ＣＴ／ＣＴ图像融合用于非小细胞肺癌放射治疗对Ｖ２０及放射性肺炎影响的临床研究

目的　探讨ＣＴ／ＣＴ图像融合技术应用于非小细胞肺癌（ＮＳＣＬＣ）放射治疗计划对Ｖ２０和放射性肺炎（ＲＰ）的影响。方法　４０例入组患者均经病理组织学或细胞学证实为ⅢＡ、ⅢＢ期ＮＳＣＬＣ，三维适形放疗（３Ｄ-ＣＲＴ）剂量达到４０００ｃＧｙ肿块缩小达２５％后随机分为常规缩野放疗组２０例（Ａ组）和ＣＴ／ＣＴ图像融合缩野放疗组２０例（Ｂ组），两组均追加剂量至６６００ｃＧｙ。记录临床资料、Ｖ２０、放疗结束３个月内ＲＰ发生情况等。ＲＰ用ＲＴＯＧ急性放射性损伤分级标准判断。采用ＳＰＳＳ１１.５软件包进行统计学分析。结果　４０例患者中ＲＰ发生率为２２.５％（９／４０），其中Ａ组６例（３０.０％），Ｂ组３例（１５.０％），两组间差异无统计学意义（Ｐ＝０.２5６）。Ａ、Ｂ组的患侧肺Ｖ２０（ＩＶ２０）和全组的健侧肺Ｖ２０（ＣＶ２０）、患侧肺Ｖ２０均与ＲＰ发生有关，差异有统计学意义（Ｐ＜０.０５），Ｗｉｌｃｏｘｏｎ检验两组间患侧肺Ｖ２０、健侧肺Ｖ２０差异均有统计学意义（Ｐ＜０.０５）。结论　ＣＴ／ＣＴ图像融合执行的缩野追加剂量放疗未增加ＲＰ的发生率，且有可能降低患侧肺Ｖ２０，为进一步提高局部放疗剂量，获得更好的局控率提供了理论参考依据。

Study of the impact of CT/CT image fusion radiotherapy on V20 and radiation pneumonitis of non-small cell lung cancer

Objective To investigate the value of CT/CT image fusion radiation treatment planning in non-small cell lung cancer（NSCLC） and the impact on V20 and radiation pneumonitis（RP）.Methods Patients who were pathologically or cytologically diagnosed of stage ⅢA and ⅢB NSCLC were treated with three-dimensional conformal radiation therapy（4000cGy）.Forty patients got at least 25% tumor reduction were randomly divided into two groups： group A of regular shrink field radiotherapy（20 cases） and group B of CT/CT image fused shrink field radiotherapy（20 cases）.Dosage reached 6600cGy.Clinical data,V20 and RP were observed within 3 months after radiotherapy.Statistical analysis was conducted for the NSCLC patients.Results 22.5%（9/40） patients got RP during follow up.Group A accounted for 6 cases（30%）,and group B had 3 cases（15%）.There was no marked difference between the two groups（P=0.256）,univariate analysis revealed that the IV20 of A and B groups,and IV20 and CV20 of all patients were statistically related to the incidence of RP（P〈0.05）.With Wilcoxon method assay,the ipsilateral lung V20 and contralateral lung V20 had statistical significance between the two groups（P〈0.05）.Conclusion The CT/CT image infusion treatment planning could increase the radical dosage with better tumor control probability but won＇t increase adverse reaction.