体部伽玛刀联合化疗姑息治疗癌性上腔静脉综合征的临床观察

Clinical observation on efficacy of body-γ-knife combined with chemotherapy in the alleviative treatment of supeerior vena cava syndrome

目的探讨体部伽玛刀联合化疗治疗恶性肿瘤伴发上腔静脉综合征(SVCS)的疗效。方法 55例恶性肿瘤伴发SVCS采用伽玛刀联合同步化疗1周期,伽玛刀治疗结束后继续化疗4~6个周期;伽玛刀治疗处方剂量为以50%等剂量曲线包绕PTV,60%等剂量曲线包绕90%以上GTV,DT 45~54 Gy/10~12次;观察症状缓解快慢、近期疗效及远期疗效。结果55例患者均按计划完成治疗,SVCS症状均在伽玛刀治疗期间开始缓解,无未缓解或病情进展患者,中位治疗缓解次数6次;2周内完全缓解28例(50.9%),2个月总有效率(RR)为98.2%(54/55),无进展患者。全组随访时间为1~31个月,1年生存率为72.7%(40/55),2年生存率为43.6%(24/55);0~1级急性放射性肺炎4例,0~1级急性放射性食管炎3例,1~2级骨髓抑制9例,0~2级胃肠道反应12例,脱发4例;未出现3~4级不良反应。结论伽玛刀联合化疗治疗癌性SVCS有缓解快、有效率高、复发率低、耐受性好及副反应发生率低的特点,不失为治疗SVCS的好方法。

Objective To investigate the efficacy of the alleviative treatment of superior vena cava syndrome（SVCS） combined body-γ-knife with chemotherapy.Methods Fifty-five cases of SVCS were treated with γ-knife combined with 1 cycle chemotherapy in the.After the γ-knife treatment,the patients were received 4 to 6 cycles of chemotherapy;the 50% isodose curve was used as the prescerption isodose curve to wrap PTV,and the 60% odose curve wrapped more than 90% GTV;according to the pathological type,the total dose was 45-54 Gy for 10-12 fractions.The symptom relief rate,short-term efficacy and long-term efficacy were observed.Results All of the 55 patients were accomplished treatment according to the plan, all the symptoms of SVCS were relieved during the treatment of γ-knife and median treatment was 6 times.There was no one patient who had not been relieved.The complete remission was achieved in 28 cases （50.9%） within two weeks,the total effective rate of two months was 98.2%（54/55）.There was no one patient with PD.All patients were followed up for 1-31 months.The 1-year survival rate was 72.7% （40/55）, 2-year survival rate was 43.6% （24/55）;4 cases of grade 0-1 grade acute radiation pneumonitis （7.2%）,3 cases of grade 0-1 grade acute radiation esophagitis （5.4%）,9 cases of grade 0-2 bone marrow suppression （16.3%）,12 cases of grade 0-2 gastrointestinal reaction （21.8%）,4 cases of alopecia （7.2%）,and did not appear 3-4 grade adverse reactions.Conclusion γ-knife combined with chemotherapy in the treatment of SVCS has the characteristics of fast response,high efficiency,low recurrence rate,good tolerability and fewer side effects,therefore combined body-γ-knife with chemotherapy as therapeutic strategy is a good method to treat SVCS.