立体定向放疗治疗肺癌的临床有效性及安全性研究

Effectiveness and Safety Study of Stereotactic Body Radiation Therapy in Lung Cancer

目的分析立体定向放疗(SBRT)对肺癌患者的临床效果及安全性。方法选取2011年2月至2013年9月成都市第三人民医院收治的肺癌患者84例,按照抽签法分为研究组和对照组,各42例。其中研究组给予SBRT治疗,对照组采用手术切除病灶治疗。所有病例在治疗后3个月、6个月时再次复查,进行基本生理指标(白细胞计数、空腹血糖、平均动脉压、心率、丙氨酸转氨酶)检查和影像学检查;此后每6个月随访1次,直至24个月,记录肿瘤进展状况及预后结果。结果两组白细胞计数、空腹血糖、平均动脉压、心率及丙氨酸转氨酶在组间、不同时点间、组间·不同时点间比较,差异均无统计学意义(P>0.05)。与手术后3个月比较,手术后6个月研究组和对照组的缓解率比较差异无统计学意义(P>0.05)。两组患者复发、远处转移、病死率比较差异无统计学意义(P>0.05)。治疗后3、6、12、24个月的两组患者卡氏功能状态评分法均呈上升趋势[研究组:(71.1±7.9)分、(75.2±10.3)分、(79.7±11.1)分、(82.2±9.8)分;对照组:(68.1±8.7)分、(73.1±9.5)分、(78.9±10.4)分、(81.8±10.5)分](P<0.05)。研究组无放射性气管炎、切口感染和肺不张,发生率均为0%,均低于对照组[9.5%(4/42)、19.0%(8/42)、11.9%(5/42)](P<0.05)。结论对于早期肺癌患者,SBRT能达到与手术相当的治疗效果,同时避免了手术带来的并发症,其本身引起的放射性不良反应较轻,可能在未来替代手术用于早期肺癌的治疗。

Objective To analyze the clinical effect and safety of stereotactic body radiation therapy（ SBRT） in lung cancer. Methods Total of 84 cases with lung cancer in Chengdu Third People＇s Hospital from Feb. 2012 to Sep. 2013 were divided as the study group and control group by drawing method,42 cases each. The study group was treated with SBRT,and the control group was treated by surgical resection. The basic physiological index（ White blood cell count,fasting blood glucose,mean arterial pressure,heart rate,alanine aminotransferase） and imaging examination at 3rd month and 6th month after treatment were reexamined. Followed up was done to record the progress of the tumor and prognosis once every 6 months to 24 months. Results White blood cell count,fasting blood glucose,mean arterial pressure,heart rate and alanine aminotransferase between groups,different time points,groups·different time points,had statistically significant differences（ P〉 0. 05）. Compared with three months after surgery,remission rate of the study group and the control group at six-month after surgery had no statistically significant differences（ P〉0. 05）. The recurrence,distant metastasis,mortality of the two groups had no statistically significant differences（ P〉 0. 05）. 3,6,12,24 months after treatment,both groups showed an upward trend in Karnofsky scores[study group：（ 71. 1 ± 7. 9） scores,（ 75. 2 ± 10. 3） scores,（ 79. 7 ± 11. 1） scores,（ 82. 2 ± 9. 8） scores; control group：（ 68. 1 ± 8. 7） scores,（ 73. 1 ± 9. 5） scores,（ 78. 9 ± 10. 4） scores,（ 81. 8 ± 10. 5） scores]（ P〈 0. 05）.There was no radioactive bronchitis,wound infections or atelectasis in the study group,the incidence was0%,all lower than the control group[9. 5%（ 4 /42）,19. 0%（ 8 /42）,11. 9%（ 5 /42）（ P〈 0. 05） ].Conclusion For early lung cancer patients,SBRT can achieve similar effect to surgery,and avoid complications caused by surgery,with light radiation adverse effect,which suggests it may be replacing surgery for the treatment of early lung cancer in the future.