立体定向放疗治疗老年Ⅰ期肺癌的不良反应和疗效观察  

Stereotactic body radiotherapy for elderly patients with stage I lung cancer:toxicity and effectiveness

作　　者：施世明[1] 何健[1] 黄艳[1] 胡永[1] 沈亚[1] 张建英[1] 曾昭冲[1] 

机构地区：[1]复旦大学附属中山医院放疗科,上海200032

出　　处：《复旦学报（医学版）》2016年第2期188-194,共7页Fudan University Journal of Medical Sciences

基　　金：上海市科学技术委员会医学引导类项目(14411970100)~~

摘　　要：目的评估立体定向放射治疗技术(stereotactic body radiotherapy,SBRT)治疗70岁及以上老年Ι期肺癌患者的不良反应和疗效。方法根据入选标准收集2011年6月至2013年6月期间的30例Ⅰ期肺癌老年患者,所有患者使用螺旋断层放疗系统(tomotherapy system,TOMO)配合四维计算机断层扫描(4-dimensional computed tomography,4D-CT)呼吸时相融合控制技术进行SBRT治疗。周围型病灶为50 Gy/5F,中央型病灶为60 Gy/10F。放疗结束后随访观察不良反应和疗效。结果中位随访时间为28.3个月。1年和2年局部控制率(local control rate,LCR)均为77.9%,1年和2年无进展生存率(progression-free survival,PFS)分别为66.7%和56.4%,1年和2年总生存率(overall survival,OS)分别为96.7%和92.1%。2级和3级急性放射性肺炎的发生率分别为6.6%和3.3%。中央型与周围型病灶相比,治疗效果及不良反应差异无统计学意义。结论使用TOMO配合4D-CT呼吸时相融合控制技术对老年Ⅰ期肺癌患者进行SBRT治疗,患者耐受良好,对周围型和中央型肺癌均可取得较好的LCR和OS,是一种安全有效的治疗手段。Objective To evaluate the toxicity and effectiveness after stereotactic body radiotherapy（SBRT）for elderly patients（age≥70 years）with stage Ⅰ lung cancer. Methods Thirty eldly patients with stage I lung cancer were recruited between June 2011 and June 2013 with strict inclusion criteria.All patients were treated with SBRT via helical tomotherapy combined with4D-CT respiratory gating system.A total of 60 Gy in 10 fractions was delivered in the central tumors,while 50 Gy in 5fractions in the peripheral tumors.The clinical follow-up was performed regarding to toxicity and effectiveness after treatment. Results The median follow-up period was 28.3 months.One-and twoyear local control rates（LCR）were all 77.9%.One-and two-year progression-free survival（PFS）rates were 66.7% and 56.4%,respectively.One-and two-year overall survival（OS）rates were96.7% and92.1%,respectively.The incidence of grade 2 and grade 3 radiation pneumonitis were 6.6% and3.3%.No significant difference was found in the toxicity and effectiveness between the central and the peripheral tumors. Conclusions Treatment of SBRT via helical tomotherapy combined with 4D-CT respiratory gating system was feasible and well tolerated for elderly patients with stage I lung cancer,and resulted in excellent LCR and OS for both peripheral and central tumors.

关 键 词：立体定向放射治疗 肺癌 老年 疗效 

分 类 号：R734.2[医药卫生—肿瘤]