全身γ刀治疗不能手术Ⅰ和Ⅱ期非小细胞肺癌的临床结果  

Clinical outcome of whole body gamma knife therapy inoperable stage Ⅰ/Ⅱ non-small cell lung

作　　者：夏廷毅[1] 李宏奇[1] 王颖杰[1] 李平[1] 孙庆选[1] 范乃斌[1] 于勇[1] 

机构地区：[1]中国人民解放军空军总医院肿瘤放疗科,北京100036

出　　处：《中华放射肿瘤学杂志》2007年第2期91-97,共7页Chinese Journal of Radiation Oncology

摘　　要：目的评价全身γ刀治疗Ⅰ、Ⅱ期非小细胞肺癌的疗效和放射反应。方法对43例因医学原因不能手术的Ⅰ、Ⅱ期非小细胞肺癌采用国产全身γ刀治疗，用真空负压袋固定体位、慢速CT定位扫描和三维治疗计划。PTV边缘总剂量50%剂量线50 Gy分10次2周完成（肺门肿大淋巴结40 Gy），中心最大剂量80～100 Gy，70 Gy覆盖GTV 90%以上。中位随访时间27个月。结果治疗后3～6个月，原发灶完全缓解率为63%，总有效率为95%。1、2、3年肿瘤局部控制率均为95%，1、2、3年总生存率Ⅰ期分别为100%、91%、91%、Ⅱ期分别为73%、64%、64%、Ⅰ＋Ⅱ期分别为88%、78%、78%。肺早晚期反应较轻，3级放射性肺炎仅1例。放射性食管反应在周围型肺癌中没有，中心型肺癌的9例中，1级8例，2级1例。结论我国独创的全身γ刀治疗早期非小细胞肺癌局部控制率和生存率较好，而且放射反应轻，是一种安全有效的局部治疗手段。Objective To evaluate the efficacy and toxicity of hypofractionated stereotactic body radiotherapy （SBRT） in patients with inoperable stage Ⅰ/Ⅱ non-small cell lung cancer. Methods Forty-three such patients were treated with home-manufactored stereotactic gamma-ray whole-body therapeutic system（whole body gamma-knife radiotherapy, QGD; OUR International Technology ＆ Science Co., LTD, Shenabon, China） with 30 rotary conical-surface ^60Co sources on the target volume. For whole body-γ-knife treatment,a stereotactic body frame for exact tumor localization, reproducible vacuum fixation, low-speed computed tomagraphy simulation were conducted, which was followed by three-dimensional conformal radiotherapy planning. A total dose of 50 Gy was delivered at 5 Gy/fraction to the 50% isodose line covering the planned target volume, with a total dose of 70 Gy delivered at 7 Gy/fraction to the gross target volume. The median follow-up duration was 27 months. Results Three to six months after treatment, the complete response rate for whole body-gamma knife radiotherapy was 63%, and the overall response rate was 95%. The 1-, 2-, and 3-year local control rates were all 95%. In stage Ⅰ patients, the 1-, 2-, and 3-year overall survival rate was 100%, 91%, and 91%, respectively. In patients with stage Ⅱ, it was 73%, 64%, and 64%, respectively. In patients with stage Ⅰ＋Ⅱ,it was 88% ,78% ,and 78%. Only 2 % （1/43） of the patients had grade 3 pneumonitis. Conclusion Our highly focused stereotactic body radiotherapy method has resulted in promising local control and survival with minimal toxicity.

关 键 词：癌 非小细胞肺/立体定向放射疗法 全身Γ刀 治疗效果 临床结果 

分 类 号：R686[医药卫生—骨科学]