伽马射线立体定向放射治疗肺转移瘤42例

Retrospective analysis of 42 cases with lung metastases treated by gamma beam stereotactic body radiotherapy

目的：回顾性分析了采用伽马射线体部肿瘤立体定向放射治疗（SBRT)的方法治疗肺转移瘤的疗效及毒副反应。方法:对2012年至2014年接受治疗的42例肺转移瘤患者进行回顾性分析。42例肺转移瘤患者共68个肺转移瘤病灶行伽马射线SBRT治疗，其中男性18例，女性24例;年龄45~67岁，中位年龄56岁；病理鳞癌25例，腺癌17例;所有患者之前均接受过多程化疗。采用体位固定床和真空负压袋固定体位，在螺旋CT下行薄层定位扫描，应用OUR-QGD型治疗计划系统，制定治疗计划以50%等剂量曲线为处方剂量线,处方剂量范围：0~54Gy,(次/d、5次/周、3~8Gy/次,5~18次完成。治疗后定期复查CT。结果:肺转移瘤病灶完全缓解44.丨％(30/68),部分缓解38.2%(26/68),稳定14.7%(10/68),进展3%(2/68),总有效率为82.3%,肿瘤局部控制率为97%(66/68)。（年生存率为97.6%(41/42)。随访时间6~20个月，中位随访时间1个月。全组无严重毒副反应。结论:体部伽马刀治疗化疗无效肺转移瘤,能获得较高的局控率，延长生存期，是一种毒副反应轻、并发症少，且安全有效的治疗方法。

Objective: To investigate the clinical effect and toxicity of 42 cases of lung metastases tumors treated by gamma beam based SBRT. Methods : All 42 patients with lung metastases tumors treated by gamma beam based SBRT,were retrospectively analyzed. There were 68 lung metastases tumor in 42 patients. Among these patients, 18 were male and 24 female, aged 45 to 67 years ( median 56 years). The pathological diagnosis of 25 patients was squa-mous carcinoma, and other was adenocarcinoma. Although those patients were accepted multiple cycles of chemothera-py, it was evaluated that chemotherapy was invalid to those patients. The lung metastases tumors of those patients were uncontrolled. Position fixed bed and vacuum bag with negative pressure was used to fix patients, then CT scan was used to get image of patients. OUR - QGD planning system was used to make radiotherapy plan. Body y - knife radio-therapy for 50% isodose curve planning target volume, a single dose of 3 - 8 Gy / 5 times / week, for a total of 5 - 18 times the edge of the tumor total dose of 40 - 54 Gy. It was regular examination to make CT scan. Results : Complete response rate of lung metastases was 44. 1% (30/68) ,partial response rate was 38. 2% (26/68) ,stable disease rate was 14.7% (10/68) ,and progressive disease rate was 3% (2/68). The effective rate was 82. 3 % ,and the overall local control rate was 97% (66/68 ). 1 - year survival rate was 97. 6% (41/42 ). Follow - up time was from 6 to 20 months,median follow - up was 12 months. There were no serious complication and toxicity. Conclusion: For patients with lung metastases treated by gamma beam based SBRT,it could achieve high rate of local control and prolong the survival time. Gamma beam based SBRT is a safe and effective radiotherapy, with low complications and toxicities.