200例肺部肿瘤SBRT的经验和疗效

Experience and efficacy of SBRT for lung cancer：an analysis of 200 patients

目的 评价SBRT肺部肿瘤的安全性及临床疗效。方法 回顾分析2012—2015年在浙江省肿瘤医院经SBRT的200例肺部肿瘤患者。早期原发性NSCLC 118例,肺孤立转移82例,80%等剂量线作为处方剂量覆盖95%PTV,100%等剂量线覆盖100%IGTV,4.0~18.0 Gy/次,每天或隔天1次,BED为40.0~151.2 Gy （中位数100 Gy）。结果 所有患者均完成治疗,随访率96.0%。原发瘤组CR率14.8%（17/115）,PR率65.2%（75/115）。转移瘤组组CR率25%（19/77）,PR率38%（29/77）。2、3级急性RP发生率分别为4.7%、3.1%。中位随访时间14.9个月,1、2年原发和转移瘤组LC率分别为95.7%、84.3%和92%、73%,OS率分别为94.5%、92.0%和85%、62%。结论 SBRT对早期原发性NSCLC和肺孤立转移瘤的1、2年LC、OS率较高且发症低,是一种安全有效的治疗手段。

Objective To evaluate the safety and clinical efficacy of stereotactic body radiation therapy （SBRT） for lung cancer. Methods A retrospective analysis was performed on 200 patients with primary non-small cell lung cancer （NSCLC）（118 patients） or solitary pulmonary metastasis （82 patients） who underwent SBRT in Zhejiang Cancer Hospital from January 2012 to September 2015. The 80% isodose line covered 95% of the planning target volume, and the 100% isodose line covered 100% of the internal gross tumor volume. The fractional dose was 4.0-18.0 Gy daily or every other day, and the biologically equivalent dose ranged from 40.0 to 151.2 Gy （median 100 Gy）. Results All patients completed treatment. The follow-up rate was 96.0%. The complete response and partial response rates were 14.8%（17/115） and 65.2%（75/115） for the primary tumor group, versus 25%（19/77） and 38%（29/77） for the metastasis group. The incidence rates of grade Ⅱ and Ⅲ acute radiation pneumonitis were 4.7% and 3.1%, respectively. The median follow-up was 14.9 months. The 1-and 2-year local control rates were 95.7% and 84.3% for the primary tumor group, versus 92% and 73% for the metastasis group. The 1-and 2-year overall survival rates were 94.5% and 92.0% for the primary tumor group, versus 85% and 62% for the metastasis group. Conclusions SBRT is a safe and effective treatment for early primary NSCLC and solitary pulmonary metastasis, resulting in high 1-and 2-year local control and overall survival rates and low rate of complications.