射波刀治疗周围型非小细胞肺癌临床分析

Cyberknife radiosurgery treatment of peripheral non-small cell lung cancer:clinical analysis

目的研究射波刀治疗周围型非小细胞肺癌的近期疗效和不良反应,评估射波刀治疗周围型肺癌的安全性和有效性。方法对66例周围型非小细胞肺癌患者进行射波刀治疗,金标追踪25例,肺追踪35例,椎体追踪6例;65%~75%等剂量线覆盖计划靶区(planning target volume,PTV),总剂量为42~60Gy,分割次数4~6次,生物等效剂量(biological equivalent dose,BED)为71.4~150.0Gy。治疗后4~12周CT扫描评价近期疗效;随访时间为11~29个月,中位时间为18个月。结果全组患者完全缓解31例,部分缓解28例,稳定5例,疾病进展2例,有效率89.4%,肿瘤大小和BED是影响疗效的重要因素(P=0.019,P=0.007)。结论射波刀治疗周围型非小细胞肺癌安全、有效,可获得较好的肿瘤控制率,远期疗效需进一步随访。

Objective To study the short time outcome and adverse effect of cyberknife in treatment of peripheral non- small cell lung cancer, so as to evaluate the safety and efficacy of eyberknife in treatment of peripheral lung cancer. Methods A total of 66 patients with peripheral non-small cell lung cancer completed their cyberknife radiosurgery, with real-time target tracking through fiducial marker implantation in 25 cases, X-sight lung synchrony in 35 cases, and X-sight spine tracking in 6 cases. Total prescribed dosage ranged from 42 to 60 Gy, with 4 to 6 fractions prescribed to the 65^-75~/00 isodose lines for planning target volume. The biological effective dose （BED） was 71.4-150. 0 Gy. The follow up time was 11-29 months and the median time was 18 months. Results A total of 31 patients had complete radiographic responses, 28 had partial response, 5 patients had stable disease and 2 had progressive disease. The response rate was 89. 4%. Tumor size and BED were the significant factors affecting the result of treatment （P=0. 019, P=0. 007）. Conclusion Cyberknife radiosurgery treatment is effective and safe for peripheral non-small cell lung cancer. It can achieve satisfactory tumor control rate, while the long term outcome needs further follow up.