目的 探讨CT/CT图像融合技术应用于非小细胞肺癌(NSCLC)放射治疗计划对V20和放射性肺炎(RP)的影响.方法 40例入组患者均经病理组织学或细胞学证实为ⅢA、ⅢB期NSCLC,三维适形放疗(3D-CRT)剂量达到4000cGy肿块缩小达25%后随机分为常规缩野放疗组20例(A组)和CT/CT图像融合缩野放疗组20例(B组),两组均追加剂量至6600cGy.记录临床资料、V20、放疗结束3个月内RP发生情况等.RP用RTOG急性放射性损伤分级标准判断.采用SPSS 11.5软件包进行统计学分析.结果 40例患者中RP发生率为22.5%(9/40),其中A组6例(30.0%),B组3例(15.0%),两组间差异无统计学意义(P=0.256).A、B组的患侧肺V20(IV20)和全组的健侧肺V20(CV20)、患侧肺V20均与RP发生有关,差异有统计学意义(P＜0.05),Wilcoxon检验两组间患侧肺V20、健侧肺V20差异均有统计学意义(P＜0.05).结论 CT/CT图像融合执行的缩野追加剂量放疗未增加RP的发生率,且有可能降低患侧肺V20,为进一步提高局部放疗剂量,获得更好的局控率提供了理论参考依据.%Objective To investigate the value of CT/CT image fusion radiation treatment planning in non-small cell lung cancer(NSCLC) and the impact on V20 and radiation pneumonitis(RP). Methods Patients who were pathologically or cytologically diagnosed of stage ⅢA and ⅢB NSCLC were treated with three-dimensional conformal radiation therapy(4000cGy). Forty patients got at least 25％ tumor reduction were randomly divided into two groups: group A of regular shrink field radiotherapy(20 cases) and group B of CT/CT image fused shrink field radiotherapy(20 cases). Dosage reached 6600cGy. Clinical data, V20 and RP were observed within 3 months after radiotherapy. Statistical analysis was conducted for the NSCLC patients. Results 22. 5％ (9/40) patients got RP during follow up. Group A accounted for6 cases(30％ ) ,and group B had 3 cases( 15％ ). There was no marked difference between the two groups( P =0. 256), univariate analysis revealed that the Ⅳ20 of A and B groups, and Ⅳ20 and CV20 of all patients were statistically related to the incidence of RP( P ＜0.05). With Wilcoxon method assay, the ipsilateral lung V20 and contralateral lung V20 had statistical significance between the two groups (P ＜0.05 ). Conclusion The CT/CT image infusion treatment planning could increase the radical dosage with better tumor control probability but won't increase adverse reaction.
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