体部伽玛刀治疗非小细胞肺癌的效果及其影响因素  

Clinical Effect and Influencing Factors of Body Gamma Knife Radiotherapy for Non-small Cell Lung Cancer

作　　者：杨新辉[1] 苏加利[1] 周光华[1] 刘利民[1] 廖海丽[1] 易正生[1] 

机构地区：[1]解放军第163医院,湖南长沙410003

出　　处：《医学临床研究》2008年第2期236-239,共4页Journal of Clinical Research

摘　　要：【目的】评价体部伽玛刀治疗非小细胞肺癌（NSCLC）的疗效，探讨影响疗效的相关因素。【方法】对332例I～Ⅲ期NSCLC患者应用体部伽玛刀治疗，治疗方案为50％～80％剂量曲线4～8Gy／次，每周5次，生物等效剂量56～90Gy。治疗开始计算生存时间，治疗结束后1个月评价近期疗效。对不同性别、年龄、卡氏评分、肿瘤大小、病理类型、肿瘤位置、临床分期、生物等效剂量对近期疗效及3年生存率的影响进行分析。【结果】332例患者近期总有效率为88．86％（295／332），其中完全缓解率为29．52％（98／332），1、2、3年总生存率分别为90．94％、66．33％、37．86％。年龄大、卡氏评分低、肿瘤大、临床分期晚、生物等效剂量低的患者近期总有效率及3年生存率下降。主要的急性放射反应为白细胞下降、放射性食管炎及放射性肺炎，其发生率分别为27．71％、30．42％、19．88％。三种放射反应均为I～Ⅱ级。【结论】体部伽玛刀高分次短疗程治疗NSCLC的疗效较好，急性放射反应发生率低，程度轻，对于不愿或不能手术的早中期NSCLC病人是一种较好的治疗方法。年龄、卡氏评分、肿瘤大小、临床分期、生物等效剂量是影响预后的主要因素。[Objective] To evaluate the clinical effect and radiation reactions of body gamma knife radio-therapy for non-small cell lung cancer patients. [Methods] Three hundred and thirty two patients with non- small cell lung cancer were treated with body gamma knife and regularly followed up. They received biological effective dose from 56Gy to 90Gy, 4～8Gy/fraction （50% ～80% dosage curve）, 5fractions/ week. The influence of sex, age, Karnofsky performance score, clinical stage, pathological type, tumor size, tumor location and biological effective dose on the short-term effect and 3-year survival was observed. Effects and radiation reaction were analyzed by X^2 test. And survival rate was calculated by Kaplan-meier method and log-rank test. [Results] The overall response rate was 88.86% in 332 cases, and complete response rate was 29.52%. The 1,2,3-year overall survival rates were 90. 940/00, 66. 330/00, 37. 860/00 respectively. The main radiation reactions were leucopenia, local radiation pneumonia and radiation esophagitis, and their incidence were 27.21%, 19. 88% and 30.42 0% respectively. These radiation reactions were grade I ～II . All patients could tolerate this therapy. Short-term effective rate and 3-year survival in patients with old age, low Karnofsky performance score, big tumor, late clinical stage and low biological effective dose had decreased. [Conclusion] Body gamma knife radiotherapy for non-small cell lung cancer patients is effective. The radiation reactions are mild. The important factors influencing therapeutic effect are age, Karnofsky performance score, tumor size, clinical stage and biological effective dose.

关 键 词：癌 非小细胞肺/外科学 Γ射线 放射外科手术 

分 类 号：R730.26[医药卫生—肿瘤]