射波刀治疗31例晚期非小细胞肺癌患者的疗效观察

摘要

背景与目的 射波刀是近年来新出现的一种立体定向放射治疗技术,具有大剂量、高精度和周围受照射的正常组织或是重要器官的范围小等优点,在治疗非小细胞肺癌(non-small cell lung cancer,NSCLC)方面取得了显著的效果.本研究旨在探讨射波刀(Cyberknife)治疗晚期NSCLC的疗效和安全性.方法 在2009年3月-2010年3月间,我们应用射波刀治疗31例(34个肿瘤病灶)临床Ⅲ期-Ⅳ期的周围型NSCLC患者,其中Ⅲ期5例,Ⅳ期26例,腺癌15例,鳞癌12例,大细胞癌1例,腺鳞癌2例,不确定NSCLC 1例.28例患者联合了化疗.平均肿瘤体积67.2cm3,处方总剂量36 Gy-60Gy,分割2次-5次.等计量线65%-85%.治疗后1-2个月复查胸部CT,观察近期疗效,每3个月随访一次.结果 2例完全缓解,16例部分缓解.7例稳定,6例进展,总体有效率达58%,疾病控制率为81%.所有患者治疗耐受性良好.最主要的不良反应表现为乏力,无4级或是4级以上的不良反应发生.结论 射波刀治疗晚期NSCLC安全性好,有较好的近期疗效,不良反应轻,患者易耐受.但是远期疗效有待进一步随访.%Background and objective Recently, Cyberknife is a new flame-less stereotactic radiation therapy technology, which has several advantages, such as large dose, high precision and minimizing exposure to the surrounding normal tissue or adjacent vital structures, so it is successful in the treatment of non-small cell lung cancer (NSCLC).Ihe aim of this study is to determine the effectiveness and safety of robotic stereotactic radiotherapy- Cyberknife with image guidance and realtime respiratory tracking against clinical stage Ⅲ-Ⅳ peripheral NSCLC.Methods A review of treatment details and outcomes for 31 patients, with 34 tumors with histologically proven cancers treated by Cyberknife at the CyberKnife Center of Nanjing general hospital of Nanjing military command between March 2009 and March 2010 is presented.Of the 3lpatients, 15 were adenocarcinoma and 12 were squamous cell cancer.Twenty-eight patients received other forms of antineoplastic therapy such as chemotherapy.A total dose of 36 Gy-60 Gy was prescribed to the 65％-85％ isodose line and given in two to five fractions in less than 1 week using the CyberKnife radiosurgery system.CT scans were performed after one-two months, then patients were followed every 3 months.Results Two patients had complete radiographic responses, l6 patients showed PRs, 7 patients showed SDs.Two patients showed PRs (reduction in tumor size), but developed distant metastases.Response rate was 58％and disease control rate was 81％.All patients tolerated the radiosurgery well, fatigue being the main side effect.No grade 4 or above toxicity was encountered.Conclusion In this small cohort of patients with advanced peripheral NSCLC, Cyberknife seems to be a safe and has good therapeutic effects with slight adverse reaction, but long time follow-up is necessary to evaluate the survival data and late toxicity.