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PET-CT在三维适形放射治疗胰腺癌靶区勾画中的应用
王铃燕,蔡晶,刘海涛
0
(南通市肿瘤医院放射治疗科)
摘要:
目的 对比CT、PET-CT图像在局部晚期胰腺癌(local advanced pancreatic carcinoma,LAPC)三维适形放射治疗(three dimensional conformal radiotherapy, 3D-CRT)靶区勾画中的差异,探讨PET-CT在精确放疗方案制定中的可能价值。方法 13例局部晚期胰腺癌确诊患者,分别采用PET-CT融合图像及同机CT图像勾画靶区体积,对比分析大体肿瘤体积(GTV)、临床靶体积(CTV)、计划靶体积(PTV)、周围正常组织受量等指标。结果PET-CT改变GTV、PTV:13例患者靶体积均有改变,GTVCT、GTVPET-CT 分别为(57.3±22.9)、(68.4±31.7)cm3,CTVCT、CTVPET-CT 分别为(119.9±38.7)、(132.7±47.5)cm3,PTVCT、PTVPET-CT分别为(288.6±52.1)、(312.4±79.4)cm3,差异均有统计学意义(P<0.05);其中6例患者GTV体积增大明显(超过20%),平均增大36.5%(22.15 cm3 ),与PET-CT发现肿瘤浸润范围超出CT确定的肿瘤边界及PET-CT发现了更多的转移淋巴结引起有关。PET-CT改变放疗计划参数:给予相同的靶区剂量60 Gy/30次,基于PET-CT制定的放疗计划与基于CT制定的放疗计划相比,周围正常组织受量均发生相应的变化,但各项指标全组变化不明显,差异无统计意义。结论 应用PET-CT融合图像,可在保证正常组织受量符合临床要求的前提下,较精确地确定胰腺癌放射治疗靶区,有利于制定合理的三维适形放疗计划,但相关结论仍有待进一步大样本研究证实。
关键词:  PET-CT  局部晚期胰腺癌  三维适形放射治疗
DOI:10.3724/SP.J.1008.2014.00791
投稿时间:2014-05-04修订日期:2014-07-10
基金项目:
Compare the target volume delineated by CT and PET-CT in 3D-CRT for LAPC
Wang Lin-yan,Cai Jin,Liu Hai-tao
(Department of Radiotherapy,Fudan University Shanghai Cancer Center)
Abstract:
Objective To compare the difference between the target volume delineated by CT and that delineated by positron emission tomography and computer tomography(PET-CT)in locally advanced pancreatic carcinoma (LAPC), and observe the impact of PET-CT on planning of three-dimensional conformal radiotherapy (3D- CRT). Methods Thirteen patients with locally advanced pancreatic carcinoma referred for radical radiation therapy, underwent PET-CT scanning. GTV was delineated on the CT imaging and PET-CT fused imaging respectively. The two images were used to develop the radiotherapy planning.Dose-volume histograms (DVH) parameters were selected to be paralleled to compare the quality of the two plans and the impact of PET-CT on radiation plan (RP) was further analyzed. Results (1) PET-CT image altered GTV and PTV: For all patients, the GTVCT versus GTVPET-CT was 57.3±22.9cm3 versus 68.4±31.7cm3,the CTVCT versus CTVPET-CT was 119.9±38.7cm3 versus 132.7±47.5cm3,the PTVCT versus PTVPET-CT was 288.6±52.1cm3 versus 312.4±79.4cm3.The difference was statistically significant. In 6 patients, changes were obvious. The average increase was 36.5%(22.15cm3), due to the extension of the primary tumor beyond that defined by CT and additional lymph node metastases. (2) PET-CT image changed the parameters of DVH: to deliver the same target dose of 60 Gy in 30 fractions, all dose-volume characteristics altered in treatment planning, but there was no significant difference. Conclusions PET-CT image can reflect the relationship of the tumor and normal tissue more accurately. The application of PET-CT fused imaging on target volume delineation not only can provide a satisfactory the parameters of DVH, but also more precise on target volume delineation and planning of three-dimensional conformal radiotherapy for LAPC.
Key words:  PET-CT  local advanced pancreatic carcinoma (LAPC)  three dimensional conformal radiotherapy(3D-CRT)