射波刀治疗老年早期肺癌患者的初步临床疗效观察

Preliminary Results for Elderly Patients with Early Lung Cancer Treated with CyberKnife~

目的:探讨采用射波刀(CyberKnife)立体定向放射治疗技术治疗70岁以上老年早期肺癌患者的有效性和安全性。方法:回顾性分析天津医科大学附属肿瘤医院放疗科2006年11月至2010年9月间34例不能手术的老年早期肺癌患者(T_1N_0M_020例,T_2N_0M_014例),中位年龄78(70～88)岁,18例患者采用肿瘤内植入1～2枚金标的呼吸同步追踪技术(Synchrony),16例患者采用椎体追踪技术(X-Sight)。处方剂量45～60 Cy,中位剂量60 Gy,分3～6次给予。结果:25例病变完全缓解(73.5%),9例部分缓解(26.5%)。中位随访期29(11～59)个月,原发肿瘤局部控制率97.1%,1、2、3年无进展生存率分别为85.3%、81.6%、70.0%,总生存率分别为97.1%、86.6%、80.0%。31例患者(91.1%)出现治疗后的轻度乏力,15例患者(44.1%)发生Ⅰ～Ⅱ级放射性肺炎,未发现Ⅲ级及以上的不良反应。1例患者(2.9%)在经胸腔穿刺植入金标后发生严重气胸,经胸腔闭式引流后缓解。结论:射波刀立体定向放射治疗技术疗效确切,不良反应轻,为无法手术的老年早期肺癌患者的较好选择。

Objective： To evaluate the toxicity and efficacy of CyberKnifeR stereotactic radiotherapy in patients with early lung cancer aged over 70 years. Methods： The data of 34 inoperable elderly patients with early lung cancer （ 20 with T1 and 14 with T2 tu- mors ） from November 2006 to September 2010 were retrospectively reviewed. Among them, 18 were treated with the SynchronyR Re- spiratory Tracking System, which requires the implantation of 1-2 gold markers. The other 16 patients were treated with the X-sight~ technology. A total dose of 45-60 Gy （ median of 60 Gy ） was delivered in 3-6 fractions. Results： Complete response was achieved in 25 of the 34 patients （ 73.5% ）, and partial response was achieved in the other 9 （ 26.7% ）. At a median follow-up of 29 months, the pri- mary tumor control rate was 97.1%. The one-, two-, and three-year disease-free survival rates were 85.3%, 81.6%, and 70%, respective- ly. The one-, two-, and three-year overall survival rates were 97.1%, 86.6%, and 80%, respectively. Slight fatigue was reported in 31 of the 34 patients （ 91.1% ）. Grades I and II radiation pneumonitis were observed in 15 of the 34 patients （ 44.1% ）. Grade III radiation pneumonitis was not observed. Pneumothorax requiring tube thoracostomy occurred in one patient （ 2.9% ） following CT-guided fidu- cial placement. Conclusion： CyberKnife~ stereotactic radiotherapy is an effective therapeutic modality for elderly patients with early lung cancer. This therapy can provide a high local-control rate for primary tumors and has minimal toxicity.