Ⅰ期周围型非小细胞肺癌立体定向消融放疗临床分析

The clinical analysis of stereotactic ablative radiotherapy for stage Ⅰ peripheral non-small cell lung cancers

目的 分析Ⅰ期周围型非小细胞肺癌立体定向消融放疗的疗效和毒性反应.方法 36例Ⅰ期周围型非小细胞肺癌患者行立体定向消融放疗,放疗分割方案12 Gy×4次/1-2周,要求95％处方剂量的等剂量曲线包绕100％计划靶体积（PTV）,危及器官剂量限制参考美国放射治疗协作组0236研究方案制定,所有患者在投照前均行扇形束或锥形束CT图像引导和配准,随访观察患者放疗的毒副反应和近期疗效.结果 中位随访时间18.7个月（4- 36个月）,CR 17例（47.2％）,PR 15例（41.7％）,SD 4例（11.1％）,治疗后总缓解率为88.9％,1年和3年生存率估计值分别为92.3％（95％ CI：86.3％ -97.1％）和85.3％（95％ CI：80.5％ -90.6％）.3年局部控制率估计值为90.2％（95％ CI：85.7％ -94.8％）,未出现Ⅲ级或以上治疗相关毒性反应.结论 图像引导立体定向消融放疗治疗周围型Ⅰ期非小细胞肺癌取得了良好的局部控制率和生存率,治疗毒性反应低,耐受性良好.

Objective To investigate the efficacy and toxicity of stereotactic ablative radiotherapy for stage Ⅰ peripheral non-small cell lung cancers.Methods Thirty six patients of stage Ⅰ peripheral non-small cell lung cancers were treated with stereotactic ablative radiotherapy.The prescription dose was 12 Gy per fraction ×4 fraction in one to two weeks.The 100% planning target volume （PTV） was covered by the isodose curve of 95% prescription dose.Organs at risk and their respective tolerance doses used during treatment planning were developed from the research scheme of the Radiation Therapy Oncology Group 0236.Before the radiation delivery,all patients were scanned by the fan beam CT or the cone beam CT for image guidance and registration.The follow-up for the patients was given to observe the toxicity and efficacy of stereotactic ablative radiotherapy （SABR）.Results The median follow-up time was 18.7 months （range of 4 to 36 months）.After treatment,the overall response rate was 88.9%,with complete response （CR） 17 cases（47.2%）,partial response （PR） 15 cases（41.7%）,and stable disease （SD） 4 cases（11.1%）.The estimated overall survival rate at 1 and 3 years was 92.3% （95% confidence interval [CI],86.3% -97.1%） and 85.3% （95% CI,80.5% -90.6%）.The estimated local control rate at 3 years was 90.2% （95% CI,85.7% -94.8%）.There was no gradeⅢ or above toxicity related to treatment.Conclusions The stereotactic ablative radiotherapy attains good local control and survival efficacy for the stage Ⅰ peripheral non-small lung cancer patients.It is well tolerated owing to low toxicity.