早期周围型非小细胞肺癌立体定向放疗临床疗效分析

Efficacy of stereotactic body radiotherapy in treatment of early-stage peripheral non-small cell lung cancer

目的总结射波刀立体定向放射治疗对早期周围型非小细胞肺癌的近期疗效。方法回顾性分析中国人民解放军总医院2012年1月-2014年11月收治的40例早期（T1/T2N0M0）周围型非小细胞肺癌患者的病例资料,其中男性31例,女性9例,中位年龄74.5（43～90）岁,以总生存率（overall survival,OS）和无进展生存率（progress-free survival,PFS）为主要观察指标,以客观缓解率（objective response rate,ORR）、疾病控制率（disease control rate,DCR）、无局部失败生存率（local failure-free survival,LFFS）、无区域失败生存率（regional failure-free survival,RFFS）和无远处转移生存率（distant metastasisfree survival,DMFS）为次要观察指标,同时观察失败模式及不良反应。结果中位随访28.5（7～44）个月,2例失访,16例CR（42.1%）,7例PR（18.4%）,8例SD（21.1%）,7例PD（18.4%）。肿瘤ORR为60.5%,DCR为81.6%。1年和3年OS分别为89.7%和83.3%,T1组的1年和3年OS均为100%,T2组的1年和3年OS分别为68.8%和45.8%,两组OS有统计学差异（P=0.000）。1年和3年PFS分别为88.6%和78.2%,1年和3年LFFS分别为97.0%和89.5%,1年和3年DMFS分别为91.5%和87.9%。12例（31.6%）发生Ⅰ度放射性肺炎,4例（10.5%）发生Ⅱ度放射性肺炎,8例（21.1%）发生Ⅰ度疲乏,无Ⅲ级及以上的不良反应。结论射波刀立体定向放射治疗对早期非小细胞肺癌具有较高的局部控制率、总生存率且无远处转移率,不良反应较轻,可作为早期非小细胞肺癌根治性治疗选择之一。

Objective To evaluate the clinical efficacy of stereotactic body radiotherapy in treatment of patients with early-stage peripheral non-small cell lung cancer（NSCLC）. Methods A retrospective analysis of 40 newly diagnosed early stage（T1/T2N0M0） peripheral NSCLC patients treated with Cyberknife in Chinese PLA General Hospital from January 2012 to November 2014 was carried out. There were 9 women and 31 men with the median age of 74.5 years old（ranging from 43 to 90 years old）. The primary outcome measurements included overall survival（OS） and progression-free survival（PFS）, the secondary outcome measurements were objective response rate（ORR）, disease control rates（DCR）, local failure-free survival（LFFS）, regional failure-free survival（RFFS） and no distant metastasis-free survival（DMFS）, and the failure mode and adverse reactions were observed at the same time. Results The median follow-up was 28.5 months（range, 7-44 months） with two cases lost to follow up. Complete response（CR） was achieved in 16 patients（42.1%）, partial response（PR） in 7 patients（18.4%）, stable disease（SD） in 9 patients（23.7%）, and progressive disease（PD） in 8 patients（21.1%）. The objective response rate（ORR） was 60.5%, and the primary tumor local control rate was 81.6%. One-year OS rate and three-year OS rate were 89.5% and 83.3% respectively for the entire group. One-year OS rate and three-year OS rate were 100.0% and 100.0% for T1 tumor, and 68.8% and 45.8% for T2 tumor, respectively（P=0.000）. For the entire group, one-year PFS rate and three-year PFS rate were 88.6% and 78.2%, one-year LFFS rate and three-year LFFS rate were 97.0% and 89.5%, one-year DMFS rate and three-year DMFS rate were 91.5% and 87.9%, respectively. GradeⅠand gradeⅡradiation pneumonitis were observed in 12 patients（31.6%） and 4 patients（10.5%）, respectively. GradeⅠfatigue was observed in 8 patients（21.1%）, and gradeⅢ or above adverse reaction was not found. Conclusion Cyberknife stereotactic radiotherapy provides a treatment option for early stage non-small cell lung cancer patients, with high local control rate, overall survival rate, distant disease control and low adverse reaction.