射波刀治疗22例髂血管旁淋巴结转移性病变的疗效和预后分析

Clinical observation on the treatment efficacy of Cyberknife for iliac lymph node metastasis

目的 评价射波刀治疗髂血管旁淋巴结转移性病变的疗效.方法 回顾性分析2010年5月至2016年5月间接受射波刀治疗的22例（27个靶点）髂血管旁淋巴结转移性病变患者资料.肿瘤体积为0.88 ～ 125.66 cm3（中位数18.87 cm3）,处方剂量为21 ～51Gy（中位数39 Gy）,分割次数为3～8次（中位数5次）,生物等效剂量为35.7 ～100 Gy（中位数72.6 Gy）,64％ ～82％（中位数72％）等剂量线覆盖计划靶区.采用CT为基础评价有无进展.Kaplan-Meier法计算生存率并进行Log-rank检验.结果 随访时间为8～ 97个月（中位33个月）.完全缓解、部分缓解、稳定、疾病进展率分别为37％（10/27）、48％（13/27）、7.5％（2/27）、7.5％（2/27）,有效率为92.5％ （25/27）.局部无进展生存时间为4～ 68个月（中位21个月）.1、2、3年局部控制率均为90.6％,总生存率分别为78.8％、60.6％、43.4％.治疗不良反应主要为恶心、呕吐、乏力等胃肠道反应.射波刀治疗前接受过化疗有助于提高生存.所有伴有腰痛或下肢水肿的患者在治疗后均能使症状得到迅速缓解.结论 射波刀是髂血管旁淋巴结转移性病变安全、有效的局部治疗手段之一,能够诱导症状迅速缓解,而不良反应极低.

 Objective To evaluate the response rate and efficacy of Cyberknife in the treatment of iliac lymph node metastases （ILNM）.Methods Twenty-two patients with 27 ILNM were treated by Cyberknife from May 2010 to May 2016.Tumor volume range from 0.88 to 125.66 cm3 （median 18.87 cm3）.The total doses ranged from 21 to 51 Gy （median 39 Gy） and biological effective doses from 35.7 to 100 Gy （median 72.6 Gy） in 3-8 fractions （median 5）.Sixty-four percent to eighty-two percent （median 72%） isodose line covered planning target.The survival rates were calculated by Kaplan-Meier method and compared with Log-rank test.Results Follow-up time ranged from 8 to 97 months （median 33 months）.The complete response,partial response,stable disease and progression disease rates were 37%,48%,7.5%,48%,respectively.In addition,effective rate was 92.5%.Overall survival range from 4 to 68 months （median 21 months）.The 1-,2-,3-year local control rate was all 90.6% and the survival rates were 78.8%,60.6% and 43.3%,respectively.Adverse reactions after treatment were gastrointestinal reactions such as nausea,vomiting,fatigue.The chemotherapy before Cyberknife helped to improve overall survival.The patients with backache or edema of lower extremity got rapid relief after treatment.Conclusion The treatment of ILNM with Cyberknife has provided a high response rate with minimal side effects.Cyberknife is a safe and effective local treatment method for ILNM.