99Tcm-HL91显像评价鼻咽癌放疗前原发灶乏氧状况

摘要

目的 观察鼻咽癌放疗前原发灶的乏氧状况,分析放疗前各临床因素与原发灶乏氧的关系.方法 69例初治鼻咽癌患者,疗前利用99Tcm4,9-二氮-3,3,10,10-四甲基十二烷.2,11-二酮肟(HLg1)对原发灶进行乏氧显像.采用目测定性分析判定乏氧显像阳性病例;再利用感兴趣区(ROI)技术对阳性病例进行半定量分析,计算鼻咽病灶内放射性浓聚部位(T)与正常鼻咽组织(N)的放射性比值;根据目测分析结果和T/N的均数将原发灶乏氧程度分为阴性、轻度及重度乏氧;分析疗前各临床因素与乏氧程度的关系.采用SPSS 10.0软件对数据进行统计学处理.结果 63例(91.3%)患者乏氧显像阳性.患者不同年龄(＜45岁和≥45岁)、性别、病理分型(WHO Ⅲ型和Ⅲ型)和疗前Hb水平(＜130 g/L和≥130 g/L)的原发灶乏氧程度差异均无统计学意义(χ2值分别为-0.864,-0.881,-0.293,-0.514,P均＞0.05);不同原发灶体积(＜40 cm3和≥40 am3)之间及不同T分期(T1+T2,T3+T4)之间乏氧程度差异有统计学意义(χ2值分别为-4.672和-3.322,P值分别为0.000和0.001);在乏氧显像阳性病例中,原发灶体积与乏氧程度呈正相关(r=0.648,P＜0.01).结论 大多数初治鼻咽癌患者原发灶存在不同程度的乏氧;原发灶体积较大及T晚期患者的乏氧程度较体积小、T早期患者严重;乏氧程度有随原发灶体积增大而逐渐加重的趋势.%Objective Tumor hypoxia is known to be associated with resistance to radiotherapy and with increased tumor aggressiveness.The aims of this study were two.One was to localize the hypoxic area of primary nasopharyngeal carcinoma(NPC)tumor with99Tcm 4,9-diaza-3,3,10,10-tetramethyldodecan-2,11-dione dioxime(HL91)SPECT with X-ray.The other was to analyze the relationship between the clinical variables and the degee of hypoxia in primary NPC tumor.Methods From Jun.2004 to Oct.2005,69 primary NPC patients were involved in the study.All received head and neck SPECT at 3.5 to 4h after intravenous injection of 925 MBq99Tcm-HL91 before their radiotherapy.Visual interpretation of HL91-positive was defined as the uptake being higher than normal nasopharyngeal(NP)wall and was calculated as lesion(primary tumor)to non-lesion(normal)radioactivity ratio(T/N).Results from both visual and T/N were classified into normal,moderate and severe and compared to the clinical variables.SPSS 10.0 was used for data analysis.Results Sixty-three of 69(91.3%)NPC patients had HL91 visual defined positive uptake.Of the 63 patients,significant differences were observed in those with tumor volumes of≥40 cm3(χ2=-4.672,P=0.000)and with T3-4 stage(χ2=-3.322,P=0.001).For T/N ratios,only tumor volumes of≥40 cm3 were significant.Conclusion Hypoxic cells were existed in most of the primary NPC tumor,with predominant in large tumor( ≥40 cm3)and higher T(T3-4)stage.