图像重建联合立体定向放射治疗肺癌36例_临床医学论文.docVIP

图像重建联合立体定向放射治疗肺癌36例_临床医学论文 图像重建联合立体定向放射治疗肺癌36例_临床医学论文 作者：范风云，张丙芳，陆军，魏文胜，石梅，南克俊 【关键词】 肺肿瘤 　　【Abstract】AIM： To discuss the clinical effects of image reconstruction and stereotactic radiotherapy in the management of lung carcinoma. METHODS: Included in this study were 36 patients with lung carcinoma. After the lesions were localized by CT scans with 2 mm slice thickness, the images were reconstructed and the clinical tumor volume (CTV), planning tumor volume (PTV) and dose-volume histograms of the involved lung were calculated. By using Leibinger stereotactic radiotherapy planning system and Varian Clinic 600 c or 2300 EX, a series of 5~8 fractions of radiotherapy was conducted once daily with 5~7 Gy per fraction. RESULTS: None of the 36 patients died during the treatment. The general conditions of the patients were assessed by means of Karnofsky performance status (KPS). Preradiotherapy KPS scores were 50~90 (mean 67.2), while the postradiotherapy KPS scores were 60~100 (mean 79.4). Follow-up（6-36 months）found 6 cases of complete remission, 23 cases of partial remission, 3 cases of no change and 4 progressed, with control rate being 80.6%. CONCLUSION: Image reconstruction and stereotaxis radiotherapy has excellent short-term curative effects in the treatment of lung carcinoma. 　　【Keywords】 lung neoplasms; image processing, computerassisted; stereotaxic techniques; radiotherapy 　　【摘要】目的： 研究用图像重建方法放射治疗肺癌的临床疗效.方法： 对36例肺癌患者采用CT定位2 mm层厚连续扫描并通过计算机进行图像重建，确定临床靶体积(CTV),计划靶体积(PTV) 及受累器官体积的照射量-体积直方图，然后应用德国Leibinger的立体定向系统和Varian 600c或2300EX加速器进行放射治疗.采用中等剂量，每次5~7 Gy, 每日1次，连续治疗5~8次.结果： 36例肺癌无死亡病例，Karnofsky(KPS)评分放疗前50~90（平均672）分，放疗后60~100（平均794）分.随访6~36（平均18）mo，通过CT复查，按照实体瘤疗效标准： 完全缓解(CR)6例，部分缓解(PR)23例，无变化(NC)3 例，进展( PD)4例，肿瘤控制有效率(CR+PR) 80.6%(29/36).结论： 图像重建联合立体定向放射治疗肺癌的近期疗效良好. 　　【关键词】 肺肿瘤; 图像处理，计算机辅助；立体定位技术；放射疗法 　　0引言 　　肺癌是最常见的恶性肿瘤，2003年美国约有157万人死于肺癌，其中绝大多数为非小细胞肺癌，约占80%［1-3］.其死亡率居高不下的原因主要是大多数患者在明确诊断时已为晚期或远处转移；失去手术根治的机会.全身化学治疗及局部放射治疗虽可暂时缓解症状，使肿瘤缩小，生存期也有一定提高，但因放化疗的毒副反应，如剧烈呕吐、骨髓抑制等