胰腺癌CTV范围的多排螺旋CT与病理学研究

doi:10.3760/cma.j.issn.1004-4221.2016.01.014

摘要
图/表
参考文献()
相关文章 (15)
点击分布统计
下载分布统计

全文: PDF (2554 KB) HTML (1 KB)
输出: BibTeX | EndNote (RIS) 背景资料

摘要目的探索胰腺癌原发灶CT扫描与术后病理大小的关系及显微病灶浸润范围,以确定放疗靶区勾画中CTV范围。方法对2013—2014年在解放军总医院和空军总医院收治的19例胰腺癌患者进行研究。15例被测量术前多排螺旋CT图像和术后大体标本上肿瘤横断面最大直径,19例被在显微镜下测量病理切片上肿瘤浸润范围和计算的实际浸润范围。配对t检验不同测量方法结果差异。结果 15例患者大体标本、CT测量的肿瘤最大直径分别为33.6、30.1 mm (P=0.000),二者差值的中位数、平均值分别为3.1 mm (1.2~8.0 mm)、(3.6±2.0) mm,95%CI为1.2~6.0 mm。19例患者最大实际浸润距离、最大测量距离分别为3.50、3.19 mm (P=0.000),二者差值的中位数和平均值分别为0.31 mm (0.15~0.50 mm)、(0.30±0.09) mm。原发灶边缘至浸润灶距离最大值为5.21 mm,中位数、平均值分别为3.34 mm (2.19~5.21 mm)、(3.50±0.88) mm,95%CI为2.19~5.06 mm。结论增强CT低估了胰腺癌原发灶实际大小,在GTV基础上外扩5 mm作为CTV可能不够充分,建议再增加1~3 mm。

	服务

	把本文推荐给朋友
	加入我的书架
	加入引用管理器
	E-mail Alert
	RSS
	作者相关文章
	董猛
	常冬姝
	胡琪璐
	郑吉春
	任力
	石怀银
	夏廷毅

关键词 ：体层摄影术, X线计算机, 病理学, 胰腺肿瘤/放射疗法, 临床靶体积

Abstract： Objective To compare the tumor sizes of primary lesions in pancreatic cancer based on CT scan and postoperative pathological analysis and measure the extent of filtration under a microscope, and to determine the CTV in radiotherapy target delineation. Methods A total of 19 patients with pancreatic cancer who were admitted to PLA General Hospital and Air Force General Hospital, PLA from 2013 to 2014 were analyzed. In 15 patients, the maximum diameters of tumor cross-section were measured based on the images of preoperative multi-slice spiral CT and postoperative gross samples, respectively. In 19 patients, the extent of tumor infiltration was measured on pathological sections under a microscope and the actual extent of infiltration was calculated. The paired t-test was applied to analyze the differences in the results of different measurement methods. Results In the 15 patients, the maximum tumor diameters measured with gross samples and CT scan were 33.6 mm and 30.1 mm, respectively (P=0.000), and the median and mean of the differences were 3.1 mm (1.2-8.0 mm) and 3.6±2.0 mm, respectively (95%CI 1.2-6.0). In the 19 patients, the maximum actual infiltration distance and the maximum distance measured were 3.50 mm and 3.19 mm, respectively (P=0.000), and the median and mean of the differences were 0.31 mm (0.15-0.50 mm) and 0.30±0.09 mm, respectively. The maximum distance between the margin of primary lesions and the infiltrating lesions was 5.21 mm, with a median of 3.34 mm (2.19-5.21 mm) and a mean of 3.50±0.88 mm (95%CI 2.19-5.06). Conclusions Contrast-enhanced CT scan underestimates the actual size of primary lesions in pancreatic cancer, and an extension of 5 mm outside gross tumor volume (GTV) as CTV may not be sufficient. It is recommended to extend another 1-3 mm outside GTV as CTV.

Key words： Tomography,X-ray computed Pathology Pancreatic neoplasms/radiotherapy Clinical target volume

收稿日期: 2014-12-23

通讯作者: 夏廷毅,Email:xiatingyi1959@163.com

引用本文:

董猛,常冬姝,胡琪璐等. 胰腺癌CTV范围的多排螺旋CT与病理学研究[J]. 中华放射肿瘤学杂志, 2016, 25(1): 54-58.

Dong Meng,Chang Dongshu,Hu Qilu et al. A study on clinical target volume of pancreatic cancer under the scope of ct scanning and patholog[J]. Chinese Journal of Radiation Oncology, 2016, 25(1): 54-58.

链接本文:

http://journal12.magtechjournal.com/Jweb_fszlx/CN/10.3760/cma.j.issn.1004-4221.2016.01.014 或 http://journal12.magtechjournal.com/Jweb_fszlx/CN/Y2016/V25/I1/54

[1]Jemal A,Siegel R,Ward E,et al. Cancer statistics,2009[J].CA Cancer J Clin,2009,59(4):225-249.DOI:10.3322/caac.20006.
[2]Stojadinovic A,Brooks A,Hoos A,et alAn evidence—based approach to the surgical management of resectable pancreatic adenocarcinoma[J].J Am Coll Surg,2003,196(6):954-964.DOI:10.1016/S1072-7515(03)00010-3.
[3]Griffin JF,Smalley SR,Jewell W,et al. Patterns of failure after curative resection of pancreatic carcinoma[J].Cancer,1990,66(1):56-61.DOI:10.1002/1097-0142(19900701)66:1<56::AID-CNCR2820660112>3.0.CO;2-6.
[4]Hattangadi JA,Hong TS,Yeap BY,et al. Results and patterns of failure in patients treated with adjuvant combined chemoradiation therapy for resected pancreatic adenocarcinoma[J].Cancer,2009,115(16):3640-3650.DOI:10.1002/cncr.24410.
[5]Van den Broeck A,Sergeant G,Ectors N,et al. Patterns of recurrence after curative resection of pancreatic ductal adenocarcinoma[J].Eur J Surg Oncol,2009,35(6):600-604.DOI:10.1016/j.ejso.2008.12.006.
[6]Willett CG,Czito BG,Bendell JC,et al. Locally advanced pancreatic cancer[J].J Clin Oncol,2005,23(20):4538-4544.DOI:10.1200/JCO.2005.23.911.
[7]Ben-Josef E,Shields AF,Vaishampayan U,et al. Intensitymodulated radiotherapy (IMRT) and concurrent capecitabine for pancreatic cancer[J].Int J Radiat Oncol Biol Phys,2004,59(2):454-459.DOI:10.1016/j.ijrobp.2003.11.019.
[8]Okusaka T,Ito Y,Ueno H,et al. Phase Ⅱ study of radiotherapy combined with gemcitabine for locally advanced pancreatic cancer[J].Br J Cancer,2004,91(4):673-677.
[9]Shinchi H,Takao S,Noma H,et al. Length and quality of survival after external-beam radiotherapy with concurrent continuous 5-fluorouracil infusion for locally unresectable pancreatic cancer[J].Int J Radiat Oncol Biol Phys,2002,53(1):146-150.DOI:10.1016/S0360-3016(01)02806-1.
[10]Arvold ND,Niemierko A,Mamon HJ,et al. Pancreatic cancer tumor size on CT scan versus pathologic specimen:implications for radiation treatment planning[J].Int J Radiat Oncol Biol Phys,2011,80(5):1383-1390.DOI:10.1016/j.ijrobp.2010.04.058.
[11]DeWitt J,Devereaux B,Chriswell M,et al. Comparison of endoscopic ultrasonography and multidetector computed tomography for detecting and staging pancreatic cancer[J].Ann Intern Med,2004,141(10):753-763.DOI:10.7326/0003-4819-141-10-200411160-00006.
[12]Müller MF,Meyenberger C,Bertschinger P,et al. Pancreatic tumors:Evaluation with endoscopic US,CT,and MR imaging[J].Radiology,1994,190(3):745-751.DOI:10.1148/radiology.190.3.8115622.
[13]Legmann P,Vignaux O,Dousset B,et al. Pancreatic tumors:comparison of dual-phase helical CT and endoscopic sonography[J].Am J Roentgenol,1998,170(5):1315-1322.DOI:10.2214/ajr.170.5.9574609.
[14]Koong AC,Le QT,Ho A,et al. Phase I study of stereotactic radiosurgery in patients with locally advanced pancreatic cancer[J].Int J Radiat Oncol Biol Phys,2004,58(4):1017-1021.DOI:10.1016/j.ijrobp.2003.11.004.
[15]Koong AC,Christofferson E,Le QT,et al. Phase Ⅱ study to assess the efficacy of conventionally fractionated radiotherapy followed by a stereotactic radiosurgery boost in patients with locally advanced pancreatic cancer[J].Int J Radiat Oncol Biol Phys,2005,63(2):320-323.DOI:10.1016/j.ijrobp.2005.07.002.
[16]Schellenberg D,Goodman KA,Lee F,et al. Gemcitabine chemotherapy and single-fraction stereotactic body radiotherapy for locally advanced pancreatic cancer[J].Int J Radiat Oncol Biol Phys,2008,72(3):678-686.DOI:10.1016/j.ijrobp.2008.01.051.
[17]Chang DT,Schellenberg D,Shen J,et al. Stereotactic radiotherapy for unresectable adenocarcinoma of the pancreas[J].Cancer,2009,115(3):665-672.DOI:10.1002/cncr.24059.
[18]Brade A,Brierley J,Oza A,et al. Concurrent gemcitabine and radiotherapy with and without neoadjuvant gemcitabine for locally advanced unresectable or resected pancreatic cancer:a phase Ⅰ-Ⅱ study[J].Int J Radiat Oncol Biol Phys,2007,67(4):1027-1036.DOI:10.1016/j.ijrobp.2006.10.015.