立体定向放射治疗Ⅰ期非小细胞肺癌临床分析  

Steretacitc radiotherapy(SRT) for Stage I non-small-cell lung cancer(NSCLC)

作　　者：王鹏[1] 黄勇[1] 潘绵顺[1] 

机构地区：[1]合肥脑科医院肿瘤放射治疗中心,230022

出　　处：《临床肺科杂志》2005年第6期741-743,共3页Journal of Clinical Pulmonary Medicine

摘　　要：目的使用立体定向放射治疗52例Ⅰ期非小细胞肺癌的临床效果,并探讨使用淋巴引流区照射的价值.方法从1998年6月～2003年6月共有52例因医学原因或者拒绝手术Ⅰ期非小细胞肺癌患者接受了根治性立体定向放射治疗.所有患者均接受根治性立体定向放射治疗,治疗方案为边缘剂量6Gy×7次和7Gy×6次,以60%～90%的等剂量曲线包括靶区,每周4次,总疗程不超过2周,其中有23例患者同时接受淋巴引流区照射.结果中位随访期为20个月(范围:8～60个月);1、2、3年的局部控制率分别为88%,69%,63%;1、2、3年的生存率分别为73%,51%,34%;7Gy×6次生存率和6Gy×7次之间无显著性差异.接受与未接受淋巴引流区照射之局部控制率,生存率之间无显著差异.未出现严重早和晚反应放射毒副反应.结论立体定向放射治疗是治疗Ⅰ期非小细胞肺癌安全有效的治疗方法;它缩短治疗总时间,提高了肿瘤吸收剂量;不进行淋巴引流区照射不影响局部控制率和生存率.Objective To review the clinical outcome of 52 Stage Ⅰ non-small-cell lung cancer treated by stereotactic radiotherapy （SRT） using a stereotactic body frame and to investigate the value of elective nodal irradiation in this study group. Methods Between 1998 and 2003, 52 patients were treated with SRT for un-operable stage I histologically confirmed non-small- cell lung cancer; 24 with TiN0 and 28 with T2N0 disease. All patients were treated with SRT to a total dose of 42 Gy given daily with doses of 6 or 7 Gy every other day. Prognostic factors were analyzed with respect to their impact on overall survival. 29 patients received radiotherapy （RT） directed to elective regional lymphatics to doses of 45 50 Gy. The remaining 23 patients were treated to limited fields confined to the primary lung cancer with a margin. The patterns of failure were reviewed. Results The median follow-up was 20 months （ranging between 8 and 60 months）. The actuarial localeontrol rate was 88%, 69%, and 63%, at 1, 2, and 3 years, respectively. The actuarial overall survival rate was 73%, 51%, and 34% at 1, 2 and 3 years, respectively. The RT dose was the only factor predicting the overall survival in our analysis. There was no difference in local control and survival between limited fields of irradiation and of elective regional lymphatics irradiation. No serious acute and late radiation reactions have been encountered. Conclusion Steretotacitc radiotherapy is a feasible, safe, and effective procedure with reduced overall treatment time and higher local absorption dose for Stage Ⅰ non-small-cell lung cancer. Elective nodal failures were uncommon in the group treated with limited RT fields. However, further investigation in a larger patient population with extended follow-up is needed.

关 键 词：Ⅰ期非小细胞肺癌 医学原因 立体定向放射治疗 放射反应 癌临床分析 淋巴引流区 局部控制率 肺癌患者 毒副反应 等剂量曲线 

分 类 号：R734.2[医药卫生—肿瘤]