体部伽玛刀治疗头颈部腺样囊性癌多发肺转移瘤临床观察

Clinical study of stereotactic gamma-ray body radiation therapy for patients with pulmonary metastases derived from adenoid cystic carcinoma of the head and neck

目的观察体部伽玛刀治疗头颈部腺样囊性癌多发肺转移瘤的临床疗效。方法对15例头颈部腺样囊性癌肺转移瘤患者共计137个病灶采用立体定向体部伽玛刀治疗。单次治疗病灶2—10灶，中位数5灶。以50％剂量线为处方剂量线，单次照射剂量3—5Gy，中位数4Gy，1次／d，5次／周，10～16次。肿瘤边缘总剂量30～52Gy，中位数40Gy。结果137个病灶中，完全缓解58灶（42-3％），部分缓解64灶（46．7％），稳定15灶（10．9％），进展0灶，总有效率为89．1％。治疗后1、2、3年局控率均为100．0％。治疗后1、2、3、4、5年生存率分别为100．0％、100．0％、90．9％、63．6％、31．8％。结论体部伽玛刀治疗头颈部腺样囊腺癌多发肺转移瘤疗效较好，反应轻微，是一种安全有效的治疗手段。

Objective To evaluate the value of the stereotactic gamma-ray body radiation therapy for patients with pulmonary metastases derived from adenoid cystic carcinoma of the head and neck. Methods 15 patients with 137 lung metastases treated with stereotactie gamma-ray body radiation therapy were analyzed. The patients experienced one to five courses of stereotactic gamma-ray body radiation therapy. 2 to 10 lesions were radiated in one treatment and the median number is 5. The daily radiation dose of 50 % isodose line covering metastatic lesions was from 3-5 Gy and 5 fractions per week. 30-52 Gy total doses in the edge of 50 % isodose line were divided into 10-16 times. Results 58 （42.34 %） lesions completely disappeared, 64 （46.72 %） lesions were assessed into partial responses, 15 （10.94 %） stable disease and 0 progression disease. The total effective rate was 89.06 %. Local control rates of 1, 3 and 5-year were all 100 %. The overall survival rates of 1 year, 2-year, 3-year, 4-year and 5-year were 100 %, 100 %, 90.9 %, 63.6 % and 31.8 %, respectively. Conclusion The stereotactic gamma-ray body radiation therapy is an effective and safe method in treatment with lung metastases from primary adenoid cystie adenocarcinoma of head and neck.