射波刀治疗Ⅰ期周围型非小细胞肺癌疗效的临床观察

Clinical outcomes of CyberKnife radiosurgery for patients with peripheral stage Ⅰ non-small cell Lung cancer

目的:评价射波刀治疗Ⅰ期周围型非小细胞肺癌的临床疗效和安全性。方法:50例Ⅰ期周围型非小细胞肺癌患者(84%的患者有病理学诊断)接受射波刀治疗,其中ⅠA期30例,ⅠB期20例;放疗总剂量为48～60Gy(中位剂量为57Gy),72%以上的等剂量面必须包括95%以上的计划靶体积。50例患者均采用肿瘤内植入金标的同步呼吸追踪技术,完成治疗后评估近期和远期疗效以及不良反应。结果:随访时间为3～40个月(中位随访时间为29个月),其中完全缓解40例、部分缓解6例、疾病稳定2例、疾病进展2例,有效率为92%,2年局部控制率为96%;1年总生存率为86%,2年总生存率为74%。3例患者发生Ⅲ级穿刺相关并发症,5例发生Ⅲ级治疗相关不良反应。结论:对于无法手术的Ⅰ期周围型非小细胞肺癌患者,射波刀治疗是一种近期及远期疗效均较好的治疗方法,且不良反应可以耐受,但对其长期的疗效和不良反应仍有待进一步观察。

Objective： To investigate the clinical outcomes of patients with peripheral stage Ⅰ NSCLC （non-small cell lung cancer） receiving CyberKnife radiosurgery and its safety. Methods： Fifty patients with peripheral stage Ⅰ NSCLC （pathologic result was available in 84% of the patients）, who refused surgery or were medically inoperable, received CyberKnife radiosurgery with 48 to 60 Gy （median 57 Gy） in three fractions. Of the 50 patients, 30 had a T1 tumor （stage ⅠA） and 20 had a T2 tumor （stage ⅠB）. More than 95% of the planning target volume was covered by the 72% isodose surface. Gold fiducial markers were implanted in or near the tumors in all patients to track movement of the tumor and the breathing pattern. The short- and long-term responses and the adverse effects were observed. Results： The median follow-up time was 29 months （range： 3-40 months）. CT scan evaluation revealed that 40 patients had a CR （complete response）, 6 patients had a PR （partial response）, 2 patients had a SD （stable disease）, and 2 patients had a PD （progressive disease）. The response rate （CR＋PR） was 92%, and the two-year local control rate （CR＋PR＋SD） was 96%. The one-year and two-year overall survival rates were 86% and 74%, respectively. The grade 3 complications associated with gold fiducial marker placement occurred in three patients, and grade 3 toxicities induced by CyberKnife radiosurgery occurred in 5 patients. No toxicities greater than grade 3 were observed. Conclusion： CyberKnife radiosurgery for patients with inoperable peripheral stageⅠ NSCLC may obtain a high rate of local control and a long-term curative effect with acceptable toxicity. Longer-term follow-up is necessary to evaluate the survival and the late toxicities.