To study the value of 18F-FDG PET/CT and enhanced CT in the delineation of radiotherapy target area for non-small cell lung cancer （NSCLC） and its effect on progression free survival time （PFS） and total survival time （OS）. Methods Seventy-eight cases diagnosed as NSCLC treated with radiotherapy in Renmin Hospital of Wuhan University （“our hospital” for short） from January to December 2013 and the radiotherapy target area was delineated with enhanced CT that were enrolled in the enhanced CT group， while 78 NSCLC cases from January to December 2014 treated with radiotherapy in our hospital and the radiotherapy target area was delineated with 18F-FDG PET/CT， that were enrolled in the PET/CT group. The data of the two groups were preserved and compared. Adverse reaction rate of the two groups were compared. Follow-up results of 3 years and evaluation of the quality of life， PFS， OS were compared between the two groups. Results The total effective rate in the PET/CT group （32.05%） was higher than that in the enhanced CT group （14.10%）， and the total effective rate of the PET/CT group was higher than the enhanced CT group （P < 0.01）. Adverse reaction rate and the incidence degree in the PET/CT group were lower than that in the enhanced CT group （P < 0.05）. The lungs V5， V20， V30 in the PET/CT group were better than the enhanced CT group （P < 0.05）. After 3 years of follow up， the quality of life in the PET/CT group was better than the enhanced CT group （P < 0.01）. PFS， OS in the PET/CT group were longer than the enhanced CT group （P < 0.05）. Detection rate of lesions via enhanced CT was lower than using PET/CT （P < 0.05）. The gross tumor volume （GTV） was smaller in the PET/CT group， and the maximum uptake value （SUVmax） was smaller in the PET/CT group than the enhanced CT group. Conclusion It is more precisely to use PET/CT to delineate the radiation field， that can improve the accuracy and reduce partial radiation quantity. It will reduce adverse incidence degree and improve the prognosis， so as to extend PFS and OS.

[Key words] Non-small cell lung cancer； Radiotherapy； Fluorodeoxyglucose F18； Positron emission tomography

肺癌是最常见的恶性肿瘤之一，具有发病率高、复发率高、死亡率高的特点。非小细胞肺癌（non small celllung cancer，NSCLC）是肺癌的主要类型之一，约占总数的85%[1-3]，主要分为鳞癌与腺癌。近年来，我国NSCLC的发病率呈逐年上升的趋势，且早期诊断率较低，确诊时通常已经处于中晚期，丧失了手术治疗的机会，因此放射治疗已成为NSCLC的一种重要治疗方法[4-6]。以往放疗靶区勾画主要以反映解剖结构、组织密度等信息的CT扫描为依据，但以CT信息为依据勾画靶区时无法完全满足适形调强放疗（Intensive modulatedradiotherapy，IMRT）的需要。尤其对于肺癌合并肺不张、阻塞性疾病及判断纵隔淋巴结转移时CT所提供的信息较少。PET/CT是将功能与解剖组织信息相结合的一种新型医学影像学方法，以PET显像反映病灶及周围组织功能、代谢等相关分子信息，联合CT显像精准定位肿瘤灶的解剖位置，能更加准确地勾画肿瘤与非肿瘤组织间界限，为放疗提供更加精准的靶区信息。……