肺部寡转移瘤立体定向放疗疗效及安全性

Clinical efficacy and safety of stereotactic body radiotherapy for pulmonary oligometastatic tumors

目的初步探讨寡转移性疾病肺部立体定向放疗(SBRT)的疗效及安全性。方法回顾性分析2017年1月至2018年5月46例SBRT治疗的肺部寡转移瘤患者, 其中原发性肺癌肺内寡转移36例, 继发性肺寡转移瘤10例。病理类型:腺癌31例, 鳞癌12例, 其他3例。剂量方案:6 MV X射线, 48~60 Gy分4~8次。采用Kaplan-Meier法分析1、2年总生存(OS)率, Spearman法分析肺部寡转移的处方剂量模式、靶区体积和肺部剂量与急性放射性肺炎(ARP)相关性。结果中位随访期15.5个月, 1、2年OS率分别为65%和37%。其中1级ARP为27例(59%)、2级为16例(35%)、3级为3例(7%), 未发生4级ARP。ARP分级与处方剂量模式、靶区体积相关(P<0.05), >2级ARP与双肺V5相关(P<0.05)。结论 SBRT治疗肺部寡转移癌安全有效, 处方剂量模式、靶区体积、双肺V5与ARP发生密切相关并可能成为其重要预测因素。

Objective To preliminarily evaluate the clinical efficacy and safety of stereotactic body radiotherapy(SBRT)for pulmonary oligometastatic tumors.Methods A retrospective analysis was performed on 46 patients treated with SBRT for pulmonary oligometastatic tumors from Jan 2017 to May 2018.There were 36 cases with primary pulmonary oligometastasis,10 cases with secondary pulmonary oligometastasis.The pathological type included 31 cases of adenocarcinoma,12 cases of squamous cell carcinoma and 3 cases of others.Dosage regimen was designed as 6 MV X-ray,48-60 Gy/4-8fx.The Kaplan-Meier method was used to analyze the overall survival(OS)rates of 1 and 2 years.The Spearman method was used to analyze the correlation between the prescription dose pattern,target volume,whole lungs dose and the incidence of acute radiation pneumonitis(ARP),respectively.Results The median follow-up time was 15.5 months.OS of 1 and 2 years were 65%and 37%,respectively.There were 27 cases with grade 1 ARP(59%),16 cases with grade 2(35%),3 cases with grade 3(7%),none of grade 4 ARP.The grade of ARP was related to the dose pattern of prescription and the planning target volume(P<0.05).Grade 2 ARP was related with whole lungs V5(P<0.05).Conclusions SBRT was safe and effective in the treatment of pulmonary oligometastases.The dose pattern of prescription,planning target volume and double lung V5 were closely related to the occurrence of ARP and may become important predictors.