体部立体定向放射治疗Ⅰ期周围型肺癌50例疗效观察

Therapeutic effect of stereotactic radiotherapy for 50 cases of peripheral lung cancer

目的观察体部立体定向放射治疗(SBRT)Ⅰ期周围型肺癌的临床疗效以及不良反应。方法选取2012年3月—2013年9月哈尔滨医科大学附属肿瘤医院放疗科收治Ⅰ期周围型肺癌患者50例作为研究对象,其中I_A患者30例,I_B患者20例。SBRT总量60 Gy/8次,1次/d,95%以上计划靶区(PTV)满足处方剂量,90%等剂量线完全覆盖靶区,严格限制双肺V5<50%、V20<20%;脊髓、心脏都限制在正常范围内。所有患者定位行4D-CT扫描,治疗前给予断层扫描(CBCT)验证,随访观察患者的近期疗效以及不良反应。结果 50例患者均获得随访,随访时间3—32个月,中位数26个月。其中完全缓解(CR)40例,部分缓解(PR)6例,稳定(SD)2例,进展(PD)2例,局部控制率(CR+PR)为92.0%,疾病控制率(CR+PR+SD)96.0%,1年和2年OS分别为86.0%和74.0%。其中5例(10.0%)患者发生Ⅲ级晚期不良反应,未出现Ⅲ级以上不良反应。结论Ⅰ期周围型肺癌行SBRT治疗能够提高肿瘤的局部控制率和生存率,不良反应较低,但是生存期和晚期不良反应仍需长期随访评估。

Objective To observe the clinical efficacy and adverse reactions of stereotactic radiotherapy （ SBRT） in patients with primary peripheral lung cancer.Methods Fifty patients with peripheral stage Ⅰ NSCLC were treated with 60 Gy in eight divided doses,Thirty patients had IA tumors, and 20 patients had IB tumors.more than 95% PTV meet the pre-scribed dose,90%of the prescription isodose line complete coverage of PTV, and strictly control the lung V5〈55%,V20〈20%,heart and spinal cord organ at risk by volume control in the normal range.all patients in the projection of 4DCT and cone beam CT （ CBCT） precision verification and registration.Observation and follow-up of patients were being with side effects of radiotherapy and efficacy.Results All the 50 patients were followed up for 3 to 32 months, with a median of 26 months.The complete remission （ CR） 40 cases, partial remission （ PR） 6 cases, stable （ SD） in 2 cases, progress （ PD） in 2 cases, local control rate （ CR＋PR） was 92.0%, disease control rate （ CR＋PR＋SD） of 96.0%, 1 and 2 years were 86.0%and 74.0%OS.Among them, 5 patients （10.0%） had gradeⅢadverse reactions, and the adverse reactions were not more thanⅢ.Conclusion SBRT treatment of peripheral lung cancer can improve the local control rate and survival rate, and the adverse reaction is low, but the survival and late adverse reactions still need long-term follow-up evaluation.