| Purpose:In this study,patients with locally advanced unresectable non-small cell lung cancer were used as targets.SPECT lung perfusion imaging technology was used to reassess lung function.In the design of lung cancer radiotherapy plan,the shortcomings of simply using anatomical images were overcome to minimize the radiation of functional lung.damage.By observing the conditions of lung injury and radiological parameters after radiotherapy,the application value of SPECT lung perfusion imaging in guiding radiotherapy path,optimizing the radiotherapy plan for lung cancer and protecting lung function in locally advanced non-small cell lung cancer radiotherapy was discussed.Methods:A total of 84 patients with stage III unresectable non-small cell lung cancer who were treated in the Department of Radiation Oncology of the Affiliated Hospital of Qingdao University from September 2017 to August 2019 were randomly divided into an observation group(40 cases)and a control group according to the order of admission 44cases).Both groups of patients underwent intensity-modulated radiation therapy,with simultaneous or continuous chemotherapy,with a radiation dose of 5000?6600 cGy /2Gy.The control group made plans based on conventional CT images;the observation group made plans based on the lung function information prompted by the SPECT / CT fusion images,and a certain dose limit was given to Functional lung(FL).At the same time,each patient in the observation group developed two plans: P1 and P2.P1 is a plan based on conventional CT images;P2 is a plan based on lung function information prompted by SPECT / CT fusion images,and all patients in the observation group are finally treated according to the P2 plan.The incidence of radiation pneumonitis,changes in lung function before and after radiotherapy,and changes in inflammatory factors before and after radiotherapy were compared between the two groups of patients;the dose-volume parameters of P1 and P2 were compared.Results:1.A total of 84 patients with locally advanced non-small cell lung cancer were enrolled in this study.All patients successfully completed the treatment,and there was nostatistically significant difference between the chemotherapy and chemotherapy regimens between the two groups(P> 0.05).2.A total of 17 patients with radiation pneumonitis occurred after radiotherapy,including 7 cases of grade 1/2 radiation pneumonia and 3 cases of grade 3/4 radiation pneumonia in the control group;5 cases of grade 1/2 radiation pneumonia in the observation group,3/4 2 cases of grade radiation pneumonitis.3.In this study,40 patients underwent SPECT lung perfusion imaging,and 38 patients had various degrees of perfusion defects,accounting for about 95% of all patients.There were 17 patients with grade 1 perfusion defects,12 patients with grade 2 perfusion defects,and 9 patients with grade 3 perfusion defects.4.The lung function FEV1 / FVC and DLCO of the two groups of patients after radiotherapy,1 month after radiotherapy,and 3 months after radiotherapy decreased compared with before radiotherapy.Statistical significance(all P values?0.001).5.IL-1?,IL-6 and TNF-? all increased after radiotherapy in the two groups,and the increase in the control group was more obvious,the difference was statistically significant(P values were 0.013,0.04,0.04);two after radiotherapy The IL-10 of the patients in the group decreased,and the decrease in the control group was more obvious,the difference was statistically significant(P value was 0.037).6.After the optimization of SPECT lung perfusion imaging,the dose and volume parameters of the whole lung and functional lung are reduced;the average dose of spinal cord and functional lung is reduced;the dose and volume parameters of the heart do not change much;the change of the average dose of whole lung is not obvious.After optimization,WV10,WV20,WV30,WV50,and FV10,FV20,FV30,FV40,FV50 are significantly reduced,the difference is statistically significant(P values are 0.000,0.000,0.000,0.023,0.000,0.000,0.000,0.000,0.000);the optimized SC and MFLD are significantly reduced,the difference is statistically significant(P value is 0.000,0.011);HV20,HV30 change little,the difference is not statistically significant(P value 0.942,0.304);MLD change Not obvious,the difference was not statistically significant(P value0.065).Conclusion:1.SPECT lung perfusion imaging is more capable of displaying patients' local lung function information than conventional CT examination.2.According to the lung function information provided by SPECT lung perfusion imaging,passing the irradiation field through the non-functioning lung can reduce the irradiation of the lung tissue functional area and reduce the occurrence of radiation-induced lung injury.3.SPECT lung perfusion imaging optimizes the intensity-modulated radiotherapy plan,which can reduce the functional lung dose and increase the tumor radiotherapy dose without increasing the amount of other endangered organs. |
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