58例肺部肿瘤立体定向放射治疗的疗效分析

Efficacy of stereotactic body radiotherapy using helical tomotherapy for primary lung cancer and lung metastasis: An analysis of 58 patients

目的:分析采用螺旋断层放疗系统行立体定向放射治疗治疗肺部肿瘤的安全性及疗效。方法:纳入2014年至2017年在我科治疗的61例肺部肿瘤患者,早期肺原发组32例,肺转移组29例。单次剂量5~7Gy,治疗10次,中位等效生物剂量96Gy。结果:所有患者均完成治疗,3例患者失访,随访率95.1%。肺原发组和肺转移组CR率、PR率分别为18.8%(6/32)、59.4%(19/32)和19.2%(5/26)、57.7%(15/26)。肺原发组1、2、3年PFS率分别为64.7%、38.5%、8.3%,中位PFS时间为18.9个月。肺转移组1年PFS率为38.7%,中位PFS时间为10.7个月。1、2、3年肺原发组和肺转移组LC率分别为94.7%、88.0%、66.0%和91.8%、80.9%、67.4%,OS率分别为93.6%、86.4%、79.7%和82.3%、62.9%、55.0%,无Ⅲ级以上毒副反应发生。远处转移为主要的失败模式。结论:SBRT治疗肺部肿瘤可获得良好的PFS、LC和OS,是一种安全有效的治疗手段。

Objective:To investigate the safety and efficacy of stereotactic body radiotherapy (SBRT) using helical tomotherapy (HT) for lung cancer.Methods:From July 2014 to December 2017,61 consecutive patients with primary non-small cell lung cancer (NSCLC)(32 patients) or solitary pulmonary metastasis (29 patients) who underwent SBRT using HT along with appropriate systemic therapy were collected.The radiation dose ranged from 5.0 to 7.0 Gy per fraction,multiplied by 10 fractions,and the median estimated biological effective dose at 10 Gy (BED 10 ) was 96.0 Gy.Results:All patients completed the therapy without interruption,and the follow-up rate was 95.1%.The complete response (CR) and partial response (PR) rates were 18.8%(6/32),59.4%(19/32) and 19.2%(5/26),57.7%(15/26) for the primary tumor group and the metastasis group,respectively.The media progression-free survival(PFS) time was 18.9 months and the 1-,2-and 3-year PFS rates was 64.7%,38.5%,8.3% for the primary tumor group,while the media PFS time was 10.7 months and the 1-year PFS rate was 38.7% for the metastasis group.The 1-,2-and 3-year local control (LC) rates were 94.7%,88.0%,66.0% for the primary tumor group,versus 91.8%,80.9%,67.4% for the metastasis group.The 1-,2-and 3-year overall survival(OS) rates were 93.6%,86.4%,79.7% for the primary tumor group,versus 82.3%,62.9%,55.0% for the metastasis group.No above grade 3 complications were observed.The main pattern of failure was distant recurrence.Conclusion:HT-SBRT may be safe and effective for primary and lung metastasis,resulting in high PFS,LC and OS rates.