呼吸门控结合Bodyfix固定装置立体定向放疗治疗肺寡转移肿瘤的临床疗效观察  

Clinical Efficacy of Respiratory Gating Combined with Bodyfix Immobilization Device in Stereotactic Radiotherapy for Pulmonary Oligometastatic Tumors

作　　者：龙霞 罗明焱 麻佳慧 徐鹏[2] 秦远[3] 刘敏[3] 张鹏[2] 郎锦义 Long Xia;Luo Mingyan;Ma Jiahui;Xu Peng;Qin Yuan;Liu Min;Zhang Peng;Lang Jinyi(Department of Oncology,the Afiliated Hospital of Southwest Medical University,Luzhou 646000,Sichuan,China;Department of Radiation Oncology,Radiation Oncology Key Laboratory of Sichuan Province,Sichuan Clinical Research Center for Cancer,Sichuan Cancer Hospital&Institute,Sichuan Cancer Center,University of Electronic Science and Technology of China,Chengdu 610041,Sichuan,China;Radiation Physics Laboratory,Radiation Oncology Key Laboratory of Sichuan Province,Sichuan Clinical Research Center for Cancer,Sichuan Cancer Hospital&Institute,Sichuan Cancer Center,University of Electronic Science and Technology of China,Chengdu 610041,Sichuan,China)

机构地区：[1]西南医科大学附属医院肿瘤科,四川泸州646000 [2]四川省肿瘤医院·研究所,放射肿瘤学四川省重点实验室,四川省肿瘤临床医学研究中心,四川省癌症防治中心,电子科技大学附属肿瘤医院放疗科,成都610041 [3]四川省肿瘤医院·研究所,放射肿瘤学四川省重点实验室,四川省肿瘤临床医学研究中心,四川省癌症防治中心,电子科技大学附属肿瘤医院物理室,成都610041

出　　处：《肿瘤预防与治疗》2025年第3期182-190,共9页Journal of Cancer Control And Treatment

基　　金：中华国际医学交流基金会肿瘤精准放疗星火计划临床科研基金项目(编号:2019-N-11-24)。

摘　　要：目的:利用呼吸门控结合Bodyfix固定装置治疗肺寡转移肿瘤患者,观察立体定向放射治疗(stereotactic body radiation therapy,SBRT)的临床疗效和放射性损伤发生情况。方法:回顾性分析2019年9月至2023年1月在我院行呼吸门控结合Bodyfix固定装置下SBRT治疗的34例肺寡转移肿瘤患者的临床资料,共66个病灶行SBRT。采用SPSS软件进行统计分析,Kaplan-Meier法计算局部控制率(local control rate,LCR)、无进展生存(progression-free survival,PFS)和总生存(overall survival,OS),采用log-rank检验、Cox回归分析与临床疗效相关的预后因素,观察并统计放射性损伤的发生情况。结果:入组患者的中位年龄53岁(范围30~70岁),中位随访时间15.5个月(范围12~47个月),1年、2年LCR分别为88.2%、84.4%;1年、2年PFS率分别为70.6%、54.1%;1年、2年OS率分别为97%、97%。在行SBRT治疗的同时是否接受化疗和免疫治疗、治疗前有无肺外转移灶是无进展生存的预后因素(P<0.05)。入组患者接受治疗后多数出现无明显临床表现的0~2级放射性损伤,仅1人出现3级放射性肺炎。结论:呼吸门控结合Bodyfix固定装置下SBRT治疗肺寡转移肿瘤患者有较好的临床疗效和较低的放射性损伤发生率,全身治疗和有无肺外转移与肿瘤进展密切相关,可能为其重要预测因素。Objective:To treat patients with pulmonary oligometastasis using respiratory gating combined with the Bodyfix fixation device,and to evaluate the clinical efficacy of stereotactic body radiation therapy(SBRT)as well as the incidence of radiation-induced toxicity.Methods:A retrospective analysis was conducted on 34 patients with pulmonary oligometastases treated using respiratory gating combined with the Bodyfix fixation device at our hospital between September 2019 and January 2023.A total of 66 lesions were treated with SBRT.Kaplan-Meier method and SPSS software were used to calculate the local control rate(LCR),progression-free survival rate(PFS)and overall survival rate(OS).Log-rank method and Cox models were performed to analyze prognostic factors associated with clinical efficacy.The occurrence of radioactive damage was observed and counted.Results:The median age of the included patients was 53 years(ranging from 30 to 70),the median follow-up time was 15.5 months(ranging from 12 to 47 months).The 1-and 2-year LCRs were 88.2%and 84.4%,respectively.The 1-and 2-year PFS rates were 70.6%and 54.1%,respectively.The 1-and 2-year OS rates were 97%and 97%,respectively.Whether to receive chemotherapy and immunotherapy concurrently with SBRT,as well as the presence of extrapulmonary metastases before treatment,were factors affecting progression-free survival(P<0.05).Most of the enrolled patients experienced grade 0-2 radiation injuries without obvious clinical manifestations,and only one patient developed grade 3 radiation pneumonitis.Conclusion:SBRT combined with respiratory gating and Bodyfix immobilization demonstrates favorable clinical efficacy and a lower incidence of radiation-induced injuries in patients with pulmonary oligometastases.Systemic therapy and the presence or absence of extrapulmonary metastases are closely associated with tumor progression and may serve as important predictive factors.

关 键 词：肺寡转移 立体定向放射治疗 呼吸门控 临床疗效 

分 类 号：R734.2[医药卫生—肿瘤]