Cyberknife治疗纵隔转移淋巴结的临床分析

Clinical analysis of cyberknife stereotactic ablative radiotherapy for malignant tumors with metastases of mediastinal lymph nodes

目的:评价射波刀(Cyberknife)治疗纵隔转移淋巴结的临床价值。方法:分析射波刀治疗39例恶性肿瘤纵隔淋巴结转移患者的临床资料。病灶共计49个,直径1.5～4.3 cm。治疗剂量12～60 Gy,分割1～10次。结果:治疗后随访3～67个月(中位数20个月),胸闷、气短等症状缓解率83.3%。49个病灶CR、PR、SD分别为29、15、5个,有效率90%。1、2年局控率为100%、91%,1、2年生存率分别为84.6%、68.3%。急性期无反应者25例,1～2级、3～4级放疗反应分别为11例、3例。既往行胸部放疗、隆突下及气管食管沟病灶、放疗前后1个月行化疗者放疗不良反应发生率较高(P=0.014、0.007、0.039),反应组食管5 mL平均照射剂量30.62 Gy明显高于无反应组15.5 Gy(P=0.045)。结论:射波刀为纵隔淋巴结转移者提供了安全有效的治疗手段。

Objective： This work aimed to evaluate the clinical results of the cyberknife stereotactic ablative radiotherapy （SABR） treatment of 39 patients suffering from mediastinal lymph-node metastases of malignant tumors. Methods： Cyberknife SABR was con- secutively conducted on 39 cancer patients with 49 mediastinal nodal metastases. Planning target volume ranged from 3.7 ml to 78.5 ml （median： 12.3 ml）, and total prescribed dosage ranged from 12 Gv to 60 Gy with 1 fraction to 10 fractions. Results： Follow-up assessment was performed from 3 mos to 67 mos （median： 20）. The most commonly observed toxicity was Grade 1/2 tracheal and esophageal injuries, which occurred in 11 of the 39 patients. Grade 3/4 toxicity occurred in 3 of the 39 patients. Patients with dyspnea, superior vena cava syndrome, and chest pain achieved significant improvements in health status （response rate： 83.3%）. Total effective rate （complete and partial response） was 90% for the 49 discrete lesions （29 complete responses, 15 partial responses, and 5 stable diseases）, The 1 and 2 yr overall survival rates were 84.6% and 68.3%, respectively. Patients with metastasized nodes below 3 cm in diameter attained superior overall survival times compared with those with metastasized nodes above 3 cm in diameter （P=0.029）. Conclusion： Cyberknife SABR for the mediastinal metastases carcinoma showed a favourable outcome and minimal toxicity.