【摘 要】目的：探讨胸部恶性肿瘤患者在行强化CT模拟定位和SPECT放疗后的疗效和安全性以及肺灌注显像在胸部恶性肿瘤三维适形放疗中的应用价值。方法：回顾性分析我院2013年5月-2014年8月经病理组织学或细胞学证实的肺癌行三维适形放疗的患者40例进行研究，按照随机分配的原则分为试验组和对照组两组各20例，试验组进行强化CT和SPECT肺灌注显像检查，并将图像融合加入治疗计划系统中，用强化CT勾画大体肿瘤靶区，SPECT确定肺功能区域，通过肺灌注显像所提供的信息优化放疗计划，尽可能减少功能正常肺组织的照射体积剂量，统计分析放疗计划优化前后的肺组织剂量参数变化。对照组仅进行CT图像制定放疗计划。分别对全部受试对象进行病史采集及体格检查，详细记录呼吸道症状及体征，并参照RTOG标准对放疗前呼吸道症状进行评分。治疗前及放疗结束时采血，检测血浆中C反应蛋白、IL-6、TNF-α和TGF-β的含量。放疗过程中每周评价肺损伤情况，并按RTOG标准记录治疗副作用。放疗结束及放疗后3个月、6个月复查肺功能、胸部CT、肺灌注显像，并对肺损伤分级进行评价。结果：40例胸部恶性肿瘤三维适形放疗患者行强化CT模拟定位联合SPECT放疗计划后的安全性情况：28例患者在注药瞬间出现过性全身发热；出现恶心呕吐情况的患者有5例，前胸部等部位出现荨麻疹的患者有3例。结论：CT模拟定位联合SPECT放疗计划可以优化放疗计划，对于肿瘤疾病的控制和治疗都有着重要积极的意义。
【关键词】三维适形放疗； CT模拟定位； 靶区勾画； 恶性肿瘤
【Abstract】objective：to study the patients with malignant tumor in chest enhanced CT simulation positioning and the curative effect and security of the SPECT after radiotherapy in breast tumor and lung perfusion imaging application value of three dimensional conformal radiotherapy. Methods：retrospective analysis of 2013-2014， 4 menstrual pathological histology may or cytology confirmed lung cancer.the three dimensional conformal radiotherapy in patients with 40 cases were studied， according to the principle of randomized divided into trial group and control group in two groups， 20 cases patients with enhanced CT and SPECT pulmonary perfusion imaging examination， and add the image fusion in the treatment planning system， with enhanced CT sketch in tumor target， SPECT lung function area is determined， by pulmonary perfusion imaging information provided by the optimization of radiotherapy plan， as far as possible to reduce the function of normal lung tissue irradiation dose volume， statistical analysis of lung tissue dose parameters before and after radiotherapy plan optimization. The control group only CT image radiotherapy planning. Respectively on all subjects history collection， and physical examination， detailed record of respiratory symptoms and signs， and the reference standard of respiratory symptoms before radiotherapy RTOG score. Before treatment and radiation treatment at the end of the blood， the detection of CRP in plasma， IL - 6， the content of TNF alpha and TGF - beta. Weekly evaluation in the process of radiation lung injury situation， and recorded by RTOG standard treatment side effects. End of radiotherapy and radiotherapy after 3 months， 6 months review of pulmonary function， chest CT， pulmonary perfusion imaging， and to evaluate lung injury classification. Results：40 cases of breast tumor three-dimensional conformal radiotherapy patients to strengthen the safety of the combined SPECT after radiotherapy of CT simulation positioning： 28 cases of patients with the drug instantly show whole body fever； There have 5 cases， patients with nausea and vomiting in areas such as the chest before there were 3 cases of patients with urticaria.Conclusion：CT positioning combined SPECT radiotherapy simul(本文来自：WWw.bDFQy.com 千 叶 帆文摘:胸部恶性肿瘤三维适形放疗患者行强化CT模拟定位联合SPECT放疗计划的疗效及安全性观察)ation can accurately determine the target sketch of tumor site， for the control and treatment of tumor disease is of important and positive significance.