体部伽马刀治疗早期非小细胞肺癌临床观察

Clinical study of stereotactic ganuna-ray body radiation therapy for patients with stage I / II nonsmall cell lung cancer

目的进一步评价体部伽马刀治疗I～Ⅱ期非小细胞肺癌（NSCLC）患者的价值。方法2007--2010年间29例不能或拒绝手术的I～Ⅱ期NSCLC患者应用OUR．QGD型体部伽马刀治疗，真空负压袋固定，慢速CT扫描且不做呼吸动度限制。计划要求50％剂量线覆盖100％PTV，60％剂量线覆盖90％CTV，70％剂量线覆盖80％GTV，PTV、CTV和GTV处方剂量分别为50、60和70Gy，5次／周共10次。结果随访率为97％。治疗后第6个月原发灶有效率为93％，完全、部分缓解率分别为86％、7％。1、2年局部控制率均为93％，总生存率分别为97％、89％（I期分别为100％、92％，Ⅱ期均为67％），局部无进展生存率分别为90％、86％。急性不良反应率为34％（1、2、3级分别为6、2、2例），晚期不良反应率为38％（1、2级分别为10、1例）。结论体部伽马刀治疗早期NSCLC可获得较好疗效且不良反应轻微，是一种安全有效的体部立体定向放疗手段。

Objective To further evaluate the value of the stereotactic gamma-ray body radiation therapy （γ-SBRT） for patients with stage I/II non-small cell lung cancer （NSCLC） basing on the preliminary studies. Methods Twenty-nine eligible patients with stage I/II NSCLC who is unable or unwilling to receive surgery underwent treatment prospectively with γ-SBRT （OUR-QGD）. Patients were fixed by vacuum bag. Each patient underwent slow CT simulation at 5 s/slide with thickness of 5 mm and interval of 5 mm to take into consideration tumor motion. A total dose of 50 Gy was delivered at 5 Gy/ fraction to 50% isodose line covering 100% of the PTV, with 60 Gy at 6 Gy/fraetion to 60% isodose line covering 90% of the CTV, 70 Gy at 7 Gy/fraction to 70% isodose line covering 80% of the GTV, and 10 times finished in 2 weeks, 5 fractions per week. Results The follow-up rate was 97%. The 6 month local tumor response rate was 93% , with CR 86%, and PR 7%. The 1-, 2-year local control rates were both 93%. The 1-, 2-year overall survival rates for the whole group, stage I and stage 11 were 97% and 89%, 100% and 92% , 67% and 67% , respectively. The 1-, 2-year progression-free survival were 90% and 86%, respectively. 34% of the patients had acute radiation toxicities （ grade 1,2 and 3 in 6,2 and 2 patients, respectively）, and 38% late radiation toxicities （grade 1 and 2 in l0 and 1, patients）. Conclusions γ-SBRT is a safe and effective treatment regimen, resulted in promising local control and survival with minor toxicity.