腹膜后淋巴结转移的宫颈癌PET-CT与CT定位放疗计划比较研究

doi:10.3760/cma.j.issn.1004-4221.2016.09.007

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摘要目的评估对腹膜后淋巴结转移的Ⅱ_B—Ⅳ_A期宫颈癌患者采用PET-CT体外放疗定位、制定计划的可行性。方法疗前采用PET-CT诊断分期同时定位,利用PET-CT融合图像制定针对转移淋巴结区加量的3DRT计划,并与同期CT计划进行比较,配对t检验或非参数检验差异。结果
PET-CT计划与CT计划比较:GTV_nd、PGTV_nd、CTV、PTV均增加(P=0.012、0.010、0.018、0.018);小肠V₄₀、V₅₀、D_{1 cm³} 相近(P=0.744、0.588、0.423),V₂₀、V₃₀、D_mean均降低(68.1%:74.5%,P=0.020;36.1%:39.6%,P=0.016;2546.1 Gy:2761.4 Gy,P=0.036);肾脏V₂₀增高(9.4%∶5.7%,P=0.006),D_mean也增加(877.0 cGy∶733.8 cGy,P=0.005),V₃₀、V₄₀相近(P=0.089、0.341)。直肠、膀胱、结肠、骨盆骨、骨髓、股骨头D_mean均未增加(P=0.406、0.107、0.178、0.397、0.285、0.743)。结论利用PET-CT融合图像制定体外3DRT计划,可精确定位转移淋巴结并提高放疗剂量,具有可行性;但应特别注意对小肠和肾脏保护。

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关键词 ：体层摄影术, 正电子发射型, 宫颈肿瘤/三维放射疗法, 腹膜后淋巴结转移

Abstract：Objective To evaluate the feasibility of using positron emission tomography-computed tomography (PET-CT) to guide lesion localization and radiotherapy planning for stage Ⅱ_B-IV_A cervical cancer with retroperitoneal node metastasis. Methods Before treatment, PET-CT was used for staging and lesion localization. Three-dimensional radiotherapy (3DRT) plans with boost doses for metastatic lymph nodes were made based on the fused PET-CT images. The obtained plans were compared with CT image-guided plans within the same period. Comparison was made by paired t test or non-parametric test. Results
The PET-CT plans had significantly larger GTV_nd, pGTV_nd, CTV, and PTV than the CT plans (P=0.012, 0.010, 0.018, 0.018). There were no significant differences in V₄₀, V₅₀, or D_{1 cm³} for the small intestine between the two plans (P=0.744, 0.588, 0.423). The PET-CT plans had significantly lower V₂₀, V₃₀, and D_mean for the small intestine than the CT plans (68.1% vs. 74.5%, P=0.020;36.1% vs. 39.6%, P=0.016;2 546.1 vs. 2 761.4 Gy, P=0.036). Moreover, the PET-CT plans had significantly larger V₂₀ and D_mean for the kidney than the CT plans (9.4% vs. 5.7%, P=0.006;877.0 vs. 733.8 Gy, P=0.005). There were no significant differences in V₃₀ and V₄₀ for the kidney or D_mean for the rectum, bladder, colon, pelvic bone, bone marrow, and femoral head between the two plans (P=0.089, 0.341, 0.406, 0.107, 0.178, 0.397, 0.285, 0.743). Conclusions It is feasible to use fused PET-CT images to guide external 3DRT plans, which can accurately localize the metastatic lymph nodes and elevate the radiation dose. However, the protection of the small intestine and kidney should be taken into account.

Key words： Tomography positron emission Cervical neoplasms/three-dimensional radiotherapy Retroperitoneal nodes metastasis

收稿日期: 2015-08-24

基金资助:中国癌症基金会北京希望马拉松专项基金(LC2012B25)

通讯作者: 黄曼妮,Email:huangmanni@csco.org.cn;吴令英,Email:wulingying@ csco.org.cn

引用本文:

. 腹膜后淋巴结转移的宫颈癌PET-CT与CT定位放疗计划比较研究[J]. 中华放射肿瘤学杂志, 2016, 25(9): 944-947.

. A comparative study of positron emission tomography-computed tomography and computed tomography image-guided radiotherapy for cervical cancer with retroperitoneal node metastasis[J]. Chinese Journal of Radiation Oncology, 2016, 25(9): 944-947.

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http://journal12.magtechjournal.com/Jweb_fszlx/CN/10.3760/cma.j.issn.1004-4221.2016.09.007 或 http://journal12.magtechjournal.com/Jweb_fszlx/CN/Y2016/V25/I9/944

[1] Beriwal S,Gan GN,Heron DE,et al. Early clinical outcome with concurrent chemotherapy and extended-field,intensity-modulated radiotherapy for cervical cancer[J].Int J Radiat Oncol Biol Phys,2007,68(1):166-171.DOI:10.1016/j.ijrobp.2006.12.023.
[2] Eifel PJ,Winter K,Morris M,et al. Pelvic irradiation with concurrent chemotherapy versus pelvic and para-aortic irradiation for high-risk cervical cancer:an update of Radiation Therapy Oncology Group Trial (RTOG) 90-01[J].J Clin Oncol,2004,22(5):872-880.DOI:10.1200/JCO.2004.07.197.
[3] Grigsby PW,Heydon K,Mutch DG,et al. Long-term follow-up of RTOG 92-10:cervical cancer with positive para-aortic lymph nodes[J].Int J Radiat Oncol Biol Phys 2001,51(4):982-987.DOI:10.1016/S0360-3016(01)01723-0.
[4] 林琳,郑容,吴令英,等.宫颈癌PET-CT图像放疗靶区四种勾画方法的初步研究[J].中华放射肿瘤学杂志,2012,21(1):56-59.DOI:10.3760/cma.j.issn.1004-4221.2012.01.016.
Lin L,Zheng R,Wu LY,et al. Comparison of four methods for delineation of gross tumor volume on FDG PET-CT for patients with cervical cancer[J].Chin J Radiat Oncol,2012,21(1):56-59.DOI:10.3760/cma.j.issn.1004-4221.2012.01.016.
[5] Smits RM,Zusterzeel PL,Bekkers RL.Pretreatment retroperitoneal para-aortic lymph node staging in advanced cervical cancer:a review[J].Int J Gynecol Cancer,2014,24(6):973-983.DOI:10.1097/IGC.0000000000000177.
[6] Rose PG, Bundy BN, Watkins EB, Thigpen JT, Deppe G, Maiman MA, Clarke-Pearson DL, Insalacos S:Concurrent cisplatin-based chemoradiation improves progression-free survival in advanced cervical cancer:results of a randomized Gynecologic Oncology Group study. New Engl J Med 1999, 340:1144-1153.
[7] Grisaru D,Almog B,Levine C,et al. The diagnostic accuracy of ¹⁸F-fluorodeoxyglucose PET-CT in patients with gynecological malignancies[J].Gynecol Oncol,2004,94(3):680-684.DOI:10.1016/j.ygyno.2004.05.053.
[8] Grigsby PW.PET-CT imaging to guide cervical cancer therapy[J].Future Oncol,2009,5(7):953-958.DOI:10.2217/ fon.09.70.
[9] Kidd EA,Siegel BA,Dehdashti F,et al. Clinical outcomes of definitive intensity-modulated radiation therapy with fluorodeoxyglucose-positron emission tomography simulation in patients with locally advanced cervical cancer[J].Int J Radiat Oncol Biol Phys,2010,77(4):1085-1091.DOI:10.1016/j.ijrobp.2009.06.041.
[10] Salem A,Salem AF,Al-Ibraheem A,et al. Evidence for the use PET for radiation therapy planning in patients with cervical cancer:a systematic review[J].Hematol Oncol Stem Cell Ther,2011,4(4):173-181.DOI:10.5144/1658-3876.2011.173.
[11] Grosu AL,Piert M,Weber WA,et al. Positron emission tomography for radiation treatment planning[J].Strahlenther Onkol,2005,181(8):483-499.DOI:10.1007/s00066-005-1422-7.
[12] Haie-Meder C,Mazeron R,Magné N.Clinical evidence on PET-CT for radiation therapy planning in cervix and endometrial cancers[J].Radiother Oncol,2010,96(3):351-355.DOI:10.1016/j.radonc.2010.07.010.
[13] Mutic S,Malyapa RS,Grigsby PW,et al. PET-guided IMRT for cervical carcinoma with positive para-aortic lymph nodes-a dose-escalation treatment planning study[J].Int J Radiat Oncol Biol Phys,2003,55(1):28-35.DOI:10.1016/S0360-3016(02)03804-X.
[14] Esthappan J,Chaudhari S,Santanam L,et al. Prospective clinical trial of positron emission tomography/computed tomography image-guided intensity-modulated radiation therapy for cervical carcinoma with positive para-aortic lymph nodes[J].Int J Radiat Oncol Biol Phys,2008,72(4):1134-1139.DOI:10.1016/j.ijrobp.2008.02.063.