比较在局部晚期非小细胞肺癌患者中，基于磁共振成像（MR）与基于计算机断层扫描（CT）的肿瘤轮廓勾画在接受大分割放疗和同步化疗时的疗效。
Comparing the outcomes of MR-based versus CT-based tumor delineation in locally advanced non-small cell lung cancer treated with hypo-fractionated radiotherapy and concurrent chemotherapy.
作者信息
Zhang Pengxin, Ding Shouliang, Peng Kangqiang, He Haoqiang, Wang Daquan, Zhou Rui, Wang Bin, Guo Jinyu, Liu Hongdong, Huang Xiaoyan, Xie Chuanmiao, Liu Hui, Qiu Bo
机构信息
Department of Radiation Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou, China.
Department of Medical Imaging, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou, China.
出版信息
Transl Lung Cancer Res. 2024 Nov 30;13(11):2890-2902. doi: 10.21037/tlcr-24-341. Epub 2024 Nov 6.
BACKGROUND
Delineating gross tumor volume (GTV) using computed tomography (CT) imaging is the standard for lung cancer contouring, but discrepancies among observers compromise accuracy and reliability. Magnetic resonance imaging (MRI) provides superior soft-tissue resolution compared to CT, thus, we design this retrospective study to compare the treatment outcomes of magnetic resonance-based (MR-based) and CT-based tumor delineation in locally advanced non-small cell lung cancer (LA-NSCLC) patients treated with hypo-fractionated concurrent chemoradiotherapy (hypo-CCRT).
METHODS
A total of 293 LA-NSCLC patients treated with hypo-CCRT from three trials between October 2015 and October 2020 were screened. Ninety patients with each MR-based delineation and CT-based delineation of the primary tumor were selected for analysis. In the MR-based delineation group, T1-enhanced MR images was rigidly registered with 10 respiratory phases of planning CT images, respectively. The primary tumors were contoured on each respiratory phase based on co-registered MRI. The locoregional progression-free survival (LPFS), progression-free survival (PFS), overall survival (OS) and toxicities in both groups were analyzed.
RESULTS
The 2-year LPFS rate was 69.2% [95% confidence interval (CI): 59.6-80.2%] in the MR-based delineation group and 61.0% (95% CI: 50.9-73.0%) in the CT-based delineation group (P=0.37). There was no significant difference in median PFS (P=0.45) or OS (P=0.69) between the two groups. The MR-based delineation group had smaller planning target volume (186.1 315.3 cm, P<0.001), lower incidences of ≥G2 pneumonitis (10% 24.4%, P=0.001) and ≥G3 esophagitis (2.2% 15.6%, P<0.001). In evaluating the patterns of recurrence, in-field recurrences were the dominant type in both groups (21 out of 27 patients in MR-based delineation group, 24 out of 32 patients in CT-based delineation group).
CONCLUSIONS
MR-based delineation in hypo-CCRT was feasible and achieved similar treatment efficacy to CT-based delineation. The use of MR imaging to reduce the target volume resulted in promising local control and lower incidence of radiation-induced toxicities.
背景
利用计算机断层扫描（CT）影像勾画大体肿瘤体积（GTV）是肺癌轮廓勾画的标准方法，但观察者之间的差异会影响准确性和可靠性。与CT相比，磁共振成像（MRI）具有更出色的软组织分辨率，因此，我们开展这项回顾性研究，比较在接受大分割同步放化疗（hypo-CCRT）的局部晚期非小细胞肺癌（LA-NSCLC）患者中，基于磁共振成像（MR）和基于CT的肿瘤勾画的治疗效果。
方法
筛选出2015年10月至2020年10月期间三项试验中接受hypo-CCRT治疗的293例LA-NSCLC患者。分别选取90例基于MR和基于CT勾画原发肿瘤的患者进行分析。在基于MR的勾画组中，将T1增强MR图像分别与计划CT图像的10个呼吸期进行刚性配准。基于配准后的MRI在每个呼吸期勾画原发肿瘤。分析两组的局部区域无进展生存期（LPFS）、无进展生存期（PFS）、总生存期（OS）和毒性反应。
结果
基于MR的勾画组2年LPFS率为69.2%[95%置信区间（CI）：59.6 - 80.2%]，基于CT的勾画组为61.0%（95%CI：50.9 - 73.0%）（P = 0.37）。两组的中位PFS（P = 0.45）或OS（P = 0.69）无显著差异。基于MR的勾画组的计划靶体积较小（186.1±315.3 cm³，P < 0.001），≥2级肺炎（10%对24.4%，P = 0.001）和≥3级食管炎（2.2%对15.6%，P < 0.001）的发生率较低。在评估复发模式时，两组均以野内复发为主（基于MR的勾画组27例患者中有21例，基于CT的勾画组32例患者中有24例）。
结论
在hypo-CCRT中基于MR的勾画是可行的，且与基于CT的勾画具有相似的治疗效果。使用MR成像缩小靶体积可实现良好的局部控制，并降低放射性毒性的发生率。
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