大分割伽玛射线立体定向放射治疗脑部和体部恶性肿瘤疗效分析

Therapeutic analysis of gamma ray stereotactic radiation therapy for brain and body malignant tumor

目的评价大分割伽玛射线立体定向放射治疗脑部和体部恶性肿瘤的临床疗效。方法采用伽玛射线立体定向放射治疗脑部和体部恶性肿瘤患者30例（52个病灶）。单纯伽玛射线立体定向放射治疗采取大分割分次方式,处方剂量3.5-5 Gy,每周5次,计划靶区边缘（50%或60%等剂量线处）总剂量全程为32-50 Gy;常规放射治疗后伽玛射线立体定向放射治疗补量为20-32 Gy。结果52个病灶中,完全缓解（CR）21个（40.4%）,部分缓解（PR）26个（50%）,好转（MR）2个（3.8%）,稳定（SD）3个（5.8%）,有效率为90.4%,其中脑转移瘤有效率为100.0%,肺转移肿瘤有效率为88.8%,肺原发肿瘤有效率为87.5%。治疗前肿瘤体积（GTV）〈2.38 cm^3组CR率明显高于GTV≥2.38 cm3组（P〈0.05）。30例患者急性放射反应分级为：0级24例（80%）,Ⅰ级4例（13.3%）,Ⅱ级2例（6.67%）。结论大分割伽玛射线立体定向放射治疗脑部和体部恶性肿瘤近期疗效满意。

Objective To evaluate the clinical efficacy and safety of gamma ray stereotactic radiation therapy for encephalic and body malignant tumor. Methods Thirty patients（ 52 focuses of infection） were treated with gamma ray stereotactic radiation therapy, prescription dosage 3.5 -5Gy, five times a week. The total radiation dose （50% -60% isodose line） was 32 - 50Gy for total course gamma ray stereotactic radiation therapy and 20 - 32Gy for boost after routine radiotherapy. Results Among the 52 cases, the complete response （CR） rate, partial response （PR） rate, moderate response （MR） rate and stable disease （SD） rate were 40.4% （21 focuses） ,50% （26 focuses） ） ,3.8% （2 focuses） ） and 5.8% （3 focuses） ） ,respectively,and total effectiveness rate was 90.4%. Effective response rates changed because of the tumor category. The effective response rate of brain metastatic tumor,lung metastatic tumor and lung primary malignant tumor were 100.0% ,88.8% and 87.5% ,respectively. CR rate of the pre-therapy gross tumor volume（GTV） group which was higher than 2.38 cm^3 was higher than that of the GTV 〉 2.38 cm^3 group（ P 〈 0.05 ）. The side effects were slight. Among the 30 cases, the acute radiation reaction developed as follows： Grade 0,24 cases （ 80% ） ; Grade 1,4 cases （ 13.3% ） ; Grade 2,2 cases （ 6.67% ）. Conclusion Major disectional gamma ray stereotactic radiation therapy is a safe and effective treatment modality for encephalic and body malignant tumor.