分次立体定向放射治疗肺转移瘤31例疗效和安全性分析
The efficacy and safety analysis of fractionated stereotactic radiotherapy in the treatment of lung metastatic tumors in 31 cases
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摘要: 目的:评价分次立体定向放射治疗(FSRT)肺转移瘤的疗效及安全性。方法:对31例肺转移瘤(每例病灶数目1~3个)患者给予FSRT,单次靶区周边剂量为3~5 Gy,总剂量为30~45 Gy,分7~9次完成,50%等剂量曲线包绕计划靶体积。结果:截至2011年12月,25例患者病死。全组中位生存期为20.7个月(3.5~42.9个月),1年及2年生存率分别为78.4%和43.2%,临床症状缓解率为84.1%,肿瘤局部控制率为90.4%。有肺外病灶和无肺外病灶的生存率比较差异有统计学意义(P=0.043)。鳞状细胞癌和腺癌病灶的治疗有效率分别为83.3%(10/12)和85.7%(12/14),上皮来源(包括鳞状细胞癌和腺癌)及非上皮来源的病灶治疗有效率分别为84.6%和3/3,差异均无统计学意义(P=1.000)。结论:采用FSRT肺转移瘤是有效和安全的,可延长患者生存期,但需严格掌握适应证;单发肺转移和无肺外病灶存在者的预后较好。Abstract: Objective:To evaluate the efficacy and safety of fractionated stereotactic radiotherapy(FSRT) in the treatment of lung metastatic tumors.Methods:Thirty-one cases(1 to 3 lesions each case) were treated with FSRT.Single target dose of surrounding area was from 3 to 5 Gy,which total radiation dose was from 30 to 45Gy through 7 to 9 times completing.The 50% of dosage curve covered the planning target volume.Results:Up to Dec.2011,25 patients died.The median overall survival was 20.7 months(3.5 to 42.9 months),the overall survival rates of 1 year and 2 years were 78.4% and 43.2%,respectively.The clinical symptoms remission and local tumor control rates of all patients were 84.1% and 90.4%,respectively.The differences of the survival rate of patients with pulmonary lesions and no pulmonary lesions were significant(P=0.043).The effective rates of squamous carcinoma and adenocarcinoma were 83.3%(10/12) and 85.7%(12/14),respectively.The effective rates of cancer derived from epithelium and no epithelium were 84.6% and 3/3,respectively,which differences were not significant(P=1.000).Conclusions:FSRT in the treatment of lung metastasis is effective and safe,which can prolong the survival under strict mastering indications.The prognosis of patient with single and no pulmonary metastasis is good.