射波刀治疗脑转移瘤临床疗效分析  

Clinical outcomes of Cyberknife in brain metastases

作　　者：王志震[1] 于海丽[1] 袁智勇[1] 王平[1] 

机构地区：[1]天津医科大学附属肿瘤医院放疗科,300060

出　　处：《中华放射肿瘤学杂志》2009年第4期295-298,共4页Chinese Journal of Radiation Oncology

摘　　要：目的回顾性分析射波刀（Cyberknife）治疗脑转移瘤临床疗效。方法搜集2007年前1年天津肿瘤医院资料完整、射波刀治疗的脑转移病例40例，其中原发灶为肺癌27例、乳腺癌4例、消化道肿瘤4例、肾癌1例、原发灶不明4例。脑转移病灶共计68个，最大直径0．4—7．5cm，平均1．9cm。在脑转移发现时，35例患者原发病经手术或化疗达到部分缓解或者稳定状态。射波刀治疗以计划靶体积几何中心为射野等中心及剂量归一点，通过数百个方向的射线束照射，使得80％等剂量面必须包括95％以上计划靶体积。采用低分割照射5～25Gy／次，1—5次，总剂量18—36Gy。结果失访2例，随访率为95％。射波刀治疗后1周评价临床症状改善有效率为90％（36例），3个月后复查颅脑强化CT或MRI后的病灶治疗有效（CR＋PR＋SD）率为94％（64／68）。3个月局部控制率、1年生存率分别为78％（53／68）、68％（27例）。在原病灶范围以外出现新发病灶14例（35％）；新发病灶与年龄、是否行全脑放疗、肿瘤数目、肿瘤最大直径、射波刀单次治疗剂量、治疗次数和总治疗剂量等因素无关。结论单纯射波刀作为脑转移首程治疗临床效果较好。Objective To retrospectively analyze clinical outcomes of brain metastases treated with Cyberknife. Methods From Aug. 2006 to Aug. 2007, 40 patients with brain metastases treated with Cyberknife in Tianjin Cancer Hospital were included. Totally 68 brain metastatic lesions were treated. The maximal diameter was 0.4 - 7.5 cm （ average 1.9 cm）. The primary tumor of 35 patients was partial re- ponse or stable to the previous treatment at the diagnosis of brain metastasis. The geometric center of target volume was set as the isocenter and the nominal standard dose point. More than 95% target volume was covered by 80% isodose surface. Hypofractionated radiation was 18 - 36 Gy given in 1 - 5 fractions of 5 - 25 Gy. Results The Follow-up rate was 95%. The clinical symptom remission rate （including complete and partial remission） at one week after Cyberknife treatment was 90% （36/40）. The therapeutic effective rate （CR ＋ PR ＋ SD ） was 94% （64/68） after three months follow-up, which was evaluated by contrast-enhanced CT or MRI. The 3-month local control and 1-year survival rates were 78% （53/68） and 68% （27/40）. New brain metastatic lesions outside the radiation field occurred in 14 patients within 3 months, which was independent of age, whole brain iiradiation, number or maximal diameter of original lesions, fraction dose, frequency or total dose of Cyberknife treatment. Conclusions Cyberknife, used as the primary treatment of brain metastases, can achieve good clinical outcomes.

关 键 词：肿瘤转移 脑/放射疗法 射波刀 治疗结果 

分 类 号：R686[医药卫生—骨科学]