摘要
目的:回顾性研究氟18-氟代脱氧葡萄糖正电子发射断层(~(18)F-FDG PET)-CT对复发性宫颈癌患者调强放射治疗(IMRT)方案的影响。方法:选取36例治疗后复发的宫颈癌患者,在行IMRT前进行~(18)F-FDG PET-CT检查,并在3周之内行CT或MR等常规影像学检查,分别根据常规影像(CI)及~(18)F-FDG PET-CT勾画大体肿瘤体积(GTV)靶区,对比二者的体积差异。结果:在36例行~(18)F-FDG PET-CT检查的复发宫颈癌患者中,~(18)F-FDG PET-CT诊断复发宫颈癌患者的灵敏度、特异度及准确率分别为97.1%,100%和97.2%。~(18)F-FDG PET-CT改变了61.1%(22/36)患者的治疗方案,其中14例患者仍进行了IMRT,但放射治疗靶区因PET-CT而发生了改变。结论:~(18)F-FDG PET-CT对于复发的宫颈癌患者,是一项灵敏度、特异度及准确率较高的治疗前再分期诊断手段,改变了部分复发性宫颈癌患者的治疗方案。
Objective: The aim of this retrospective study was to evaluate the contribution of fluorine-18-fluoro-2-deoxyglucose positron emission tomography/computed tomography(~(18)F-FDG PET-CT) for the plan of intensitymodulated radiation therapy(IMRT) on the patients with recurrent cervical carcinoma. Methods: A total of 36 patients with recurrent cervical carcinoma who were candidates for IMRT underwent the detection of ~(18)F-FDG PET-CT before they received IMRT. And in three weeks, they received other routine imaging detections included of CT or MR. Besides, the target area of gross tumor volume(GTV) was delineated according to conventional imaging(CI) and ~(18)F-FDG PETCT, respectively, and the difference of volume between them was compared. Results: In the 36 patients with recurrent cervical carcinoma who underwent the detection of ~(18)F-FDG PET-CT, the sensitivity, specificity and accuracy rate of them were 97.1%, 100% and 97.2%, respectively. The therapeutic decision of 61.1% of patients(22/36) were changed. Although other 14 patients still received IMRT, the target areas of radiotherapy in them also were changed due to PETCT. Conclusion: ~(18)F-FDG PET-CT is a valuable tool with higher sensitivity, specificity and accuracy rate for patients with recurrent cervical carcinoma, and it can change treatment plan in a part of them.
引文
[1]胡金龙,吴令英,李晓光,等.早期巨块型宫颈癌复发的临床分析[J].中华肿瘤杂志,2012,34(5):378-381.
[2]Ghaemmaghami F,Saleh-Gargari S,Sahebdel B,et al.Risk factors and clinical aspects of recurrent invasive cervical carcinoma[J].JObstet Gynaecol India,2012,62(6):674-678.
[3]Lee YS,Kim YS,Kim JH,et al.Feasibility and outcome of concurrent chemoradiotherapy for recurrent cervical carcinoma after initial surgery[J].Tumori,2010,96(4):553-559.
[4]Sardain H,LavouéV,Foucher F,et al.[Curative pelvic exenteration for recurrent cervical carcinoma in the era of concurrent chemotherapy and radiation therapy.Asystematic review][J].J Gynecol Obstet Biol Reprod(Paris),2016,45(4):315-329.
[5]Badakh DK,Grover AH.Reirradiation with high-dose-rate remote afterloading brachytherapy implant in patients with locally recurrent or residual cervical carcinoma[J].J Cancer Res Ther,2009,5(1):24-30.
[6]Ahamad A,D'Souza W,Salehpour M,et al.Intensity-modulated radiation therapy after hysterectomy:comparison with conventional treatment and sensitivity of the normal-tissuesparing effect to margin size[J].Int J Radiat Oncol Biol Phys,2005,62(4):1117-1124.
[7]Carballo N,Gonzalez-Cortijo L,Gonzalez-Martin A,et al.Indications for adjuvant radiotherapy treatment after surgery and novel modalities for treatment[J].Gynecol Oncol,2008,110(3 Suppl2):S41-44.
[8]I?dem S,Ercan T,Al?o G,et al.Dosimetric comparison of intensity modulated pelvic radiotherapy with 3D conformal radiotherapy in patients with gynecologic malignancies[J].Eur J Gynaecol Oncol,2009,30(5):547-551.
[9]Cetina L,Serrano A,Cantú-de-León D,et al.F18-FDG-PET/CT in the evaluation of patients with suspected recurrent or persistent locally advanced cervical carcinoma[J].Rev Invest Clin,2011,63(3):227-235.
[10]Chung HH,Jo H,Kang WJ,et al.Clinical impact of integrated PET/CT on the management of suspected cervical cancer recurrence[J].Gynecol Oncol,2007,104(3):529-534.
[11]Perez-Medina T,Pereira A,Mucientes J,et al.Prospective evaluation of 18-fluoro-2-deoxyD-glucose positron emission tomography for the discrimination of paraaortic nodal spread in patients with locally advanced cervical carcinoma[J].Int J Gynecol Cancer,2013,23(1):170-175.
[12]Kang S,Kim SK,Chung DC,et al.Diagnostic Value of(18)F-FDG PET for evaluation of paraaortic nodal metastasis in patients with cervical carcinoma:a metaanalysis[J].J Nucl Med,2010,51(3):360-367.
[13]Kruser TJ,Bradley KA,Bentzen SM,et al.The impact of hybrid PET-CT scan on overall oncologic management,with a focus on radiotherapy planning:A prospective blinded study[J].Technol Cancer Res Treat,2009,8(2):149-158.
[14]Dolezelova H,Slampa P,Ondrova B,et al.The impact of PET with 18FDG in radiotherapy treatment planning and in the prediction in patients with cervix carcinoma:results of pilot study[J].Neoplasma,2008,55(5):437-441.
[15]Dong Y,Wang X,Wang Y,et al.Validity of 18F-fluorodeoxyglucose positron emission tomography/computed tomography for pret reatment evaluation of patients with cervica l carcinoma:a retrospective pathology-matched study[J].Int J Gynecol Cancer,2014,24(9):1642-1627.
