局部晚期非小细胞肺癌体部伽玛刀治疗的临床研究  

Clinical study on γ-ray sereotactic radiotherapy for stage Ⅲ non-small cell lung cancer

作　　者：郁志龙[1] 牛广明[1] 张保祯[1] 张哲林[1] 杨桂荣[1] 陈妍[1] 赵建国[1] 杨昭义[1] 

机构地区：[1]内蒙古医学院附属医院放疗科,内蒙古呼和浩特010050

出　　处：《中华肿瘤防治杂志》2006年第17期1329-1332,共4页Chinese Journal of Cancer Prevention and Treatment

摘　　要：目的：观察立体定向伽玛射线（体部伽玛刀）放射治疗Ⅲ期非小细胞肺癌（non-small cell lungcancer，NSCLC）的近期疗效和急性放射反应。方法：将92例不接受手术及化疗的Ⅲ期NSCLC患者，随机分为伽玛刀组和普通放疗组。普放组45例，采用常规放射治疗，Dr64～66Gy。伽玛刀组47例，采用螺旋CT下扫描定位，对计划靶区（planning target volume，PTV）在50％等剂量线处给定处方刺量4～8Gy／次，共治疗5～13次，3次／周，隔日治疗，总剂量40～52Gy，分2～4周完成。结果：全组病例全部随访1年以上，普放组总有效率．CR、PR、NC．PD．局部控制率、1年生存率和3年生存率分别是55．5％（25／45）、22．2％（10／45）、33．3％（15／45）、22．2％（10／45）、22．2％（10／45）、77．7％（35／45）、40．O％（18／45）和6．7％（2／30）；伽玛刀组总有效率、CR、PR、NC、PD、局部控制率、1年生存率和3年生存率分别是78．7％（37／47）、29．8％（14／47）、48．9％（23／47）、10．6％（5／47）、10．6％（5／47）、89．3％（42／47）、44．7％（21／47）和25．0（8／32）。两组总有效率比较差异有统计学意义，χ^2=5．6223，P=0．017；1年局部控制率比较差异无统计学意义，χ^2=2．4326，P=0．132；1年生存率比较差异无统计学意义，χ^2=1．8734，P=0．191；3年生存率和局部控制率比较差异有统计学意义，χ^2=3．9412，P=0．046。无严重放射反应。结论：立体定向伽玛射线放射治疗是一种定位精确、局控率高且并发症少的精确放射疗法，可有效提高不能手术的Ⅲ期NSCLC患者生存质量，有望改善生存期。OBJECTIVE： To assess the immediate response and acute side effects of y-ray stereotactic radiotherapy （γSRT） for 47 patients with inoperable stage Ⅲ non-small cell lung cancer （NSCLC）. METHODS： From April 2000 to April 2003, 92 patients with NSCLC were randomized into conventional radiotherapy group （CRT） and γSRT group. Dr 64-66 Gy were given to 45 patients in CRT group by common means. There were 47 patients in γSRT group, which were treated with OUR-QGD stereotactic γ-ray therapeutic system under the guide of computer tomography imaging. Each lesion was given a 50% isodose curve coverage PTV and 4-8 Gy peripheral dosage per fraction, 3 fractions per week with the total dosed ranging from 40-52 Gy and finished in two-four weeks. RESULTS： The complete response （CR） and overall response rates in the CRT group and the γSRT group were 22.2%（10/45） ,55.5%（25/45） and 29.8%（14/47）, 78.7% （37/47）, respectively. The differences were significant （χ^2=5. 6223,P=0. 017）. The 1-year overall survival rate and local control rate of the CRT group were 40% （18/45） and 77.7% （35/45）, respectively, the 1-year overall survival rate and local control rate of the γSRT group were 44.7%（21/47） and 89.3% （42/47）. Their differences were not significant （χ^2=1. 8734,P= 0. 191 and χ^2 = 2. 4326, P= 0. 132, respectively）. The 3-year overall survival rate and local control rate were different between the two groups-the values of the CRT group were 6.7% （2/30） and 6.7% （2/30） respectively, whereas 25% （8/32） and 25% （8/32） of the γSRT group. The difference was significant （χ^2= 3. 9412, P= 0.046）. The sever acute side effects were not occurred in the course of γSRT. CONCLUSION： γSRT is a feasible, safe, and effective radiotherapy method, and could be well tolerated in most of patients, especially for elder patients. It can increase the local control rate and decrease the incidence of radiation induced normal tissue toxicity within a more short

关 键 词：癌 非小细胞肺/放射疗法 立体定位技术 Γ射线 放射外科手术 

分 类 号：R734.2[医药卫生—肿瘤]