射波刀治疗早期周围型肺癌结果的初步分析

An initial report of cyberknife radiosurgery treatment in early stage lung cancer

目的评价采用射波刀（Cyberknife）立体定向放射手术平台治疗早期周围型肺癌患者的疗效和初期毒性反应。方法接受射波刀治疗的17例周围型肺癌患者年龄54～87岁，临床分期Ⅰa期（T1N0M0期）8例、Ⅰb期（T2N0M0期）9例，病理类型鳞癌3例、腺癌8例（6例因拒绝穿刺等以PET—CT为诊断依据）。肺癌计划靶体积6～82cm^3，中位36cm^3，总剂量45～60Gy，中位剂量50Gy，分割3～5次。10例采用肿瘤内植入金标的呼吸同步追踪技术（Synchrony），7例采用椎体追踪（X—Sight）技术。结果所有患者治疗耐受性良好，主要不良表现为乏力。疗后2～10个月中（中位时间7个月），17例均存活。影像学复查结果为13例完全缓解，4例部分缓解，未发现肿瘤进展、复发及远处转移。出现放射性肺炎1级3例、2级1例，骨髓抑制1级3例，经对症处理后好转。结论采用射波刀进行立体定向放射治疗周围型肺癌疗效显著，安全性好，远期结果需进一步随访。

Objective To study the efficacy and toxicity of the eyberknife in the treatment of medi- cally inoperable patients with early stage lung cancer. Methods From September 2006 to July 2007,17 patients with clinical stage Ⅰ a- Ⅰ b lung cancer were treated with cyberknife at Tianjin Cancer Hospital. Of the 11 patients receiving CT guided biopsy,3 were squamous cell cancer and 8 were adenocarcinoma. Six patients refused intrusive operation and were diagnosed by PET-CT scan. All patients were medically inoperable evaluated by a thoracic surgeon. The PTV = GTV ＋ 3 -5 mm, and the median volume of PTV was 36 cm3 （6-82 cm^3）. The median total prescription dose was 50 Gy（45-60 Gy） at 3-5 fractions. Results The median follow-up time was 7 months（ 3-11 months）. All the patients finished the treatment and were alive by the last follow-up. Slight fatigue was the most common complain. Evaluated by CT scan, 13 were complete response and 4 were partial response. No recurrence, progression or distant metastasis oecured. There were 3 patients with grade Ⅰ granulocytopenia,3 grade Ⅰ pneumonitis and 1 grade Ⅱ pneumonitis. Conclusions The cyberknife radiosurgery treatment in early stage lung cancer shows a high rate of local control and minimal toxicity. Long time follow-up is necessary to evaluate the survival data and late toxicity.