食管癌IMRT前FDG PET-CT显像对治疗决策的影响

目的 探讨食管癌初治患者IMRT前PET-CT显像对其治疗方案的影响。方法 回顾分析60例经食管镜检证实的食管癌患者,患者均为初次治疗,经常规影像检查后拟行IMRT。放疗前行PET-CT显像,观察是否有分期和治疗方案改变。结果 与常规影像比,PET-CT显像使12例患者分期发生改变(2例T期上调、6例N期上调、2例N期下调、2例M期上调)。3例患者由于新发现较多的远处转移,治疗方案由放疗改为化疗。PET-CT检查导致20例患者靶区改变,其中16例因发现更多转移淋巴结使靶体积增大,4例则排除了淋巴结转移使靶区缩小。结论 PET-CT对食管癌区域淋巴结和远处转移诊断有一定优势,有助提高分期准确性,改变了部分患者治疗决策方案。

Impact of FDG-PET/CT before intensity-modulated radiotherapy on treatment regimen in patients with esophageal cancer

Objective To investigate the impact of ¹⁸F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) before intensity-modulated radiotherapy (IMRT) on treatment regimen in patients with newly diagnosed esophageal cancer. Methods A retrospective analysis was performed on 60 patients with esophageal cancer newly diagnosed by esophagoscopy, who underwent conventional imaging examination and IMRT. All patients underwent PET/CT before IMRT to evaluate whether the staging and treatment regimen would be changed. Results PET/CT provided additional information and led to changes in staging in 12 patients (2 patients with increased T stage, 6 patients with increased N stage, 2 patients with decreased N stage, and 2 patients with increased M stage). In addition, PET/CT changed management from radiotherapy to chemotherapy in 3 patients for detecting more distant metastases. The use of PET/CT led to changed target volumes in 20 of 57 patients:16 patients showed an increase in gross target volume or clinical target volume for more positive lymph nodes detected, and 4 patients exhibited target volume reduction for some positive lymph nodes excluded. Conclusions PET/CT has advantages in detecting positive local lymph nodes and distant metastases and helping improve the accuracy of staging in patients with esophageal cancer, which may lead to change in treatment regimen.