γ射线体部立体定向放射治疗中晚期及复发性非小细胞肺癌39例临床观察  

Clinical Observation of Stereotactic Body Radiation Therapy in the Treatment of 39 Patients with Moderate and Advanced and Recurrent Non-Small Cell Lung Cancer

作　　者：周宁[1] 欧阳志勇[1] 张佳宁[1] ZHOU Ning;OUYANG Zhi-yong;ZHANG Jia-ning(Gamma Knife Therapy Center,Bethune International Peace Hospital of PLA,Shijiazhuang 050082,China)

机构地区：[1]解放军白求恩国际和平医院伽玛刀中心,石家庄050082

出　　处：《临床误诊误治》2018年第10期13-16,共4页Clinical Misdiagnosis & Mistherapy

基　　金：国家重点研发计划项目(2017YFC0113700)

摘　　要：目的观察γ射线体部立体定向放射治疗(stereotactic body radiation therapy,SBRT)中晚期及复发性非小细胞肺癌(non-small cell lung cancer,NSCLC)的临床效果及安全性。方法回顾性分析2015年1月—2016年7月在我院伽玛刀中心接受治疗的失去手术时机或术后、化疗后复发的39例中晚期NSCLC临床资料,病情评估后给予SBRT治疗,对计划靶区体积(PTV)<3 cm者采用孔径适当的单靶点照射,对PTV>3 cm者采用孔径不同的多靶点组合照射。治疗平均总剂量42 Gy,分4~13次治疗,每周5次。治疗3个月后采用WHO实体瘤近期疗效评价标准评价近期疗效,治疗后6个月采用行为状态量表(KPS)评估患者生活质量,观察治疗期间放射性损伤发生情况。结果 39例治疗后3个月完全缓解10例(25. 64%),部分缓解26例(66. 67%),总有效率为92. 31%。治疗后患者KPS评分改善,KPS评分≥70分者所占比例显著高于治疗前(χ~2=12. 745,P=0. 025),且随访2年病情稳定。治疗期间发生Ⅱ级以下消化道反应8例(20. 51%),Ⅱ级以下放射性肺损伤及放射性食管炎各3例(7. 69%),经对症处理症状消失,均无严重放射性损伤及心脏、脊髓等部位损伤发生。结论 SBRT治疗中晚期及复发性NSCLC的局部控制率优于常规放疗,可明显改善患者生存质量,且不良反应少。Objective To observe clinical effect and safety of stereotaetie body radiation therapy （SBRT） in the treatment of patients who had moderate and advanced and recurrent not-smal cell lung cancer （NSCLC）. Methods Clinical data of 39 patients with moderate and advanced NSCLC who missed the opportunities for surgery in Gamma Knife Therapy Center in our hospital and who had recurrence after surgery or chemotherapy between January 2015 and July 2016 were retrospectively analyzed. SBRT was given after evaluation of severity of the condition, and reasonable aperture of single target point irradiation and different apertures of multi-target points combination irradiation were respectively pertbmled for PTV less than 3 cm and PTV larger than 3 cm. Mean total dose was 42 Cy, and it was divided into 4-13 times for treatment 5 times a week. After 3 months of treatment, the short-tern1 efficacy was evaluated by the short-tern1 efficacy evaluation criteria of WHO solid tumors. Karnofsky Pertbmlance Status （KPS） was used to assess the quality of life of patients 6 months af}er treatment, and the occmTence of radiation-induced injury during treatment was obsmwed. Results Three months after treatment, lesions were completely disappeared in 10 patients （25.64%）, partial remission was found in 26 patients （66.67%）, and the total effective rate （ CPt ＋ PR） was 92.31%. Kamofsky score was improved after treatment, the proportion of KPS score≥70 was significantly higher than that before treatment （ χ^2 = 12. 745, P = 0. 025 ） , and the condition was stable dming 2-year follow-up. During the treatment, there were 8 eases （20.51%） of gastrointestinal reactions （ 〈 grade II ）, 3 eases （7.69%）of radiation-induced lung injury （ 〈 grade II ） and 3 cases of radiation esophagifis （ 〈 grade II, 7.69% ）. The symptoms disappeared after symptomatic treatment. There was no serious radiation-induced injury or injuries of the body parts, including the heart and the spinal cord. Conclusion The l

关 键 词：癌 非小细胞肺 放射外科手术 治疗结果 

分 类 号：R730.26[医药卫生—肿瘤]