非小细胞肺癌放疗前后~(18)F-FDG符合线路正电子显像与~(99)Tc~m-HL91乏氧显像临床研究

详细信息    查看全文 | 推荐本文 |

英文篇名：Changes of ~(18)F-FDG and ~(99)Tc~m-HL91 imaging before and after radiotherapy for non-small cell lung cancer 作者：邓咏梅 ; 张金山 ; 李园 ; 麦家杰 英文作者：DENG Yong-mei;ZHANG Jin-shan;LI Yuan;MAI Jia-jie;Department of Nuclear Medicine and Radiation Oncology,the Third Affiliated Hospital of Guangzhou Medical University; 关键词：非小细胞肺癌 ; 三维适形放疗 ; 18F-FDG符合线路正电子显像 ; 99 ; Tcm-HL91乏氧显像 英文关键词：Non-small cell lung cancer;;three-dimensional conformal radiotherapy;;18F-FDG;;99 Tcm-HL91 中文刊名：HNZD 英文刊名：Journal of Chinese Practical Diagnosis and Therapy 机构：广州医科大学附属第三医院核医学科兼放射治疗科; 出版日期：2016-08-03 16:17 出版单位：中华实用诊断与治疗杂志 年：2016 期：v.30 基金：广州市属高校科研立项资助项目(201110A241) 语种：中文; 页：HNZD201608012 页数：3 CN：08 ISSN：41-1400/R 分类号：40-42

摘要

目的观察非小细胞肺癌(non-small cell lung cancer,NSCLC)患者放疗前、后~(99)Tc~m-HL91乏氧显像与~(18)F-FDG符合线路正电子显像变化,探讨2种方法评价NSCLC放疗疗效的价值。方法 NSCLC患者20例,均行三维适形放疗,分别于放疗前1周、放疗结束后8周行18F-FDG符合线路正电子显像、静脉注射~(99)Tc~m-HL91后4h平面及SPECT/CT断层显像,采用半定量法测量肿瘤病灶和对侧正常肺组织摄取~(18)F-FDG及~(99)Tc~m-HL91比值(T/N);依据放疗疗效将20例患者分为放疗有效组和无效组,观察2组放疗前、后T/N比值变化,分析其与放疗疗效的关系。结果放疗后病灶和对侧正常肺组织摄取18F-FDG T/N比值(5.47±1.69)较放疗前(7.51±1.53)降低(P<0.05);放疗后病灶和对侧正常肺组织摄取~(99)Tc~m-HL91的4h平面及SPECT/CT断层显像T/N比值(1.20±0.11、1.61±0.27)较放疗前(1.44±0.08、1.98±0.21)降低(P<0.05);放疗前后摄取~(99)Tc~m-HL91的4h平面及SPECT/CT断层显像T/N比值明显低于摄取~(18)F-FDG T/N比值(P<0.05);放疗结束后8周评价放疗疗效,有效13例,无效6例,死亡1例;放疗有效组、无效组放疗后病灶与对侧正常肺组织摄取~(99)Tc~m-HL91的4h断层显像T/N比值(1.34±0.13、1.82±0.35)低于放疗前(1.69±0.21、2.04±0.32)(P<0.05),且2组放疗前后T/N比值比较差异有统计学意义(P<0.05);有效组治疗前~(18)F-FDG显像T/N比值(7.34±1.25)与无效组(7.58±1.62)比较差异无统计学意义(P>0.05),放疗后有效组T/N比值(4.61±1.32)较放疗前降低,且低于无效组放疗后(7.23±1.34)(P<0.05);病灶摄取~(18)F-FDG和~(99)Tc~m-HL91 4h断层显像的T/N比值呈直线相关(r=0.641,P=0.034)。结论放疗可有效降低肿瘤的乏氧水平和肿瘤的葡萄糖代谢活性;~(99)Tc~m-HL91显像可反映病灶的乏氧状态及放疗前后乏氧水平改善程度,初步评价放疗疗效。
        Objective To evaluate the value of ~(99)Tc~m-HL91 and ~(18)F-FDGto assessing the therapeutic effect of radiotherapy on non-small cell lung cancer(NSCLC)by observing the changes of ~(99)Tc~m-HL91 and ~(18)F-FDGimaging before and after radiotherapy.Methods Twenty patients with NSCLC receiving three-dimensional conformal radiotherapy(3D-CRT)underwent ~(18)F-FDGimaging,and ~(99)Tc~m-HL91 hypoxia SPECT and planar imaging in 4hours after injection of~(99)Tc~m-HL91 one week before and eight weeks after radiotherapy.Regions of interest(ROI)were drawn in the tumor(T)and contralateral position(N)and the radioactivity ratio of T/N was calculated by semi-quantitative method.These 20 patients were divided into response group and no-response group according to the radiotherapy results.The changes of T/N values before and after radiotherapy were observed to analyze their relationship with the radiotherapy response.Results The T/N ratio in ~(18)F-FDGimaging after radiotherapy(5.47±1.69)was significantly lower than that before radiotherapy(7.51±1.53)(P<0.05).The T/N ratios of the 4-hour tomography and planar in ~(99)Tc~m-HL91 imaging after radiotherapy(1.20±0.11,1.61±0.27)were significantly lower than those before radiotherapy(1.44±0.08,1.98±0.21)(P<0.05),which were significantly lower than those in ~(18)F-FDGimaging(P<0.05).The response to radiotherapy was evaluated in 8weeks after radiotherapy,showing response in 13 cases,no change in 6cases and one death.The T/N ratios of the 4-hour tomography and planar in ~(99)Tc~m-HL91 imaging after radiotherapy(1.34±0.13,1.82±0.35)were significantly lower than those before radiotherapy(1.69±0.21,2.04±0.32)in response and no-response groups(P<0.05).There were no significant differences in the T/N ratios in ~(18)F-FDGimaging between response group(7.34±1.25)and no-response group(7.58±1.62)(P>0.05),and the T/N ratio was significantly lower after radiotherapy(4.61±1.32)than that before radiotherapy in response group and lower than that in no-response group after radiotherapy(7.23±1.34)(P<0.05).There was a linear correlation between the T/N ratio in ~(18)F-FDGimaging and in the 4-hour tomography in ~(99)Tc~m-HL91(r= 0.641,P= 0.034).Conclusion Radiotherapy can effectively decrease the tumor hypoxic levels and tumor glucose metabolism activity.~(99)Tc~m-HL91 imaging can reflect the hypoxia conditions of the NSCLC focus and the hypoxic improvement after radiotherapy,and can preliminarily assess the effect of radiotherapy.

引文

[1]丁小博,金刚,王艳波,等.99 Tcm-HL91SPECT乏氧显像在非小细胞肺癌放疗中的疗效评价[J].肿瘤防治研究杂志,2010,37(2):209-212.
    [2]王振宇,李根,刘珊珊,等.99 Tcm-HL91乏氧显像检测肺癌病灶乏氧状态及对调强放疗的指导[J].中国老年学杂志,2013,33(1):30-31.
    [3]朱旭生,邹德环,佘立群,等.18F-FDG符合线路正电子显像评价非小细胞肺癌手术或放化疗疗效价值[J].中华实用诊断与治疗杂志,2014,28(10):1019-1021.
    [4]Sun X,Niu G,Chan N,et al.Tumor hypoxia imaging[J].Mol Imaging Biol,2011,13(3):399-410.
    [5]冯彦林,谭家驹,杨劼,等.肺部恶性肿瘤99 Tcm-HL91乏氧显像与18F-FDG符合显像的对比研究[J].中国现代医学杂志,2004,14(4):75-77.