局部晚期非小细胞肺癌的高龄患者采用全身γ刀SBRT治疗临床观察  

Clinical analysis of whole body γ-knife radiotherapy for the elderly patients with locally advanced non-small cell lung cancer

作　　者：庞军[1] 陈浩涛[1] 陈燕[1] 姜林[2] 郝光远[3] 李长青[4] 

机构地区：[1]武警湖北省总队医院伽玛刀中心,湖北武汉430061 [2]武警湖北省总队医院肿瘤科,湖北武汉430061 [3]武警湖北省总队医院影像科,湖北武汉430061 [4]湖北省肿瘤医院放疗科,湖北武汉430079

出　　处：《中国癌症杂志》2012年第4期295-299,共5页China Oncology

摘　　要：背景与目的:体部立体定向放射疗法(stereotactic body radiation therapy,SBRT)治疗早期非小细胞肺癌(non-small cell lung cancer,NSCLC)具有较好的疗效,但对局部晚期NSCLC的治疗报道相对较少。该研究旨在探讨全身γ刀SBRT治疗高龄局部晚期NSCLC的疗效、不良反应及临床应用的可行性。方法:采用超级γ刀(SGS-Ⅰ型)治疗高龄局部晚期NSCLC患者68例,根据肿瘤的位置、临床靶体积、患者的身体状况与治疗目的,制定放射治疗计划。肿瘤体积56.9～1 097.0 cm3,等剂量曲线50%～60%,周边照射总剂量35～45 Gy,分割处方剂量3.5～5.0 Gy,重复治疗8～12次,每周5次。治疗前按定位时体位复位,再次CT扫描离线体位验证及调整计划靶体积(planned target volume,PTV)剂量分布。采用Kaplan-Meier法计算局部控制率和生存率。结果:68例患者治疗后中位随访18个月,随访率为100%。治疗结束后2～3个月经过CT复查,24例(35.29%)肿瘤消失,42例(60.29%)肿瘤缩小,2例(4.41%)无变化,总有效率为95.59%。1年局部控制率分别为61.76%。1、2、3年总生存率分别为82.35%、34.04%和20.69%。2级放射性肺炎及食管炎发生率分别为16.18%和19.12%,无2级以上放射性肺炎、食管炎的发生。PTV和验证靶区适形指数分别为0.41±0.08和0.39±0.12(t=0.09,P>0.05)。结论:全身γ刀SBRT治疗局部晚期NSCLC高龄患者临床疗效确切,不良反应较轻。Background and purpose： An definitive effect has been seen in the treatment for the patients with early stage non-small cell lung cancer （NSCLC） using body stereotactic radiotherapy, but the reports were relatively few in the patients with local advanced NSCLC. In this study, we evaluated the early effect and acute radiation reaction and the clinical application of stereotactic radiotherapy with whole body 7-knife in the elderly patients with local advanced NSCLC. Methods： From Mar. 2007 to Aug. 2010, 68 elderly patients with local advanced NSCLC were treated using stereotactic radiotherapy with super-T-knife. The total radiation dose was 35-45 Gy, 3.5- 5.0 Gy per fraction （50%-60% isodose line）, one fraction per day, 5 days a week. Before treatment, the position and dose verification and correction were investigated by offline CT scanning. The effect and side effect of stereotactic radiotherapy were analyzed. Results： The follow-up rate was 100%. In 68 patients, the tumor shrinked in 24 （35.29%） patients, reduced in 41 （60.29%） patients, and unchanged in 3 （4.41%） patients with a response rate of 95.59% in 3 months after treatment. A median follow-up were 18 months （3-36 months）, and local control rate at 1 year was 82.35%. The 1, 2 and 3-year overall survival rates were 61.76%, 34.04% and 20.69% respectively. 12 and 13 patients （16.18% and 19.12%） developed grade 2 radiation pneumonitis and esophagitis respectively no late lung and esophagus toxicity were observed. The conformity index of plan target volume and correction target volume were 0.41-0.08 and 0.394-0.12 respectively （t=0.09, P〉0.05）. Conclusion： The clinical results of stereotactic radiotherapy with super-y-knife for the elderly patients with local advanced NSCLC are definitive and safe with mild side effect.

关 键 词：高龄 非小细胞肺癌 全身Γ刀 体部立体定向放射疗法 

分 类 号：R734.2[医药卫生—肿瘤]