分次立体定向放射治疗肺转移瘤31例疗效和安全性分析

The efficacy and safety analysis of fractionated stereotactic radiotherapy in the treatment of lung metastatic tumors in 31 cases

目的:评价分次立体定向放射治疗(FSRT)肺转移瘤的疗效及安全性。方法:对31例肺转移瘤(每例病灶数目1～3个)患者给予FSRT,单次靶区周边剂量为3～5 Gy,总剂量为30～45 Gy,分7～9次完成,50%等剂量曲线包绕计划靶体积。结果:截至2011年12月,25例患者病死。全组中位生存期为20.7个月(3.5～42.9个月),1年及2年生存率分别为78.4%和43.2%,临床症状缓解率为84.1%,肿瘤局部控制率为90.4%。有肺外病灶和无肺外病灶的生存率比较差异有统计学意义(P=0.043)。鳞状细胞癌和腺癌病灶的治疗有效率分别为83.3%(10/12)和85.7%(12/14),上皮来源(包括鳞状细胞癌和腺癌)及非上皮来源的病灶治疗有效率分别为84.6%和3/3,差异均无统计学意义(P=1.000)。结论:采用FSRT肺转移瘤是有效和安全的,可延长患者生存期,但需严格掌握适应证;单发肺转移和无肺外病灶存在者的预后较好。

Objective：To evaluate the efficacy and safety of fractionated stereotactic radiotherapy（FSRT） in the treatment of lung metastatic tumors. Methods：Thirty-one cases （ 1 to 3 lesions each case） were treated with FSRT. Single target dose of surrounding area was from 3 to 5 Gy,which total radiation dose was from 30 to 45Gy through 7 to 9 times completing. The 50% of dosage curve covered the planning target volume. Results：Up to Dec. 2011,25 patients died. The median overall survival was 20.7 months （3.5 to 42.9 months） , the overall survival rates of 1 year and 2 years were 78.4% and 43.2% , respectively. The clinical symptoms remission and local tumor control rates of all patients were 84.1% and 90.4% , respectively. The differences of the survival rate of patients with pulmonary lesions and no pulmonary lesions were significant （ P = 0. 043 ）. The effective rates of squamous carcinoma and adenocarcinoma were 83.3% （10/12） and 85.7% （12/14） ,respectively. The effective rates of cancer derived from epithelium and no epithelium were 84.6% and 3/3, respectively, which differences were not significant （P = 1. 000）. Conclusions： FSRT in the treatment of lung metastasis is effective and safe, which can prolong the survival under strict mastering indications. The prognosis of patient with single and no pulmonary metastasis is good.