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目的探讨肺癌患者肺灌注显像的特点及其放射治疗过程中的变化,观察其与放射性肺损伤发生的关系。方法31例接受根治性放疗的肺癌患者接受了肺灌注显像检查,其中8例仅在放疗前接受了此项检查。以照射前后计算区域的肺灌注平均计数值占相应全肺平均计数值的百分比,比较照射前后肺灌注的变化。放射性肺损伤的评价按美国肿瘤放射治疗组(RTOG)急性放射性肺炎标准评定。结果31例患者中,中央型22例,周围型9例。病理类型:鳞癌12例,腺癌1例,小细胞肺癌15例,未分型3例。Ⅰ、Ⅱ期8例,Ⅲa期9例,Ⅲb期14例。行适形放疗26例,常规放疗5例;照射剂量32~72Gy,中位剂量58Gy。6例发生2级或3级放射性肺炎,无放射性肺炎死亡病例。全部患者治疗前均有不同程度的灌注受损,中央型肺癌患者灌注受损范围≥2级者占68.2%(15/22),而周围型仅占22.2%(2/9,P=0.04)。受损范围为1级和2级以上者,分别有40.0%(6/15)和37.5%(6/16)的患者发生2级以上放射性肺损伤。在两次行肺灌注检查的23例中,肺灌注受损有所改善者占70.0%(16/23),其中2级以上放射性肺炎发生率为31.3%(5/16);在肺灌注受损加重者中,2级以上放射性肺炎发生率为42.9%(3/7)。结论灌注受损是肺癌患者的常见表现,中央型肺癌灌注受损较重,放射治疗后多数病例肺灌注受损有所改善;放疗前和放疗中,肺灌注受损范围的变化和放射性肺损伤的发生无明显相关性。
Objective To investigate the characteristics of lung perfusion imaging in patients with lung cancer and the changes during radiotherapy, and to observe the relationship between lung perfusion imaging and radiation lung injury. Methods Thirty-one patients with lung cancer who underwent radical radiotherapy underwent lung perfusion imaging. Eight of them received this examination only before radiotherapy. The percentage of pulmonary perfusion in the calculated area before and after irradiation accounted for the percentage of the corresponding total lung count, and the changes of lung perfusion before and after irradiation were compared. The assessment of radiation-induced lung injury was assessed according to the American Radiation Therapy Group (RTOG) Acute Radiation Pneumonia Criteria. Results Of the 31 patients, 22 were central and 9 were peripheral. Pathological types: 12 cases of squamous cell carcinoma, 1 case of adenocarcinoma, 15 cases of small cell lung cancer, 3 cases without classification. There were 8 cases in stage I and II, 9 cases in stage IIIa and 14 cases in stage IIIb. Twenty-six patients underwent conformal radiotherapy, 5 received conventional radiotherapy, and the dose ranged from 32 to 72 Gy with a median dose of 58 Gy. Six cases had grade 2 or grade 3 radiation pneumonitis, and no radiation pneumonia died. All patients had impaired perfusion before and after treatment, and 68.2% (15/22) of patients with central lung cancer who had impaired perfusion injury ranged from 22.2% (2/9, P=0.04). . In patients with grade 1 or greater impairment, 40.0% (6/15) and 37.5% (6/16) of patients had grade 2 or more radiation-induced lung injury. Among the 23 patients who underwent two-stage lung perfusion examination, the improvement of pulmonary perfusion impairment accounted for 70.0% (16/23), and the incidence of grade 2 or greater radiation pneumonitis was 31.3% (5/16); Among those with increased loss, the incidence of grade 2 or greater radiation pneumonitis was 42.9% (3/7). Conclusion Impairment of perfusion is a common manifestation of lung cancer patients. Perfusion of central lung cancer is severely impaired. Pulmonary perfusion impairment is improved in most cases after radiotherapy; changes in the extent of lung perfusion injury and radiation lung injury before and during radiotherapy. The occurrence of no significant correlation.