体部γ刀治疗异时性双肾癌疗效初探  

The therapeutic effect of stereotactic γ-ray body radiation therapy for patients with asynchronous bilateral renal cell carcinoma

作　　者：王逸君[1] 张立娜[1] 常冬姝[1] 李宏奇[1] 王颖杰[1] 夏廷毅[1] 

机构地区：[1]解放军空军总医院肿瘤放疗科,北京100142

出　　处：《中华放射医学与防护杂志》2014年第2期125-128,共4页Chinese Journal of Radiological Medicine and Protection

摘　　要：目的 探讨体部γ刀治疗异时性双肾癌的可行性、临床疗效和放射损伤情况.方法 回顾性分析2002年至2012年间9例一侧肾癌根治术后发生对侧肾癌,但无再次手术机会的异时性双肾癌患者接受体部γ刀治疗资料.治疗采用OUR-QGD型立体定向γ射线全身治疗计划系统.放疗计划要求50％剂量线覆盖计划靶体积（PTV）,70％剂量线覆盖大体靶体积（GTV）.以50％剂量线为处方剂量线,单次照射量3～5 Gy,1次/d,5次/周.PTV边缘总剂量36～51 Gy,GTV边缘总剂量60 ～ 85 Gy.计算局部控制率和生存率.结果 随访截至2013年3月,随访率100％.9例患者中,完全缓解1例,部分缓解4例,稳定3例,进展1例,总有效率55.6％.1、3、5年局部控制率分别为64.8％、43.2％、43.2％.全组患者放疗后中位生存期24（3～ 122）个月,1、3、5年总生存率分别为66.7％、53.3％及35.6％.急性放射反应4例,包括骨髓抑制1级2例、胃肠反应1级2例；晚期放射反应2例,均为胃肠反应2级.所有患者放疗后KPS评分较前提高,肾功能基本正常.结论 初步显示体部γ刀治疗异时性双侧肾癌安全有效,是一种可以选择的治疗方式.Objective To preliminarily evaluate the feasibility,therapeutic effect and normal tissue complications of stereotactic γ-ray body radiation therapy for patients with asynchronous bilateral renal cell carcinoma.Methods Nine patients with inoperable asynchronous bilateral renal cell carcinoma with a median time from the resection of the primary focus and discovery of the contralateral focus underwent stereotactic γ-ray body radiotherapy with OUR-QGD stereotactic γ-ray whole body therapeutic planning system.50％ isodose line,as the prescription dose line,was to cover the planning target volume （PTV） and the 70％ isodose line was to cover the gross target volume （GTV）.Radiotherapy was delivered,with a single dose of 3-5 Gy per fraction,one fraction per day,5 fractions per week,and totally 10-17 fractions.The PTV edge total dose was 36-51 Gy,and the GTV edge total dose was 60-85 Gy.The patients were followed up for a median time of 24 months to evaluate the local control rate and overall survival rate.Results Of the 9 patients,1 presented complete remission （11.1％） and 4 partial remission （44.5％）,with a total effective rate of 55.6％.The 1-,3-,and 5-year local control rates were 64.8％,43.2％,and 43.2％ respectively.The 1-,3-,and 5-year overall survival rates were 66.7％,53.3％,and 35.6％ respectively.Four patients （44.4％） had acute radiation reaction：2 cases with grade l leukocytopenia and 2 cases with grade 1 gastrointestinal reactions.Two patients showed grade 2 late radiation-induced reaction in gastrointestinal system.The Karnofsky score was significantly increased and the renal function was normal after radiotherapy.Conclusions Stereotactic γ-ray body radiation therapy is safe and effective in the treatment of asynchronous bilateral renal cell carcinoma.

关 键 词：肾癌 体部Γ刀 双侧肿瘤 

分 类 号：R737.11[医药卫生—肿瘤]