PET/CT对合并肺不张非小细胞肺癌治疗方案制定和放疗靶区勾画的影响

目的 观察PET/CT对合并肺不张NSCLC治疗方案制定和放疗靶区勾画的影响.方法 对拟行根治性3D-CRT的36例伴有不同程度肺不张的NSCLC患者行PET/CT扫描,观察PET/CT对其临床分期的影响,及由此带来的治疗方案的改变；再以CT图像和PET/CT融合图像分别勾画靶区,对两者进行比较.结果 PET/CT使18例(50.0％,18/36)患者的临床分期发生改变.11例(30.6％,11/36)因PET/CT发现远处转移,临床分期升为Ⅳ期,从而更改了治疗方案,其中3例由根治性放疗改为姑息性放疗,7例由放疗改为化疗,1例转为最佳支持治疗.25例行根治性3D-CRT的患者中,21例放疗靶区均有不同程度改变,其中靶区增大7例,减小12例,靶区位置移动2例；3例患者在3D-CRT的基础上增加锁骨上区常规放疗.3例姑息性放疗患者中,2例靶区减小,1例靶区增大.结论 PET/CT通过提高合并肺不张的NSCLC临床分期的准确性,辅助制定更加合理的治疗方案；通过有效检测出区域转移灶和转移淋巴结,降低靶区遗漏的可能；较CT更准确区分肿瘤与不张肺组织,提高了靶区勾画的准确性.

Impact of PET/CT on the treatment planning and target volume delineation of radiotherapy in thepatients with non-small-cell lung cancer complicated by atelectasis

Objective To investigate the impact of PET/CT on the treatment planning and target volume delineation of radiotherapy in patients with NSCLC complicated by atelectasis. Methods Pre-treat- ment PET/CT scans were performed in 36 patients with pathologically proven NSCLC complicated by atelec- tasis of different severity undergoing curative 3D-CRT planning. Clinical staging before and after PET/CT was compared and the change of treatment plan was evaluated. The target volumes were delineated by CT and PET/CT. Results PET/CT results changed the clinical staging in 18 （50.0%, 18/36） patients. PET/CT identified distant metastatic diseases in 11 （30.6%, 11/36） patients, thus excluding their eligi- bility for curative 3D-CRT. Of these 11 patients, managements were changed to palliative radiotherapy in 3 patients, chemotherapy in 7 patients and best supportive therapy in 1 patient. In the 25 patients with cura- tive 3D-CRT, PET/CT altered the radiotherapy volume in 21 cases, including 12 with volume reduction, 7 with volume enlargement and 2 with location change. Three patients were given additional conventional ra- diotherapy, since PET/CT indicated supraclavicular nodal metastases. In the 3 patients with palliative 3D- CRT, 2 had target volume reduction and 1 had target volume enlargement after PET/CT. Conclusions PET/CT may play a role in the management of patients with NSCLC complicated by atelectasis. It is also helpful for accurate delineation of target volume in 3D-CRT treatment planning.