伽玛刀立体定向放疗早期非小细胞肺癌疗效及生存质量分析

Therapeutic efficacy of stereotactic radiotherapy with gamma knife on early-stage non-small-cell lung cancer and life quality of patients

目的探讨伽玛刀立体定向放射治疗早期非小细胞肺癌患者的疗效及生存质量分析。方法20例非手术治疗的早期非小细胞肺癌患者，中位年龄76岁。I期患者10例，Ⅱ期10例。根据患者的具体状况，给予伽玛刀分次立体定向放疗（SBRT）3～6Gy×8～15次，2～3周完成，采用50％等剂量曲线包绕95％以上PTV，边缘剂量39～56Gy，中心剂量78—112Gy。在入院后、治疗结束后1、3、6和12个月至病情进展或者死亡，根据EORTCQLQ-LC43中相关变量对患者进行系统评价，比较放疗前后生存质量变化。结果中位随访时间为24个月。20例患者治疗后6个月有效率为80％，原发病灶完全缓解率为35％。1、2、3年局部控制率分别为100％、95％、95％；1、2、3年总生存率分别为95％、80％、50％；1、2、3年无进展生存率为85％、64％、33％。3年失败率为20％，5％为PTV内进展。治疗期间无3级及以上急性不良反应发生，15％的患者出现1—2级放射性肺炎。年龄、性别、有无病理诊断等临床因素与患者生存相关性较弱（P〉0．05）。生存质量中情绪功能明显改善，差异有统计学意义（P〈0．05）；呼吸困难和咳嗽有不同程度改善，躯体功能、疲倦、食欲减退和失眠无加重，差异均无统计学意义。结论SBRT对于老年患者取得了良好的结果，局部控制率高，不良反应作用小，生存率尚可，能明显改善情绪功能及患者生存质量。

Objective To evaluate the therapeutic efficacy of stereotactic body radiotherapy （SBRT） with gamma knife on stage I - II non-small-cell lung cancer（NSCLC） and the quality of life of the patients undergoing this therapy. Methods Twenty NSCLC patients with the median age of 76, 10 at stage I and 10 at stage II who were unable or unwilling to undergo surgery were given SBRT with gamma knife at the doses of 3 -6 Gy in 8 - 15 fractions, finished within 2 to 3 weeks. The prescription isodose line was 50% , the marginal dose was 39 - 56 Gy, the central dose was 78 - 112 Gy, and the total biologically effective dose was 51 -83 Gy. The patients were observed after admission and followed up by chest CT 1, 3, 6, and 12 months after treatment until progressive disease or death. EORTC QLQ-LC43 questionnaire was used to investigate the changes in quality of life. Results The 20 patients were followed up for 24 （ 12 -46） months. At six months after the treatment, the overall response rate was 80% , and the complete response rate was 35%. The 1,2 and 3-year local control rates were 100% , 95% and 95% , respectively. The 1,2 and 3-year overall survival rates were 95% ,80% and 50% respectively; The 1,2, and 3-year progression free survival rates were 85% ,64% and 33% , respectively. The failure rate was 20% and the rate of progress within the planning target volume was 5%. No acute toxicity at grade 3 and over occurred in any patient during the treatment. 15% of the patients developed grade 1 - 2 radiation pneumonia. Age, gender, pathologic index or not were weakly correlated with the overall survival. The emotional function was improved significantly after treatment （P 〈 0. 05 ）, dyspnea and cough were improved at different degrees, however, not significantly. There were no significant changes in the physical function and symptoms, such as fatigue, lack of appetite, insomnia, etc. Conclusions Significantly improving the motional function and maintaining the quality of life, SBRT with gamma knife is effective for elderly NSCLC patients with high local control rate fair overall survival rate and few side effects.