氟脱氧葡萄糖PET-CT确定食管癌淋巴结放疗靶区的可行性研究

目的分析~(18)FDG PET-CT诊断食管癌淋巴结转移的优势及确定淋巴结放疗靶区的可行性。方法回顾性分析30例食管癌患者的临床病理资料,分析PET-CT在诊断淋巴结转移方面的优势,基于CT和PET-CT确定淋巴结大体肿瘤靶区(GTVN)和临床靶区(CTVN),根据术后病理分析PET-CT在确定淋巴结放疗靶区中的价值。结果13例由CT确定的GTVN(GTVN-CT)与病理一致,19例基于PET-CT的GTVN(GTVN-PET-CT)与病理相符。对照淋巴结病理结果,PET-CT改变了15例由CT确定的GTVN和其中10例的CTVN。PET-CT导致GTV缩小(GTVN-PET-CTGTVN- CT的12例共涉及22组淋巴结,其中9例CTVN亦扩大。GTVN-PET-CT>GTVN-CT的亚组分析显示,PET-CT确定的淋巴结GTV准确率高于CT(67%:25%,P=0.041)。结论PET-CT在诊断淋巴结转移中的优势使之可作为优化和确定食管癌淋巴结放疗靶区的有用工具。

Potential role of 18FDG PET-CT for target volume definition of metastatic lymph nodes in advanced esophageal carcinoma

Objective To determine the potential value of ~(18)FDG PET-CT on target volume defini- tion of metastatic lymph nodes in patients with advanced esophageal carcinoma.Methods The clinical and pathologic data from 30 patients with advanced esophageal carcinoma were reviewed.The pathologic data was used as golden standard to determine the difference between PET-CT and CT in the definition of both gross target volume (GTV) and clinical target volume (CTV) for metastatic lymph nodes.The influence of dis- cordant findings between the two imaging modalities was analyzed on the decision as to which area should be irradiated.Results The GTVN of 13 patients(43%)defined by CT were found consistent with pathologi- cal GTV,compared with 19 patients(63%)in GTVN by PET-CT.The GTV defined by CT was altered by PET-CT in 15 patients(50%)and CTV in 10 patients(33%).In the sub-group of 3 patients with smaller GTVN defined by PET-CT than that by CT(GTVN-PET-CTGTVN-CT),nine of these patients would have led to a increase of the clinical target volume (CTVN-PET-CT>CTVN-CT),and it was in this sub-group with enlarged GTVN that the gross target volume defined by PET-CT would be more accurate than that by CT (67% vs 25%,P=0.041 ).Conclusions Due to the superiority of PET-CT in detection of lymphatic metastasis over CT,there is a practical role for this imaging fusion technique in the definition of target vol- ume for advanced esophageal cancer.As more accurate in the delineation of nodal GTN,future use of PET- CT in radiotherapy planing (RTP) for patients with esophageal cancer would be promising.