体部伽玛刀治疗局部晚期非小细胞肺癌

CLINICAL STUDY OF γ-RAY STEREOTACTIC RADIOTHERAPY FOR STAGE Ⅲ NON-SMALL-CELL LUNG CANCER

目的：观察立体定向伽玛射线放射治疗（体部伽玛刀）Ⅲ期非小细胞肺癌（non-small cell lung caneer，NSCLC）的疗效和放射反应。方法：将92例不接受手术及化疗的Ⅲ期NSCLC病人，随机分入伽玛刀组和普通放疗组。普放组45例，采用常规放射治疗，DT64～66Gy。伽玛刀组47例，采用螺旋CT下扫描定位，对CTV（clinical target volume）在50％等剂量线处给定处方剂量4～8Gy／次，共治疗5～13次，3次/wk，隔日治疗，总剂量40-52Gy，分2-4wk完成。结果：全组病例随访5a以上，其中普放组：总有效率、CR、PR、NC、PD、1a局部控制率、1a生存率、3a局部控制率、3a生存率和5a局部控制率和生存率分别是55．6％（25／45）、22．2％（10／45）、33．3％（15／45）、22．2％（10／45）、22．2％（10／45）、77．8％（35／45）、40．0％（18／45）、22．2％（10／45）、6．7％（3／45）、8．9％（4／45）及2．2％（1／45）；伽玛刀组：总有效率、CR、PR、NC、PD、1a局部控制率、1a生存率、3a局部控制率、3a生存率和5a局部控制率和生存率分别是78．7％（37／47）、29．8％（14／47）、48．9％（23／47）、10．6％（5／47）、10．6％（5／47）、89．4％（42／47）、44．7％（21／47）、38．3％（18／47）、25．5％（12／47）、21．3％（10／47）和10．6％（5／47）。两组总有效率比较差异有统计学意义（P〈0．05）；1a局部控制率、1a生存率比较差异无统计学意义（P〉0．05）；3、5a生存率和局部控制率比较差异有统计学意义（P〈0．05）。无严重放射反应。结论：立体定向伽玛射线放射治疗是一种定位精确、局控率高、并发症少的精确放射疗法，可有效改善不能手术的Ⅲ期NSCLC病人生存质量，提高了远期局部控制率和生存率。

Objective： To assess the immediate response and acute side effect of γ- ray stereotacfic radiotherapy（γSRT） for 47 patients with inoperable stage Ⅲ nonsmall cell lung cancer（NSCLC）. Methods： From April 2000 to April 2003,92 patients with NSCLC were randomized into conventional radiotherapy group（CRT） and γSRT group. DT 64 - 66Gy were given to 45 patients in CRT group by common means. There were 47 patients in γSRT group ,which were treated with OUR -QGD stereotactic γ-ray therapeutic system under the guide of computer tomography imaging. Each lesion was given a 50% isodose curve coverage PTV and 4 - 8Gy peripheral dosage per fraction,3 fractions per week with the total dose ranging from 40 - 52Gy and finished in two-four weeks. Results： All patients were followed up for more than five years. The complete response（CR） and overall response rate for the CRT group and the γSRT group were 22. 2% （10/45） ,55.6% （25/45）and 29.8% （14/47） ,78.7% （37/ 47 ）, respectively. The differences were significant in statistics （ P 〈 0. 05 ）. The one - year overall survival rate and local control rate for the group CRT were 40. 0% （18/45） and 77.8% （35/45） ,respectively,and these rates were 44.7% （21/47） and 89.4% （42/47）, for the γSRT group. Their differences were not distinct in statistics（P〉0.05）. The γ-year overall survival rate and local control rate were different between two groups-the values for the CRT group were 6. 7% （3/45） and 22. 2% （10/45） respectively, whereas 25.5% （12/47） and 38.3% （18/47） for the γSRT group. The differences were distinct in statistics（P〈0.05）. The 5-year overall survival rate and local control rate were different between two groups-the values for the CRT group are 2. 2% （ 1/45 ） and 8.9% （4/45） respectively, whereas 10. 6% （5/47）and 21.3 % （10/47）for the γSRT group. The differences were distinct in statistics （P〈0.05）. The severe acute side effect was not occurred in the course of γSRT. Conclusion：γSRT is a feasible, safe, and effective radiotherapy method, and could be well tolerated in most patients, especially for elder patients. It can increase the long - term local control rate and survival rate, and decrease the incidence of radiation induced normal tissue toxicity.