Y HOC VI|T NAM THANG 5 - SO 2/2014 so vcfi 1,2%) - Tren doi tu'dng nghien culi >40
tuoi thi tuoi cang cao t y le mac benh cang tang, 'cao nhattrong nhdm > 7 0 t u o i (17,5%);
- Nhutig ngu'di hut thuoc >15 bao/nam cd ty le mac benh cao hdn han nhuYig ngu'di hut thuoc
<15 bao/nam (9,2 so vdi 2,4%);
Thdi gian tiep xuc vdi khdi bep lam tang ty le mac benh: Tiep xuc 30 nam t y le mac 1,0%, tiep xuc >30 nam ty le mac 5,0%.
TAI UEU T H A M K H A O
1. LS VSn Anh (2006), Nghien cuV dich tihoc benh ph& tic nghin m?n b'nh trong^ dSn of thanh pho Bic Giang, Lu|ii van Bac si chuygn khoa I I , Tnidng D?i hoc Y Ha Npi.
2. Ngo Quf Ch3u v& cs (2002), l i n h hinh chan doan va diSu trj b^nh phoi tSc nghgn mgn tinh tai Khoa Hd hap B$nh vien Bach Mai trong 5 nim 1996-2000', Thdng tin Y hgc lam sang, Nha xuat ban Y hoc, tr. 50-58.
3. Phan Thu PhuUng (2010), Nghien cuii djch ^ hoc benh pha tac nghen man b'nh trong din ar ngoai thanh tiianh pho Ha Ndi va tinh Bac Glangt Luan an 71§n sy y hoc, Tru'dng Dai hgc Y Ha Ngi.
4. einh Ngoc Sy va cs (2009), Nghien cOV djch te hoc benh phdi tac nghen man tinh d Viet Nam va cac biin phap dUphdng, dieu bi, Bao cao k d qua nghieri culi khoa hoc d l tai cap nha ni/dc. Ha Ngi.
^ . Fukuchi Y , Yaiig L and Zhang Y Dai IM (2007), "Relationship between COPD and polymorphisms of HOX-1 and m EPH in a Chinese population*, Oncology reports, 17, p. 483-488.
6. Ran PX, Wang C, Mannino D et al (2006),
"Epidemiology and costs of Chronic obstructive pulmonary disease, linking outcomes and pathobiology of disease modification", Bur Re^r J, 27, p. 188-207.
7. Ramiez-Venegas A, Sansores Raul H, Perez- Pandilla R et al (2006), 'Sun/ival of patients witii Chronic obstructive pulmonary disease due to biomass smoke and tobacco'. Am J Respir Qit Care Med, ITi, p. 393-397.
GlA TRI COA PET/CT TRONG CHAN DOAN XAC DINH GIAI DOAN BENH VA MO P H 6 N G L A P KE HOACH XA TRI UNG THU" VOM MUI HONG
Le Chinh D^i*, Mai Trong Khoa*, Tr^n Hai Binli*
T6M TAT
MMC tiSu: Danh gia vai tro cua PET/CT tmng ch§n dodn giai doan b^nh va lap ke hoach xa tri cho n o b$nh nhSn ung thu' vdm mui hgng. 061 t i l i n g va phuVng phdp nghi§n cCru: 110 benh nhSn duoc chein doan la ung thU vom mui hpng, co xac chan bSng mo benh hpc, dUdc chup PET/CT x5c djnh giai doan benh va mo phong lap ke hoach xa trj trong thdi gian tif thdng 10/2009 den thang 10/2013 tai Trung t3m Y hpc hat nhan va Ung bu'du, Benh vi|n Bgch Mai.
K0t qua: Nghien cuU UO benh nhan cho ket qua: ti l§
nam/nij' la 2,9/1; tuoi trung binh 52,1±14,9. Nhom tuoi tiT 40-60 chigm ti 1$ (41%). SUV tai khoi u vom 10,88±4,70 (2,51-24,96); hach di cSn 7,48±4,79 (2,56-26,22). Gia tri SUV ti le thuan vdi ki'ch thu'dc ton thuong va giai doan benh. Thay doi giai doan benh d 30,8% BN. 2. Thay doi GTV-PET (tren 25% tfie tith) d 74/96 BN (77,1%): t3ng the tich d 21,8% BN va giam the tich d 55,2% BN. GTV-PET nho hdn GTV-CT:
94,3±13,2 cm' va 125,2±17,9 c m l Ket lu$n: 9^ia giup xdc dinh chinh xac giai doan bSnh ung thu" vdm
* Trung tam Yhgc H^t nhan va Ung budu, B$nh vien B^ch Mai
Phan bl0n khoa Ape; PGS.TS Do Doan L^i
mui hpng, quyet djnh chien Iu'dc dieu trj diUng, mang lai hieu qua dieu trj cao. PETICI mo p h ^ g l^p kl hoach xa tri la ky thuat mdi, hien dai cd nhieu \t\i diem: xac djnh chi'nh xac the tich xa trj, tap trung trufn tia vao khdi u va han chg vao nhu md lanh xung quanh, giam bien chutig do xa tri, hieu qua diilu trj cao va an toan cho ngudi benh.
S U M M A R Y
THE VALUE OF P E T / C T I N DIAGNOSIS, S T A G I N G A N D S I M U L A T I O N
FOR R A D I A T I O N THERAPY I N NASOPHARYNGEAL CANCER
( N P C ) PATIENTS
Aims: To evaluate the value of PET/CT In diagnostic and staging of NPC. To study the value of PET/CT simualation in radiotherapy planning for NPC Subjects: UO pts newly diagnosed with NPC (histophathology confirm) have been perfomwdt PET/CT for staging and simulation and Oien being, treated with linear accelerator. At the Nuclear Medidne and Oncology CenU-e, Bach Mai hospital, Hanoi, from 10/2009-10/2013. Methods: description, prospectt^
Result: 1. Among UO pts: male/female is 2,9:1,,
Y HOC VlgT NAM THANG 5 - SO a2014 average age 52,1*14,9. Group 40-60 years old
accounted for highest (41%). SUV of tumor is 10,88±4,70 (2,51-24,96); iymph node is 7,48±4,79 (2,56-26,22). Changing stage in 30,8% pts. 2.
Changing GTV-PET (threshold Is changing >25%
volume) in 74/96 pts (77,1%); inaease In 21,8% pts and decrease In 55,2% pts. Average GTV-PET volume Is smaller than GTV-CT: 94,3±13,2 cm^ vs 125,2±17,9 o n ' . Conclusions: PET/CT scan helps diagnostic stage of diseases accurately, then giving the most appropnate treatment. PET/CT simulation for radiation therapy planning has some significant advantages:
define accurate radiation volume, high dose focus In tumor while separate the normal surrounding tissue, limit the side effects of treatment and Improve outcomes.
I.OiTvXNOt
Ung thif vom mui hong (NPC) la mot trong nhiing benh k tinh thtudng gap nhat trong ung thu' viing dau mSt cS. Benh pho bien d mldc ta vdi ty I I mSc b i n h la 15,4/100.000 dan. Chan doan ung thu' vom difa tren cac trieu chutig lam sang, npl sol vom bam sinh thiet lam glal phau benh, chup CT, MRI va PET/CT. Ky thuat chup PET/CT CO dp nhay, do dSc hieu va do chinh xac cao cho phep chan doan glal doan chinh xac tru'dc dieu trj, gliJp tiSn lu'dng benh cung nhu quyet d|nh phu'dng thu'c dieu trj phii hop.
Phu'dng phSp dieu trj cd ban va co hieu qua nliat trong ung thu' vom mui hong la xa trj. Xa trj du'dc chi djnh cho phan Idn cac benh nlian ngay ca giai doan IV khI chuci cd dl c3n xa. Xa trj bSng may gia toe tuyen tinh duS trSn hinh anh PETICT mo phdng cho cac benii nhan ung thu' lan dau tien duVc iJng dung d Viet Nam, tai Trung tam Y hpc hat nhan va Ung bu'du, Benh vien Bach Mai (tif thang 10/2009) khong chi cho benh nhan ung thtf vdm mui hpng ndi rieng ma con cho cac loai ung thtf khac vung dau mat co, ung thtf thtfe quan, ung thtf phSl, ung thir tien liet tuyen, ung thtf trtfc_trSng,... Stf dgng hinh anh PET/CT mo phdng de lap kS hoach xa trj giup xac djnh the tich X? trj chinh xac hdn chup CT mo phdng, hudng cac chum tia vcio vj t r i khdi u, tranh cac cd quan I M xung quanh, mang lai hieu qua cao hdn trong dieu trj. Tai Viet Nam.frung tam Y hpc h;t nhSn \ii Ung btfdu B^nh vi^n Bach Mai la cd sd dSu HSn va duy nhat ifng dung ky thuat chup PET/CT de chan doan va md phdng lap ke hoach
xa trj cho benh nhan ung thtf vdm mui hpng.
Chung toi tien hanh nghien culj nay vdi hai muc tieu:
1. Danh gia gia trj cua PET/CT trong chan doan va xac dinh giai doan benh ung thu' vdm mui hpng.
2. Danh gia gia tri cua PET/CT md phdng lap ke hoach xa tri ung tliu'vdm mdi hpng.
II. QOI T i r c m G VA PHirOTNG PHAP NGHIEN COOJ 2 . 1 . D O I t u ' d n g : 110 benh nhan dtfdc chan doan xac djnh ung thtf vom mui hong, cd ket qua giai p h i u benh, dtfdc chup PET/Ct xac djnh giai doan benh va mo phong lap ke hoach xa tri tai Trung tam Y hpc hat nhan va Ung btfdu - Benh vien Bach Mai.
2 . 2 . T h d i g i a n n g h i e n c i h i : tCf thang 10/2009 den thang 10/2013.
2.3. Phu'dng p h a p n g h i e n c i h i : nghiSn etfu djch te hpe md ta tien culi.
2.4. Q u y t r i n h n g h i S n c i h i :
Benh nhan vao vien: chan doan xac djnh (sinh thiet chan doan mo benh hpe) -> Danh gia giai doan (lam sang, cac xet nghiem chan doan hinji aiih va y hpc hat nhan) -> Chup PET/CT chan doan, xac djnh glai doan va md phdng -»
Lap ke hoach xa trj tren hinii PET/CT md phdng -> Tien hanh dieu trj (Ltfa chpn phtfdng phap dieu tri: xa trj, cd/khdng phoi hdp hda chat) - » Theo dol, darih gia ket qua di'eu trj (lam sJng, chan doan hinh anh, PET/CT)
2.5. Thiet b| ky thu|it:
- May PET/CT Blographe 6 ciia Siemens, thiet bj laser djnh vj md phdng.
- Phan mem lap ke hoach xa trj Prov^ess Panther.
- May gia toe tuyen tinh LINAC Primus Siemens.
2 . 6 . Q u y t r i n h c h u p PET/CT:
+ Dtfdc chat phdng xa: Dung djch F-18 FOG (2-f]uoro-2-deoxy-D-glueose).
- Benh nhan dtfde tiem F-18 FDG vdi lieu 0,15 - 0,20 mCi/kg can nang (7-12 mCl).
- Tien hanh chup PET/CT sau tiem 45-60 phut:
dau benh nhan dtfdc co djnh bSng m$t na.
-f Xtf ly hinh anh va phan tich ket qud: tren hinh anh PET/CT xae djnh tdn thtfdng: sd Itfdng, vj tri, kich thtfdc, mtfc dp hap thu FDG (thdng qua gia trj hap thu FDG chuan - SUV; standard uptake value); the tich khdi u BTV tren hinh PET/CT va the tieh GTV tren hinh CT.
2.7. His ly so l i e u : bang phan mem SPSS 15.0.
iii.KfrQuA
3.1, Gii t i i cua PET/CT trong chan doin v i x i e djnh glal do^n b^nh:
Bing 1: DSc di^m benh nhan theo gidi va tudi:
Y HOC VIET NAM THANG 5-3020014
Nii' Chunq
n 82 28 l i e
Ty le »/o 74,5 25,5 100
Tuoi truna binh 51,1 ± 15,5 54,9 ± 13,0 52,1 ± 14,9
Nhin xet: Ty le nam/nff la 2,9/1; dp tuoi trung binh ciia ca hai gidi la 52,1±14,9; trong dd benh nhan nhd tuoi nhat la 9 tuoi va benh nhan nhieu tuoi nhat la 78 tuoi.
Bleu do 1: Phan bo theo nhdm tuoi benh nhan:
Nh$n xet: Nhdm tudi 40-60 chiem ty le 41%; nhdm tuoi dtfdi 40 tudi chiem 22% va nhdm tudi tren 60 tudi chiem ty le 37%.
Bang 2: Vj tn tdn thtfdnq u vdm nguyen phat:
Tran vdm
Vj tn ton thu'dng
Thanh phai Thanh trai Ton thtfdng lan rgng
Tdng
30
T» 16 °/o 16,4 45,4 27,3 10,9
Nh$n xet: Tdn thtfdng u gap tai thanh vom phai chiem ty le 45,4%, thanh vpm trai chlSm ty I?
27,3%, tran vdm la 16,4%, ton thtfdng lan rdng hai ben thanh vdm la 10,9%.
Bing 3: Phan loai theo md benh hi?c:
Mo benh hoc UTBM khdng biet hda UTBM vay
Tong UO
Ty Ig % 94,5
5,5
Nh$n xdt: The md benh hpc hay gap la ung thtf bieu md khong biet hoa, chiem ty le 94,5%, 5,5%
con'lai la ung thtf bleu md vay.
Bang 4: Gia trj SUV eua ton thtfdng u vom nguyen phat va hach cd dl can:
Ton thu'dng
u
suv trung binh 10,B8±4,70
SUV min 2,51
SUV max 24,96 . Hach di can I 7,48±4,79 | 2,56 | 26,22 . Nhan xet: Mire dd hap thu FDG (gia tri SUV trung binh) eua u vdm la 10,88±4,70; cua hach dl cSn li 7,48±4,79.
Bang 5: Gia trj SUV ciia u va giai phau benh GPB
UTBM khdng biet hda " 104
SUV 10,88±4,71
p=0,2
, UTBM vay I 6 | 11,82±5,63 . . Nhin xet: Gii tri SUV trung binh ciia nhdm UTBM khdng biet hoa la 10,88±4,71; nhom UTBM vay 14 11,82±5,63.
Bing 6: Gia tri SUV va kieh thtfdc u Kich thu'dc
<3cm 3-5 cm
>5em n 31 50 29
SUV 7,64±4,31 11,41±4,02 13,43±4,36
SUV min 2,51 3,80 5,43
SUV max 19,20 24,96 23,00
p=0,002
Y Hpc VIET NAM THANG 5 - SO 2/2014
Nhan xdt: Gia tri SUV trung binh tang dan theo nhdm kich thtfdc u <3cm la 7,64±4,31; nhdm 3-5cm la 11,41±4,02; nhdm >5cm la 13,43±4,36 vdi p=0,002.
Bang 7: Gii tri SUV va kich thtfdc hach co di can
Kich thu'dc SUV SUV min
2-4 em
5,58±2,67 10,29±4,06
2,16 13,62±6,82
p=0,001 Nh^n xet: Gia tri SUV trung bmh tang theo nhom k ch thtfdc hach <2cm la 5,58±2,67; nhdm 2-4cm la 10,29±4,06; nhdm >4cm ia 13,62±6,82 vdi p=0,001.
Bang 8: Gia tri SUV va glai doan benh SUV
I 6,16±1,80
10,41±3,69 7,84
7,43 19,20
IIB 24 11,31±4,53 2,51 19,07 p=0,002 III 51 11,83±4,88 345 24,96 _ IV I 21 I 12,97±4,46 I 8,05 | 23,00 I Nh$n xit: Gii tri SUV trung binh tJng din theo giai doan tii' I den IV, eu the: giai doan I la 6,16±1,80; glal doan IIA la 10,41±3,69; giai doan IIB la 11,31±4,53; giai doan i l l la 11,83±4,88; giai doan IV la 12,97±4,46 vdi p=0,002.
Bang 9: Phan loai giai doan benh trtfdc chup PET/CT:
Glal dogn IIA
20 IIB
38 in
38
IVA IVB IVC Tyle% I 2,7 \_ 18,2' I 34,6 I 34,6 | 2,7 | 2,7 | 4,5 . Nhfn xit: Bang cac ky thuat chSn doan thdng thtfdng (kham lam sang, npi soi vdm mui hpng, sinh thiet, chup CT, MRI vdm, sl§u am, xa hinh xtfdng) danh gia ban dau cd 34,6% BN d giai doan IIB, 34,6% d glai doan III, 18,2% d giai doan IIA, 4,5% d glal doan IVC, 2,7% d giai doan I, IVA va IVB.
Bang 10: Phan loai giai doan sau chup PET/CT:
Glal doan I IIA IIB III IVA IVB IVC
11 24 51 11
. Ty le % I 2,7 I 10,0 I 21,8 I 46,4 I 2,7 I 6,4 _ _ I l O i O ^ . Nli0nxit: Sail khi chup PET/CT danh gi^ lai giai doan benh d i cd stf thay ddi: So benh nhSn cd thay doi glal do?n benh la 34/110=30,8%.
Bing 11: So bdnh nhan thay ddi giai doan benh Glal doan bfnh tru'dc chup PET/CT
I IIA IIB I I I IVA IVB IVC Tong
xdt: Trong 34 benh nhan thay ddi giai n 3 20 38 38 3 3 5 doan no
Glai doan benh sau chup PET/CT I
3
3 ben
IIA
11
11 h ed:
IIB
3 21
24 3 ben
I I I
4 17 30
bl h nha
IVA
3
3 n giai
IVB IVC
2 4 4 3 7 doan
5 11 IA pha than hach di c5n ciing 'ben chuySn giai doan IIB, 4 benh nhan giai doan IIA va 17 benh nhan glal doan IIB phat hien hach dl can dol ben hoac tdn thtfdng xam lan nen sp chuyen sang giai dpan III, 4 bfiih nhSn glai doan III phat hien hach di can vimg thtfdng ddn chuyen giai doan IVB, 2 benh nhan glal do?n IIA vi 4'b?nh nhSn glai ddan III phat hien tdn thtfdng di can xa (xtfdng, phoi) chuyen glal do?nIVC.
3.2. Gii tr| cda PET/CT m6 phdng l$p kg hoach x? trj:
Bing 12: So sanh the tich GTV-PET (BTV) vdl GTV-CT
(n=96 benh nhan md phdng lip KHXT)
Y HOC V1|T NAM THANG 5 - S6 2/2014
So sanh GTV-PET (BTV) vdi GTV-CT (NguOng thay doi > 25i°/o the tich)
Tan sd Thay doi
Tang (%) Giam (%) , 74/96 I 77,1 I 21,8 I 55,2 _ . Nhin xet: Sii dung ky thuat PET/CT mo phdng lam thay doi 77,1% the tieh GTTV (the tich khoi u thd), trong dd 21,8% lam tang the tieh GTV va 55,2% giam the tich GTV.
IV. BAN LUAN
Trong sd 110 benh nhan cua nghien cifu cho thay ti ie nam gap nhieu hdn nij' (2,9/1); dp tudi trung binh la S2,l±14,9 (bang 1). Nhdm tudi hay mac benh la 40-60 ehiem 41% (bieu do 1). Ket qua nay phii hdp vdi djeh te hpc chung va cac nghien cifu khac: nghien ciftj eiia Mai Trpng Khoa (2012) ty le nam/ni? la 2,3/1; dp tudi trung binh la 46,1; nhdm tudi 40-60 tudi chiem ty le 55%
[1]; nghien cifu ciia Pham Van Ttiai (2011): ty le nam/nif la 2,6/1; nhdm tudi 40-60 chiem 60%
[2]. Ket qua tren cd the dtfdc giai thich do yeu to nguy cd gay benh ung thtf vdm mui hpng (tien stf hiit thuoc lao, thudc la, udng rtfdu) la thdi quen ciia nam gidi trong nhieu nam.
U vdm nguyen phat va hach di can deu hap thu FDG manh; gia tri SUV eiia u vdm la 10,88±4,70; eua hach dl c5n la 7,48±4,79 (bang 4); tao ra dp ehenh lech cao giiiS tdn thtfdng ung thtf va eae td chtfc lanh xung quanh, chp phep de dang phat hl$n tdn thtfdng va xac djnh ranh gidl eiia Chung. Dieu nay rat cd ieh trong viee ve eac the ti'ch xa trj.
Bang 6 va bang 7 cho thay mtfc dp hap thu FDG ciia tdn thtfdng u va hach di can ty le thuan vdi kieh thtfdc ciia tdn thtfdng (p<0,05): tdn thtfdng cd kieh thtfdc cang Idn thi gia trj SUV cang tSng. Mdi ttfdng quan nay chiing tdi eung thay d cae loai ung thtf khae nhtf ung thtf phoi khdng te bao nhd, lymphoma,... Theo bang S ehiing tdl thay mdi ttfdng quan thuan giifa gia trj SUV ciia u vdm va giai doan benh (p<0,05): giai doan benh sdm tdn thtfdng cd mifc hap thu FDG thap hdn giai doan benh mudn. Nhtf vay mtfc dp hap thu FDG eiia u vdm the hien tien trien ae tinh eiia benh. Nhieu nghidn cifu ntfdc ngoai da chuhg minh md'c hap thu FDG (SUV) ed gia trj trong tien Itfdng benh, thdi gian sdng them. Theo XleP va cs (2010) thi cac khdi u cd mifc dp hap thu FDG thap thi ty le sdng cdn sau 5 nSm va thdi gian sdng them khdng benh cao hdn nhifng bpnh nhan cd mtfc hap thu FDG cao [7]. Nghien
cifu ciia chiJng tdi c^n them thdi gian de theo doi cac benh nhan va du^ ra ket luan ehinh xae hdn.
PET/CT cd dp nhay va dp dae hieu cao (86%
va 87%) trong viec phat hien u vdm, hach di can va di can xa vao cac ed quan khae nhtf xudng, phdi, gan,...[6]. Chup PET/CT toan than giup danh gia dtfdc dp xam lan lan rpng ciia u va car di can, giup phan toal giai doan bdnh ehinh xac hdn. So sanh glai doan benh trtfdc va sau chuj]
PET/CT Chung tdi thay PET/CT phit hien them
diidz tdn thtfdng xam lan nen sp, hach dl canvung cd ddi ben, hach di can hd thtfdng don va cac di can xa vao xtfdng, gan, phdi. Cac phat hien nay rat co y nghia vi thay ddi hoan toan glal doan benh d 34/110 (30,8%), thay ddi phtfdng thtfe dieu tri eung nhtf tien Itfdng benh. Mai Trpng Khoa (2012) stf dung PET/CT de xae djnh giai doan benh ung thtf vdm mui hpng thay thay ddi giai doan d 7/18 (38,9%) [1].
Tren hinh anh CT md phdng xae djnh the tich GTV-CT (the tich khdi u thd) va tr§n hinh anh PET/CT md phdng xac djnh the tich BTV (thi tich khdi u sinh hpc) hay edn gpi la GTV-PET eho thay cd stf khae nhau rd ret, eg the: thay ddi the tich GTV d 77,1% sd benh nhan, trong dd 21,8% la tang the tieh GTV va 55,2% la giam the tich GIV (bang 12). Theo nghien etfu ciia Paulino trdn 40 benh nhan ung thtf dau m$t co, cho ket qua thay ddi the tieh GTV d 93% sd benh nhan, trong do GTV tang d 18% va giam d 75% [5] la vi PET/a xac dinh chinh xac ria ton thtfdng hdn CT. TliS tich GTV-CT trung binh la 125,2±17,9 cm'trang khi the tich GTV-PET trung binh la 94,3±13,2 on' (bang 13). Dieu nay cd nghia la giam the tich x?
trj xuong, han ehe lieu xa vao cac te bao lanh xung quanh, giam bien chirtig. Ben canh di, PET/CT dac biet cd gia trj trong viec phat hien di can hach viing ma tren CT khd phat hien di/flt hach ed kich thtfdc nhd. Dieu nay rat quan trong lam thay ddi GTV, thay ddi lieu xa ttf xa dii phdng sang xa dieu trj, lam tang kha nang kl6n soat tai viing, nang eao hidu qua dieu trj.
76
Y HOC V l ^ N/VM THANG 5 • SO 2/2014
V. KET LUAN
5 . 1 . PET/CT r a t c 6 g i i t r i trong chan doan va x i e djnh chinh xac giai doan benh trong ung thir v o m mui hong: mtfc dp hap thu FDG (gia trj SUV) la rat manh ddi vdi ton thtfdng u vdm (SUV tning binh=10,88) cung nhtf hach di
<3n (SUV trung binh=7,48) giup de dang phat hien tdn thtfdng; gia tri SUV t i Ie thuan vdi kich thude tdn thtfdng va glai doan benh; thay ddi giai doan benh d 30,8% benh nhan, thay ddi htfdng dieu tri cung nhtf giup Hen Itfdng benh tdt hdn.
5.2. PET/CT m o phdng rat co ich trong l$p k £ hoach xa t r j ung thu' v o m mui hpng:
giijp xac djnh chinh xac the tieh khdi u sinh hpc BTV; khdng bd sdt hach viing; thay ddi the tieh xa trj d 7 7 , 1 % cdc b$nh nhan so vdi chup CT m d phdng thdng thtfdng, giam th€ tieh xa trj d 55,2% b$nh nhan, gliip giam lieu btfc xa khdng can thiet vao eae md lanh xung quanh, han che bien chifng. The tieh GTV-PET trung binh la 94,3 cm'so vdl the tich GTV-CT la 125,2 c m ' .
TAI LIEU T H A M KHAO
1. Mai Tr^ng Khoa, Dtf Dtfc Chien, Tian Hai Binh, VQ Hifu Khiem va cs (2012): Bu'dc dau danh gia vai tro cua FDG-PET/CT trong chan doan va lap ke hoach xa tri ung thtf vom mui hong. Tap chi Dien quang Viet i^am 7,180-185.
£. Mai Trpng Khoa va cs (2011): U'ng dung ky thuat xa tri dieu bien ISu (Jo-IMRT) trong dieu tri ung thtf vom mui hpng tai Trung tam Y hpc hat nhan va Ung btfdu Bgnh vien Bach Mai. Tap chl Y hpcthi/c hanh 2,15-21.
3. Mai Trong Khoa: Lfng dung ky thuat PET/CT b'ong ung thtf. Nha xuat ban Y hoc. 2013.
4. Mai Trpng Khoa: Y hpc hat nhan (sach danh dio sau dai hgc), nha xuat ban Y hpc, 2012.
5. Koshy M, Paulino AC, Hovrell R, Schuster D, Halkar D, Davis LW: F-18 FDG PET-CT fusion in radiotherapy b-eatment planning for head and neck cancer. Head and neck canrer 2005, 27(6):
494-502.
6. Lang O, Schneider K, Breunlng A et al 1999 Head and neck cancer: value of F-18 FI3G In primary staging anhd suspicion of recurrence [abstract] J Nud Med 40 (5 Suppl):63P.
7. Xie P, Yue 3a, Fu Z, Feng R, Yu JM: Prognostic value of 18F-FDG PETiCt before and after radiotherapy for locally advanced nasopharyngeal carcinoma. Ann Oncol. 2010 May; 21(5):1078-82.
MOT s d P H A T HIEN QUA GIAM SAT VIEC THirC HIEN
CHfNH SACH PHAP LUAT BAO HIEM Y Tg GIAI DOAN 2009-2012 NGUYEN NHAN VA KHUYEN NGHI
T6MTAT
BSy l i mpt phan kSt q u i nghien ciJu ve bao hiem y te Viit Nam giai doan 2009 - 2012 ciia Trung tam Kinh te y t€ vS GISo iifC, trudng 0?i hoc Kinh te va Quin tr( kInh doanh - Oai hpc Thai Nguyen. K i t q u i : VSn dB S n t;l cd bin 6 d i y l i chua cd stf quan tam sit sao ciia d c cSp chinh quyen dja phudng ddi vdi vljc thiit hi^n mdt chinh sich Idn nhtf BHYT; ngtfdi din chua thtfe stf hiifu biet vS quyen Ipi ciing nhtf nghia v) da bin than ddi vdl vl?c tham gia BHYT; con mdt s5 vudng m k trong khi thtfe thi lu§t BHYT va diinh s i d i nhtf vtfpt tuy?n, t r i i tiiyen, ding ky khim chiia b ^ h ban d3u, ddng chl tri, bao cap ngu'dc, i i ^ chpn ngudc bpl chl qu?, ket dtf quy, phtfong thtfe
'Ban Td chlit dnh uy, tinh Vtii Nguyen
"Ofi hpc Thii liguyin
Phin bifn khoa hpc: GS.TS Ph;in Huy DDng
Pham Hong Hai*, Nguyen Dvc Li^c*'^
thanh toin, giim djnh BHYT... Nghien etfu niy nhim gop them mpt gdc nhin ve vi?c thu'c hlfn chinh sich phip luat BHYT thong qua so iieu thtf cap v i giim sit tnic tiep tai mpt sd tinh.
Td khda; Bao cap ngtfpc, l(ia chpn ngtfpc, phtfdng thtfe thanh toan, giam djnh bao hiiim y t&, dong chi t r i
SUIVIMARY
SOME F I N D I N G S FROM THE SUPERVISION OF HEALTH INSURANCE P O U C Y IMPLEMENTATION FOR THE PERIOD 2 0 0 9 -
2 0 1 2 : ISSUES AND SOLUTIONS This is part a comprehensive study on health insurance in Viemam for the period 2009-2012 in the Center for Health and Education Economic, School of Ecomomic and Business Administration, Thai Nguyen
