中央型非小细胞肺癌体部立体定向放疗临床观察  

Clinical observation of centrally located non-small cell lung cancer patients treated with stereotactic body radiotherapy

作　　者：宋雪[1] 王燕[1] 孔诚[1] 陈诚[1] 江宁[1] 赵丽君[1] 罗燕红 何侠[1] 朱军[1] 朱向帜[1] SONG Xue;WANG Yan;KONG Cheng;CHEN Cheng;JIANG Ning;ZHAOLi-jun;LUO Yan-hong;HE Xia;ZHU Jun;ZHU Xiang-zhi(Department of Radiation Oncology,Jiangsu Cancer Hospital,Jiangsu Institute of Cancer Research,Affiliated Cancer Hospital of Nanjing Medical Universiry,Nanjing 210009,P.R.China)

机构地区：[1]江苏省肿瘤医院江苏省肿瘤防治研究所,南京医科大学附属肿瘤医院放疗科,江苏南京210009

出　　处：《中华肿瘤防治杂志》2020年第7期549-553,共5页Chinese Journal of Cancer Prevention and Treatment

摘　　要：目的早期不可手术的非小细胞肺癌(non-small cell lung cancer,NSCLC)首选治疗方法是立体定向体部放疗(stereotactic body radiation therapy,SBRT)。但由于中央型NSCLC病灶紧邻纵隔重要结构,能否使用SBRT仍处于探索阶段。本研究旨在探讨SBRT对中央型NSCLC的疗效、预后及不良反应的影响。方法收集江苏省肿瘤医院放疗科2012-05-30-2016-09-27SBRT治疗的25例中央型NSCLC患者资料,所选病例均为单发肿块及术后局部复发的中央型NSCLC,放疗前肿瘤直径0.8~6.7cm,中位直径3.7cm。排除有远处转移病例。使用调强放疗或适行放疗技术照射。Kaplan-meier法计算生存率及局部控制率,常见不良反应事件评价标准(common terminology criteria for adverse events,CTCAE)4.0版(2010年)标准评估不良反应。结果全组病例1、2和3年总生存率(overall survival,OS)分别为76%、71%和53%;1年及2年局部控制率(tumor control probability,TCP)分别为84%和71%。随访过程中共10例患者出现疾病进展;单独局部复发2例,单独区域复发1例。全组共3例治疗相关死亡,其中食管穿孔导致出血死亡1例;支气管狭窄导致肺不张造成的呼吸衰竭死亡2例。结论SBRT应用于中央型NSCLC局部控制及生存数据良好,但应注意病例选择及危及器官限量。OBJECTIVE Body stereotactic radiotherapy(SBRT)is an optimal choice for early,inoperable non-small cell lung cancer(NSCLC),which has been confirmed by numerous clinical studies.However,a much debated question is whether SBRT can be used for central lung cancer.The specific objective of this study was to investigate the effect of SBRT on the efficacy,prognosis and toxicity of central lung cancer.METHODS Eligible 25 patients with histologically confirmed central NSCLC from 2012 to 2016 were treated with SBRT.Fifteen patients(60%)with tumor diameter greater than 3 cm and 8 of them(32%)with tumor diameter between 5-7 cm.Kaplan-Meier curves was used to calculate the survival rate and local control rate,and CTCAE v4.0 was used to grade the toxicity.RESULTS Estimated 1-year,2-year and3-year overall survival were 76%,71%and 53%,respectively.One patient had 5 grade adverse event with esophagus.Four patients had grade 4 treatment-related adverse events because of injury of trachea/bronchus,and 2 of them died of tracheal collapse.One patient died for pneumonia.There were two patients with ribs fracture and aerothorax,respectively.CONCLUSION SBRT could be an option for central NSCLC,however,the toxicity of esophageal and airway should be paid attention.

关 键 词：立体定向体部放疗 中央型非小细胞肺癌 疗效 毒性反应 

分 类 号：R734.2[医药卫生—肿瘤]