体部伽玛刀治疗早期非小细胞肺癌疗效的临床观察

Clinical analysis of body gamma knife radiotherapy for patients with early-stage non-small cell lung cancer

目的 评价体部伽玛刀治疗早期非小细胞肺癌的疗效、生存质量及毒副作用。方法 52例Ⅰ期和Ⅱ期非小细胞肺癌患者接受国产旋转式体部伽玛刀治疗,治疗时用真空负压袋固定体位,CT定位扫描三维计划。照射剂量肿瘤边缘（50%剂量线）4~5 Gy/次,每周5次,肿瘤局部总剂量40~50 Gy。结果 原发灶近期完全缓解率（CR）：65%（34/52）,部分缓解率（PR）：31%（16/52）,稳定（NR）：2%（1/52）,总有效率98%（51/52）。52例全部按计划完成治疗,放射反应轻,放射性肺炎Ⅰ级占7%（4/52）,Ⅱ级占3%（2/52）,放射性食管炎：周围型肺癌无,中心型肺癌6例（12%）。白细胞下降Ⅰ级占5%（3/52）,Ⅱ级占2%（1/52）。1、2、3年总生存率分别为90%（47/52）、79%（41/52）、69%（36/52）。生存质量中情绪功能、呼吸困难和咳嗽显著改善,差异有统计学意义（P〈0.05）;躯体功能、食欲减退无加重,差异无统计学意义（P〉0.05）。结论 体部伽玛刀治疗早期非小细胞肺癌近期疗效好。能明显改善患者情绪功能及生活质量。放射反应轻能为患者耐受,是不能接受手术治疗的早期非小细胞肺癌的一种安全有效的局部治疗手段。

Objective To study the curative effect of body-gamma knife radiotherapy in treating with 52 cases of stage Ⅰ and stage Ⅱnon-small cell lung cancer. Methods Fifty-two cases of non-small lung cancer in stage Ⅰ and stage Ⅱ were treated with rotary body gamma knife. Patients were fixed with vacuum bag, CT imitates to position and stereospic plan treatment. Irradiation dosage： tumor edge （50% dose line） 4-5 Gy/fraction, 5 times/week, total dose of tumor 40-50 Gy. Results The recent complete remission rate of primary lesion was CR 65%（34/52）; partial remission rate was PR 31%（16/52）, while 1%（1/52） was no remission. Overall response rate was 98%（51/52）. All 52 cases completed treatment on schedule with less complications of radiotherapy, 7%（4/52） with stage Ⅰ radiation pneumonitis, 3% （2/52） with stageⅡradiation pneumonitis, 12% （6/52） with radiation esophagitis, 5% （3/52） with stage Ⅰ leueopenia and 1%（1/52） with stage Ⅱ leueopenia. The 1, 2, 3 year survival rate were 90%（47/52）, 79%（41/52）, 69% （36/52）, respectively. The emotional functioning, expiratory dyspnea and cough were apparently improved, the differences were statistically significant （P〈0.05）. the physical functioning and anorexia didn＇t deteriorate （P〉0.05）. Conclusion Body-gamma knife with good sort-term effects and less radiotherapy complications is an useful and safe way in treating with early-stage non-small cell lung cancer who with surgical contraindication.