小细胞肺癌全脑放疗后再发病灶立体定向放疗的临床分析  

Clinical analysis of stereotactic radiotherapy for recurrent lesions of small cell lung cancer after whole brain radiotherapy

作　　者：田智峰 杜德希[2] 朱明琪[2] 周亿哲 叶永来 王永辉[2] 卜丽娜[3] 魏启春 Tian Zhifeng;Du Dexi;Zhu Mingqi;Zhou Yizhe;Ye Yonglai;Wang Yonghui;Bu Lina;Wei Qichun(Radiotherapy Department,the Second Affiliated Hospital,Zhejiang University School of Medicine,Hangzhou 310009,China;Radiotherapy Department,Lishui Municipal Central Hospital,Lishui 323000,China;Respiratory Department,Xi'an No.3 Hospital,Xi’an 710018,China)

机构地区：[1]浙江大学医学院附属第二医院放疗科,浙江杭州310009 [2]丽水市中心医院放疗科,浙江丽水323000 [3]西安市第三医院呼吸科,陕西西安710018

出　　处：《实用肿瘤杂志》2023年第5期447-455,共9页Journal of Practical Oncology

基　　金：浙江省医药卫生科技计划项目(2020KY1079);陕西省科技厅重点研发一般项目基金(2019SF-208)。

摘　　要：目的评价小细胞肺癌全脑放疗后再发病灶立体定向放疗的疗效及安全性。方法收集2015年1月至2019年12月于丽水市中心医院经全脑放疗后的再发脑转移病灶(18个病灶)给予再程立体定向放疗的13例小细胞肺癌患者,对再程放疗的疗效及不良反应进行回顾性分析。结果治疗3个月后影像学评估18个病灶,完全缓解3个(16.7%),病灶最大径≤20 mm;部分缓解12个(66.7%),其中病灶最大径≤20 mm 3个,21~30 mm 4个,>30 mm 5个;疾病稳定2个(11.1%),病灶最大径21~30 mm;疾病进展1个(5.6%),病灶最大径>30 mm。再程立体定向放疗后3个月的客观缓解率为83.3%。按照美国肿瘤放射治疗协作组(Radiation Therapy Oncology Group,RTOG)放疗毒性分级标准(中枢神经系统)评估,13例患者中,0级2例,1~2级7例,3级4例。11例有相应症状,主要表现为头晕、头痛和恶心呕吐。再程放疗前后1个月内接受化疗6例,其中中枢神经系统毒性反应3级3例(50.0%);未行化疗的7例中,中枢神经系统毒性反应3级1例(14.3%)。13例中影像学提示脑放射性坏死3例。结论经过全脑放疗的小细胞肺癌患者,再发脑转移病灶挽救性立体定向放疗安全可行。放射性脑坏死作为严重并发症发生率较低,可能与病灶最大径以及放疗剂量高低相关,≥3级的中枢神经系统毒性反应在1个月内接受全身化疗患者中更多见。Objective To evaluate the efficacy and safety of stereotactic radiotherapy for recurrent lesions after whole-brain radiotherapy for small cell lung cancer.Methods From January 2015 to December 2019,13 patients with small cell lung cancer who received the second course of stereotactic radiotherapy for recurrent brain metastases(18 lesions)after whole brain radiotherapy in Lishui Municipal Central Hospital were collected,and the efficacy and adverse reactions of the second course of radiotherapy were retrospective analyzed.Results After 3 months of treatment,18 lesions were evaluated by imaging.Three lesions(16.7%)had complete response,with maximum diameter≤20 mm.Twelve lesions(66.7%)had partial response,among which,three had maximum diameter≤20 mm,four had maximum diameter from 21 mm to 30 mm,and 5 had maximum diameter>30 mm.Two lesions(11.1%)had stable disease,with maximum diameter ranging from 21 mm to 30 mm.One(5.6%)had progressive disease,with maximum diameter>30 mm.The objective response rate(ORR)was 83.3%at 3 months after the second course stereotactic radiotherapy.According to the Radiation Therapy Oncology Group(RTOG)radiation toxicity classification criteria(central nervous system,CNS),among the 13 patients,there were two cases of grade 0,7 cases of grade 1-2,and 4 cases of grade 3.Eleven patients had corresponding symptoms,mainly including dizziness,headache,nausea and vomiting.Six patients received chemotherapy within 1 month before and after re-irradiation,grade 3 CNS toxicity occurred in three patients(50.0%);Among the seven patients without chemotherapy,grade 3 CNS toxicity occurred in one patient(14.3%).Among the 13 patients,3 patients showed radiation brain necrosis.Conclusions Salvage stereotactic radiotherapy is safe and feasible for patients with small cell lung cancer after whole brain radiotherapy.As a serious complication,radiation-induced brain necrosis has a low incidence,which may be related to the maximum diameter of the lesion and the level of radiotherapy dose.Central nervous system

关 键 词：小细胞肺癌 脑转移 再程放疗 立体定向放疗 

分 类 号：R734.2[医药卫生—肿瘤]