18FDG PET/CT定位三维适形放疗结合介入治疗原发性肝癌的疗效和预后分析

摘要

目的:研究18FDG PET/CT定位三维适形常规分割放疗结合肝动脉化疗栓塞(TACE)治疗原发性肝癌的疗效、不良反应及失败原因.方法:对64例原发性肝癌患者用信封法随机分为18FDG PET/CT定位三维适形放疗组(PET/CT组)和普通CT定位三维适形放疗组(普通CT组).PET/CT组用PET/CT扫描定位,经PET/CT扫描后将扫描数据输入治疗计划系统,将PET图像和CT图像融合后进行靶区(GTV与PTV)和重要脏器勾画、三维重建,制定治疗计划后常规分割三维适形放疗40Gy左右,然后适当缩野放疗至总剂量50Gy-60Gy;普通CT组用普通CT定位设野,三维适形放疗至相同剂量;两组放疗后均结合4-6周期TACE治疗.结果:PET/CT组共有18例显示GTV有改变,其中7例增大,6例缩小,5例GTV形状改变;放疗后全组AFP值显著下降;PET/CT组的中位复发时间11.3个月,普通CT组的中位复发时间10.2个月,两者差异有显著性统计学意义(P=0.001).两组死于局部未控、复发或转移者比例占总死亡原因的76.7%;多因素分析表明T分期早和疗前GTV≤100cm3者预后好(P均＜0.01).结论:PET/CT定位三维适形放疗原发性肝癌可以优化放疗计划,结合介入治疗可以延长中位复发时间,分期早的病变预后好.%Objective : To analyse the result of 18FDG PET/CT positioning three - dimensional conformal radiotherapy( 3DCRT ) plus transarterial chemoembolization( TACE ) for liver carcmoma. Methods : All 64 cases of liver carcinoma patients were randomly divided into 18FDG PET/CT group and normal CT group. The location of PET/CT groups cases was determined by PET/CT and the data was transmitted to the treatment planning system( TPS ) , PET image and CT image were fused together;The target volume and critical organs were determined by fused image, then conventional fraction's 3DCRT ( 40Gy or so ) was followed to a total dose of radiotherapy 60Gy -70Gy by reduced radiation field. The location of normal CT group's cases was determined by normal CT and were treated by 3DCRT to the same dose. All patients were treated by TACE to totally 4 - 6 cycles. Results :18 cases of the PET/CT group showed a changed GTV :7 cases increased, 6 cases reduced, and the other 5 cases changed the shape of GTV; AFP of whole group was significantly decreased after radiotherapy. The median recurrence time of PET/CT group was 11. 3 months, and median recurrence time of normal CT group was 10. 2 months, there was significant difference between the two groups( P = 0. 001 ). The rates of cases died of no local control, recurrence or metastasis was 76. 7％ . Multivariate analysis showed that early T stage lesions and small GTV(≤100cm3 ) were better than that of others( all P ＜0. 01 ). Conclusion : PET/CT positioning 3DCRT can optimize the radiation treatment planning for liver carcinoma, combined with interventional treatment can extend the median time to recurrence , the patients with early stage lesions have better prognosis than others.