肺转移瘤大分割精准放疗临床疗效分析

Analysis of clinical efficacy of hypofractionated precision radiotherapy for lung metastases

目的分析体部大分割放疗肺转移瘤的疗效及安全性。方法分析自2007-2019年中国医学科学院肿瘤医院收治的193例肺转移瘤患者,男124例,女69例,中位年龄58岁,中位KPS评分80分。原发肿瘤以肺癌(33.7%)、结直肠癌(21.2%)、头颈部肿瘤(13.5%)、乳腺癌(10.9%)为主。分析大分割放射治疗肺转移瘤的临床结果和不良反应。结果中位随访时间59.9个月(95%CI为55.1~64.6个月),共治疗317个病灶,90.7%应用4D-CT定位,应用调强放疗(IMRT)、容积调强弧形治疗(VMAT)、螺旋断层治疗(TOMO)技术者分别占69.4%、28.0%、2.6%,中位大体肿瘤体积、计划靶体积分别为5.0(0.2~142.3)、12.0(1.0~200.1)cm3。处方剂量以60 Gy分4~15次为主,中位计划靶体积剂量60(45~70)Gy;生物等效剂量96(60~150)Gy。1、3、5年局控率分别为95.7%、91.3%、89.9%,原发肿瘤至肺转移诊断中位时间是局控率的影响因素(P=0.027)。1、3、5年总生存率和无进展生存率分别为90.1%、60.8%、46.2%和54.3%、30.3%、19.9%,放疗前肺外远处转移和原发肿瘤至肺转移诊断中位时间是总生存、无进展生存的影响因素。未见>3级不良反应。结论图像引导放疗大分割精准放疗对肺转移瘤可取得安全且较好的结果。

Objective To evaluate the efficacy and safety of hypofractionated radiotherapy for lung metastases(LMs).Methods From March 2007 to April 2019,193 patients with 317 LMs including 124 male and 69 female admitted to our hospital were enrolled.The median age was 58 years old and the median KPS was 80.The primary tumors were mainly distributed in the lung(33.7%),colorectum(21.2%),head and neck(13.5%)and breast(10.9%),respectively.The clinical efficacy and side effects of hypofractionated radiotherapy for LMs were evaluated.Results The median follow-up time was 59.9 months(95%CI:55.1-64.6 months).Among 193 patients with 317 LMs,90.7%of them were treated with 4D-CT,69.4%for intensity-modulated radiation therapy(IMRT),28.0%for volumetric-modulated arc therapy(VMAT)and 2.6%for tomotherapy(TOMO),respectively.The median gross tumor volume(GTV)and planning target volume(PTV)were 5.0 cm3(0.2-142.3 cm3)and 12.0 cm3(1.0-200.1 cm3).The prescription dose regimen was 60 Gy in 4 to 15 fractions.The median dose for PTV was 60 Gy(45-70 Gy)and biological effective dose was 96 Gy(60-150 Gy),respectively.The 1-,3-and 5-year local control rates(LCR)were 95.7%,91.3%and 89.9%,respectively.The median time from primary cancer diagnosis to lung metastases was a prognostic factor for LCR(P=0.027).The overall survival(OS)and progression-free survival(PFS)rates were 90.1%,60.8%,46.2%,and 54.3%,30.3%,19.9%,respectively.The median time from primary cancer diagnosis to lung metastases and extrapulmonary metastases was the prognostic factor for OS and PFS.No Grade 3 toxicities were seen.Conclusion Image-guided hypofractionated precision radiotherapy is an efficacious and safe treatment for LMs.