微波全身热疗辅助立体精确放疗在晚期复治肿瘤中的作用观察及分析

Effect Observation and Analysis on Hyperthermia-therapy Adjuvant Stereotaxic Radiotherapy in the Ttreatment of Re-treating Advanced Cancer

目的观察并探讨立体定向体部放射治疗(SBRT)辅以微波全身热疗在常见几类复治性晚期肿瘤患者治疗中的临床实际意义及价值。方法对170余例患者依其主要采用治疗手段以回顾性研究方式,分为单纯放疗组(99例)、热放疗组(37例)及单纯热疗组(34例)。放射治疗主要采用60Coγ-刀治疗系统及Rapidac直线加速器精确放疗系统实施治疗。总剂量范围35~65Gy。热疗采用WB-1型高能聚焦微波热疗机行腹部照射透热方式致患者机体体温升高至39.5~41.5℃,持续60~90min。热放疗联合组为放射治疗周期期间及先后同步予以全身热疗。结果在各类复治肿瘤患者中,单纯放疗组,热疗放疗组及单纯热疗组肿瘤缓解总有效率(ORR)分别为3.3%、13.5%及2.9%;以放疗结合热疗组略高(与单纯放疗比χ2=5.35,P<0.025),其中以泌尿系及头颈肿瘤比例略高。而中位主存期(MST),尤其平均总生存期(OS),在3组不同治疗方式中,以单纯放疗组较高,差异有统计学意义(t=4.04,P<0.01)(OS分别为6.32、5.16、5.08个月),但MST 3组间差异无统计学意义(t=2.05,P>0.05)。另观察发现单纯放疗总生存期(OS)略高的复治患者中以盆腔妇科及肺、消化系肿瘤较高。结论在复治性晚期肿瘤治疗中,立体定位放疗辅以全身热疗,可部分提高肿瘤缓解有效率,但并非取得明显生存获益。总平均生存期OS以仅予单纯放疗者略高,但各瘤种在3组间MST、OS总体差异无统计学意义。对此类晚期癌患者选用单项姑息性减症性治疗(如放疗)可能更有实际临床意义。

Objective To investigate the clinical significance of hyperthermia-therapy adjuvant stereotaxic body radiotherapy（ SBRT,Gamma-knife/accelerator） in patients with several different re-treating advanced stage cancers. Methods Totally 170 patients with re-treating advanced stage cancers were retrospectively analysed and divided into three groups according to their main therapeutic methods. Among them,99 cases were mainly treated with radiotherapy alone（ group A）,while 39 cases with combined hyperthermia and radiotherapy（ group B） and other 34 cases with hyperthermia alone（ group C）. The systemic 3-dimensional orientation apparatus was used in radiotherapy. The total dose of 35-65 GY was given in synchronous or sequential radiotherapy. WB-1 high-energy-beam microwave thermotherapeutic device was used for hyperthermia on patients mainly by abdominal irradiation. The heating power was set at 500-800 W in which body temperature was exposed to elevated temperature of 39. 5-41. 5℃ lasting for 60-90 min. Results The overall responses rates（ ORR） of three groups were 3. 3%,13. 5% and 2. 9% respectively. Among them,patients with combined hyperthermia-radiotherapy achieved the highest ORR,especially for those with urological,head and neck neoplasms. In addition,patients with radiotherapy alone reached significantly higher average OS as compared with other 2 groups,especially for those with pelvic gynecologic,lung and digestive system tumor.（ Average OS in three subsets： 6. 32 m,5. 16 m and 5. 08 m,P〈0.01）. Nevertheless,the median survival time（ MST） was similar in these three groups,with non-significance difference（ P〈0.05）. Conclusion The hyperthermia-therapy adjuvant stereotaxic radiotherapy could partly increased ORR in certain patients with re-treating advanced cancers,but failed to show significant benefit on OS. A higher average OS was observed in patients with radiotherapy alone. Moreover,no significance difference was observed among different types of cancers regarding MST and OS. Thus,for patients with re-trating advanced stage cances,palliative treatment such as radiotherapy alone may be more practical and effective.