射波刀治疗腹膜后肿瘤疗效观察

摘要

目的 评价射波刀治疗腹膜后肿瘤的疗效和不良反应.方法 对28例腹膜后肿瘤患者行射波刀治疗.70％～ 84％(中位数78％)等剂量线覆盖计划靶体积,照射剂量2000～ 6000 cGy(中位数4500 cGy),生物等效剂量3750 ～10080 cGy(中位数7680 cGy,α/β=10),分割次数2～10次(中位数5次).3例患者为调强或适形放疗推量,1例为再程放疗,其余为单纯射波刀治疗.KaplanMeier法计算生存率并Logrank检验.结果 完全缓解、部分缓解、稳定、进展率分别为43％、36％、18％、4％,有效率为96％.随访时间满1、2、3年者分别为17、9、7例.1、2、3年局部控制率分别为92％、86％、86％,总生存率分别为60％、49％、49％.局部无进展生存和总生存相似(中位9.5个月和12.0个月,x2=0.17,P=0.680),腹膜后单发病灶且疗效评价缓解者局部无进展生存与全身无进展生存期也相似(中位17个月和11个月,x2=0.13,P=0.720).≥2级急性反应中乏力、厌食、恶心、呕吐、肠炎分别为9、9、7、2、2例,远期反应仅1例出现1级肠狭窄.结论 射波刀是腹膜后肿瘤安全有效的局部治疗手段之一.%Objective To evaluate the early response rate and radiation toxicity of cyberknife in the treatment of primary or metastastic retroperitoneal tumors.Methods Twenty-eight patients with retroperitoneal tumors were treated with cyberknife.The total doses were 2000-6000 cGy ( median 4500 cGy) and biological effective doses were 3750-10080 cGy (median 7680 cGy) in 2-10 fractions (median 5).Of all patients,3 received three dimensional conformal radiotherapy (3DCRT) or intensity modulated radiotherapy (IMRT) boost,1 was treated as second-course radiotherapy,and others were treated with cyberknife only.The survival rates were calculated by Kaplan-Meier method and compared with Logrank test.Results The complete response,partial response,stable disease and progression disease rates were 43％(12/28),6％ ( 10/28),18％ ( 5/28 ),4％ ( 1/28 ),respectively.The overall response rate was 96％.The number of patients who were followed up more than 1,2,3 years were 17,9,7,respectively.The 1-,2-and 3-year local control rates were 92％,86％ and 86％,respectively.The 1-,2-and 3-year overall survival rates were 60％,49％ and 49％,respectively.The difference between local progression-free survival and overall survival was not significant ( median 9.5 and 12.0 months,x2 =0.17,P =0.680).Moreover,if the patients did not have metastasis elsewhere and local treatment was effective,there was no significant difference between local progression-free survival and progression free survival (median 17 and 11 months,x2 =0.13,P=0.720).Acute radiation-induced side effects (≥ 2 grade) such as fatigue,anorexia,nausea,vomiting and epigastric discomfort occurred in 9,9,7,7 and 2 patients,respectively.Intestinal stenosis of 1 grade occurred in 1 patient.Conclusions Radiotherapy for retroperitoneal tumors with cyberknife has provided a high response rate with minimal side effects.It is a safe and effective local treatment method for retroperitoneal tumors.