Phase II study on stereotactic body radiotherapy of colorectal metastases

Surgical resection provides long term survival in approximately 30% of patients with colorectal carcinoma (CRC) liver metastases. However, only a limited number of patients with CRC-metastases are amendable for surgery. We have tested the effect of stereotactic body radiotherapy (SBRT) in the treatment of inoperable patients with CRC-metastases. Sixty-four patients with a total number of 141 CRC-metastases in the liver (n = 44), lung (n = 12), lymph nodes (n = 3), suprarenal gland (n = 1) or two organs (n = 4) were treated with SBRT with a central dose of 15 Gy×3 within 5-8 days. Median follow-up was 4.3 years. After 2 years, actuarial local control was 86% and 63% in tumor and patient based analysis, respectively. Nineteen percent were without local or distant progression after 2 years and overall survival was 67, 38, 22, 13, and 13% after 1, 2, 3, 4 and 5 years, respectively. One patient died due to hepatic failure, one patient was operated for a colonic perforation and two patients were conservatively treated for duodenal ulcerations. Beside these, only moderate toxicities such as nausea, diarrhoea and skin reactions were observed. SBRT in patients with inoperable CRC-metastases resulted in high probability of local control and promising survival rate. One toxic death and few severe reactions were observed. For the majority of patients, the treatment related toxicity was moderate.     

Fractionated stereotactic body radiation therapy for medically inoperable stage I lung cancer adjacent to central large bronchus

PurposeTo assess the body-framed stereotactic body radiation therapy (SBRT) results and toxicity for medically inoperable stage I lung cancer adjacent to central large bronchus and then compare the results with those of SBRT in peripheral lung tumor in the aspects of survival and SBRT-related pulmonary toxicities.MaterialsFrom June 1999 to May 2006, 32 patients diagnosed as stage I, T1N0 or T2N0, resectable NSCLC were treated with body-frame based fractionated SBRT. Thirty-one patients had several medical problems conflicting surgical procedure. Stereotactic body frame was used for improving setup accuracy. Doses of 10–20 Gy per fraction were delivered to the planning target volume (PTV) up to a total dose of 40–60 Gy with three to four fractions on consecutive days. Centrally located tumor was defined as the tumor within 2 cm apart from large bronchial tree, and was subdivided into bronchial (main/lobar bronchus) and peribronchial (segmental or distal).ResultsMedian follow-up was 26.5 months. The 6-month major response rate, including complete or partial response, was 53.1%. One patient showed progressive disease 1 month after SBRT. The 1- and 2-year actuarial local tumor control rates were both 85.3%. Overall survival was 70.9% at 1 year and 38.5% at 2 years, and survival was not correlated with SBRT dose. Of 9 patients with centrally located tumors, three (33%) experienced Grades 3–5 pulmonary toxicities. Eight patients showed partial or complete bronchial stricture and secondary loss of normal lung volume. Median time to bronchial stricture was 20.5 months. Overall survival did not differ by tumor location.ConclusionsSBRT in this fractionation should not be given to central lung tumors because it can cause the late major airway toxicities in some patients. More protracted hypofractionated treatment regimen may be more safe than that used usually in SBRT for central lung tumors.     

Deep inspiratory breath hold assisted by continuous positive airway pressure ventilation for lung stereotactic body radiotherapy

PurposeContinuous positive airway pressure (CPAP) ventilation hyperinflates the lungs and reduces diaphragmatic motion. We hypothesized that CPAP could be safely combined with deep inspiratory breath hold (CPAP-DIBH) during lung stereotactic radiotherapy (SBRT).Material and methodsPatients with stage-1 lung cancer or lung metastasis treated with CPAP-DIBH SBRT between 3/2017–5/2021 were analyzed retrospectively. Patient characteristics, treatment parameters, duration of breath holds in all sessions and tolerance to CPAP-DIBH were recorded. Local control (LC) was assessed from CT or PET-CT imaging. The distances between the tumor and mediastinal organs at risk (OAR) in centrally located tumors using either free breathing (FB) or CPAP-DIBH were compared. Toxicity was graded retrospectively.ResultsForty-five patients with 71 lesions were treated with CPAP-DIBH SBRT. Indications for CPAP-DIBH were prior radiation (35/71, 65%), lower lobe location (34/71, 48%), multiple lesions (26/71, 36.6%) and proximity to mediastinal OAR (7/71, 10%). Patient characteristics were: F:M 43%: 57%; mean gross tumor volume 4.5 cm³ (SD 7.9), mean planning target volume 20 cm³ (SD 27), primary: metastatic lesions (7%:93%). Mean radiation dose was 52.5 Gray (SD3.5). Mean lung volume was 5292 cm³ (SD 1106). Mean duration of CPAP-DIBH was 41.3 s (IQR 31–46.8). LC at 2 years was 89.5% (95% CI 76–95.5). In patients with central lesions, the distance between the tumor and mediastinal OAR increased from 0.84 cm (SD 0.65) with FB to 1.23 cm (SD 0.8) with CPAP-DIBH (p = 0.002). Most patients tolerated CPAP well and completed all treatments after starting therapy. Three patients did not receive treatment: 2 were unable to tolerate CPAP and 1 had syncope (pre-existing). Toxicity was grade 2 in 4/65 (6%) and grade 3 in 1/65 (1.5%). There was no grade 2 or higher esophageal or tracheal toxicities.ConclusionCPAP-DIBH assisted lung SBRT was tolerated well and was associated with minimal toxicity and favorable LC. This technique may be considered when treating multiple lung lesions, lesions located in the lower lobes or adjacent to mediastinal OAR.     

Primary unknown cancer in pulmonary hilar lymph node with spontaneous transient regression: report of a case

A 69-year-old man was referred to our hospital in December 1993 because an abnormal mass had been detected in the right pulmonary hilum. Computed tomography (CT) of the chest revealed a swollen hilar lymph node between the right middle and lower lobe bronchi, and an adherent tumor in the right ventrobasal segment (S8). Chest roentgenogram in February 1994, however, showed no evident tumor in the right lung field. In March 1996, the mass in the right pulmonary hilum reappeared on chest roentgenogram. Chest CT revealed a swollen hilar lymph node between the right middle and lower lobe bronchi, but there was no tumor in right S8. The patient underwent video-assisted thoracoscopy on 17 May 1996. Intraoperative needle biopsy of the node revealed cancer cells. We performed right middle and lower bilobectomy with mediastinal dissection. Histological diagnosis revealed a large cell carcinoma almost completely occupying a hilar lymph node. The resected middle and lower lobes showed no tumors, except for a coagulation necrosis measuring 1.5 cm in diameter in S8b, corresponding to the site where a tumor shadow had been depicted on the CT image in December 1993. We concluded that the coagulation necrosis might have been the primary site of the tumor, which had spontaneously regressed and then appeared in the metastatic interlobar node.      

肺炎性假瘤31例的X线表现分析

本文报道我院自1974年4月至1982年4月,8年间共收治肺炎性假瘤31例,其中男18例,女13例,均经手术和病理证实。X线检查发现右肺22例(以肺下叶为主,计13例),左肺9例(下叶5例)。肿块阴影多位于肺边缘区,呈圆形或椭圆形,且边界清晰(16例),或毛刺状(11例,其中7侧尚呈分叶状),另4例为浸润性。密度居中而均匀(12侧),少数较密(4例)或稍淡(7例),易误诊为良性瘤或癌。个别者见厚壁空洞(2例),肿块内见斑点状钙化(2例)或浸润状(4例),易误诊为癌,结核球或错构瘤。呈浸润状者,术中皆证实与周围组织粘连,本纽共17例,均有平片断层,26例肺门正常,5例肺可见肿大淋巴结,但病理检查皆为炎性。     

肺腺鳞癌淋巴结转移规律的探讨

目的 分析肺腺鳞癌淋巴结转移(LNM)的特点.方法 对361例肺腺鳞癌患者的临床资料进行回顾性分析.淋巴结分区和TNM分期采用国际抗癌联盟(UICC)标准(1997年).统计分析采用χ2检验、Log rank检验和Cox比例风险模型分析.结果 361例肺腺鳞癌纵隔LNM途径表现为:左肺上叶癌首先转移到主.肺动脉窗淋巴结,右肺上叶癌首先转移到下气管旁淋巴结,两侧下叶肺癌首先转移到隆突下淋巴结,右肺中叶肺癌以向上转移为主.纵隔淋巴结跳跃转移以隆突下最为多见,其次为主-肺动脉窗和下段气管旁.发生单一站纵隔淋巴结跳跃转移的患者预后好于其他LNM者.结论 不同部位肺腺鳞癌的LNM途径和跳跃转移部位有所不同,治疗时应加以考虑.不同转移模式的患者预后不同,发生单一站纵隔淋巴结跳跃转移的患者预后可能较好.     

肺腺鳞癌淋巴结转移规律的探讨

目的 分析肺腺鳞癌淋巴结转移(LNM)的特点.方法 对361例肺腺鳞癌患者的临床资料进行回顾性分析.淋巴结分区和TNM分期采用国际抗癌联盟(UICC)标准(1997年).统计分析采用χ2检验、Log rank检验和Cox比例风险模型分析.结果 361例肺腺鳞癌纵隔LNM途径表现为:左肺上叶癌首先转移到主.肺动脉窗淋巴结,右肺上叶癌首先转移到下气管旁淋巴结,两侧下叶肺癌首先转移到隆突下淋巴结,右肺中叶肺癌以向上转移为主.纵隔淋巴结跳跃转移以隆突下最为多见,其次为主-肺动脉窗和下段气管旁.发生单一站纵隔淋巴结跳跃转移的患者预后好于其他LNM者.结论 不同部位肺腺鳞癌的LNM途径和跳跃转移部位有所不同,治疗时应加以考虑.不同转移模式的患者预后不同,发生单一站纵隔淋巴结跳跃转移的患者预后可能较好.     

肺腺鳞癌淋巴结转移规律的探讨

目的 分析肺腺鳞癌淋巴结转移(LNM)的特点.方法 对361例肺腺鳞癌患者的临床资料进行回顾性分析.淋巴结分区和TNM分期采用国际抗癌联盟(UICC)标准(1997年).统计分析采用χ2检验、Log rank检验和Cox比例风险模型分析.结果 361例肺腺鳞癌纵隔LNM途径表现为:左肺上叶癌首先转移到主.肺动脉窗淋巴结,右肺上叶癌首先转移到下气管旁淋巴结,两侧下叶肺癌首先转移到隆突下淋巴结,右肺中叶肺癌以向上转移为主.纵隔淋巴结跳跃转移以隆突下最为多见,其次为主-肺动脉窗和下段气管旁.发生单一站纵隔淋巴结跳跃转移的患者预后好于其他LNM者.结论 不同部位肺腺鳞癌的LNM途径和跳跃转移部位有所不同,治疗时应加以考虑.不同转移模式的患者预后不同,发生单一站纵隔淋巴结跳跃转移的患者预后可能较好.     

肺腺鳞癌淋巴结转移规律的探讨

目的 分析肺腺鳞癌淋巴结转移(LNM)的特点.方法 对361例肺腺鳞癌患者的临床资料进行回顾性分析.淋巴结分区和TNM分期采用国际抗癌联盟(UICC)标准(1997年).统计分析采用χ2检验、Log rank检验和Cox比例风险模型分析.结果 361例肺腺鳞癌纵隔LNM途径表现为:左肺上叶癌首先转移到主.肺动脉窗淋巴结,右肺上叶癌首先转移到下气管旁淋巴结,两侧下叶肺癌首先转移到隆突下淋巴结,右肺中叶肺癌以向上转移为主.纵隔淋巴结跳跃转移以隆突下最为多见,其次为主-肺动脉窗和下段气管旁.发生单一站纵隔淋巴结跳跃转移的患者预后好于其他LNM者.结论 不同部位肺腺鳞癌的LNM途径和跳跃转移部位有所不同,治疗时应加以考虑.不同转移模式的患者预后不同,发生单一站纵隔淋巴结跳跃转移的患者预后可能较好.     

肺腺鳞癌淋巴结转移规律的探讨

目的 分析肺腺鳞癌淋巴结转移(LNM)的特点.方法 对361例肺腺鳞癌患者的临床资料进行回顾性分析.淋巴结分区和TNM分期采用国际抗癌联盟(UICC)标准(1997年).统计分析采用χ2检验、Log rank检验和Cox比例风险模型分析.结果 361例肺腺鳞癌纵隔LNM途径表现为:左肺上叶癌首先转移到主.肺动脉窗淋巴结,右肺上叶癌首先转移到下气管旁淋巴结,两侧下叶肺癌首先转移到隆突下淋巴结,右肺中叶肺癌以向上转移为主.纵隔淋巴结跳跃转移以隆突下最为多见,其次为主-肺动脉窗和下段气管旁.发生单一站纵隔淋巴结跳跃转移的患者预后好于其他LNM者.结论 不同部位肺腺鳞癌的LNM途径和跳跃转移部位有所不同,治疗时应加以考虑.不同转移模式的患者预后不同,发生单一站纵隔淋巴结跳跃转移的患者预后可能较好.     

肺腺鳞癌淋巴结转移规律的探讨

目的 分析肺腺鳞癌淋巴结转移(LNM)的特点.方法 对361例肺腺鳞癌患者的临床资料进行回顾性分析.淋巴结分区和TNM分期采用国际抗癌联盟(UICC)标准(1997年).统计分析采用χ2检验、Log rank检验和Cox比例风险模型分析.结果 361例肺腺鳞癌纵隔LNM途径表现为:左肺上叶癌首先转移到主.肺动脉窗淋巴结,右肺上叶癌首先转移到下气管旁淋巴结,两侧下叶肺癌首先转移到隆突下淋巴结,右肺中叶肺癌以向上转移为主.纵隔淋巴结跳跃转移以隆突下最为多见,其次为主-肺动脉窗和下段气管旁.发生单一站纵隔淋巴结跳跃转移的患者预后好于其他LNM者.结论 不同部位肺腺鳞癌的LNM途径和跳跃转移部位有所不同,治疗时应加以考虑.不同转移模式的患者预后不同,发生单一站纵隔淋巴结跳跃转移的患者预后可能较好.     

肺腺鳞癌淋巴结转移规律的探讨

目的 分析肺腺鳞癌淋巴结转移(LNM)的特点.方法 对361例肺腺鳞癌患者的临床资料进行回顾性分析.淋巴结分区和TNM分期采用国际抗癌联盟(UICC)标准(1997年).统计分析采用χ2检验、Log rank检验和Cox比例风险模型分析.结果 361例肺腺鳞癌纵隔LNM途径表现为:左肺上叶癌首先转移到主.肺动脉窗淋巴结,右肺上叶癌首先转移到下气管旁淋巴结,两侧下叶肺癌首先转移到隆突下淋巴结,右肺中叶肺癌以向上转移为主.纵隔淋巴结跳跃转移以隆突下最为多见,其次为主-肺动脉窗和下段气管旁.发生单一站纵隔淋巴结跳跃转移的患者预后好于其他LNM者.结论 不同部位肺腺鳞癌的LNM途径和跳跃转移部位有所不同,治疗时应加以考虑.不同转移模式的患者预后不同,发生单一站纵隔淋巴结跳跃转移的患者预后可能较好.     

肺腺鳞癌淋巴结转移规律的探讨

目的 分析肺腺鳞癌淋巴结转移(LNM)的特点.方法 对361例肺腺鳞癌患者的临床资料进行回顾性分析.淋巴结分区和TNM分期采用国际抗癌联盟(UICC)标准(1997年).统计分析采用χ2检验、Log rank检验和Cox比例风险模型分析.结果 361例肺腺鳞癌纵隔LNM途径表现为:左肺上叶癌首先转移到主.肺动脉窗淋巴结,右肺上叶癌首先转移到下气管旁淋巴结,两侧下叶肺癌首先转移到隆突下淋巴结,右肺中叶肺癌以向上转移为主.纵隔淋巴结跳跃转移以隆突下最为多见,其次为主-肺动脉窗和下段气管旁.发生单一站纵隔淋巴结跳跃转移的患者预后好于其他LNM者.结论 不同部位肺腺鳞癌的LNM途径和跳跃转移部位有所不同,治疗时应加以考虑.不同转移模式的患者预后不同,发生单一站纵隔淋巴结跳跃转移的患者预后可能较好.     

Location Matters: Stage I Non–Small-cell Carcinomas of the Lower Lobes Treated With Stereotactic Body Radiation Therapy Are Associated With Poor Outcomes

IntroductionThe lung is a heterogeneous organ with relative overperfusion of the lung bases. We determined whether a lower lobe primary tumor location was associated with poor outcomes in the setting of stage I non–small-cell lung cancer (NSCLC) treated with stereotactic body radiation therapy (SBRT).Patients and MethodsThe data from consecutive patients with stage I NSCLC treated from 2009 to 2014 with curative intent SBRT were analyzed. Primary tumors in the right and left lower lobes were compared against the tumors in all other locations to determine whether a lower lobe location was associated with worse local, regional, and distant control and worse relapse-free and overall survival. The survival rates were estimated using Kaplan-Meier analysis, and multivariate analysis was completed using the Cox proportional hazards model, adjusting for age, stage, performance status, and radiation dose.ResultsA total of 122 patients with early-stage NSCLC who underwent SBRT were evaluated at a median follow-up period of 28.6 months. On multivariate analysis, lower lobe tumors were associated with poor relapse-free survival (hazard ratio [HR], 2.78; 95% confidence interval [CI], 1.21-7.76; P = .04) and poor overall survival (HR, 2.33; 95% CI, 1.09-5.64; P = .04). The 3-year relapse-free survival for patients with a lower lobe primary was 75% compared with 89% for patients with a non–lower lobe primary (P = .04). Additionally, the 3-year overall survival rate for patients with a lower lobe primary was 63% versus 82% in patients with a non–lower lobe primary (P = .01).ConclusionLower lobe stage I NSCLC tumors treated with SBRT are associated with poor relapse-free and overall survival.     

Canadian Phase III Randomized Trial of Stereotactic Body Radiotherapy Versus Conventionally Hypofractionated Radiotherapy for Stage I,Medically Inoperable Non–Small-Cell Lung Cancer – Rationale and Protocol Design for the Ontario Clinical Oncology Group (OCOG)-LUSTRE Trial

We describe a Canadian phase III randomized controlled trial of stereotactic body radiotherapy (SBRT) versus conventionally hypofractionated radiotherapy (CRT) for the treatment of stage I medically inoperable non–small-cell lung cancer (OCOG-LUSTRE Trial).Eligible patients are randomized in a 2:1 fashion to either SBRT (48 Gy in 4 fractions for peripherally located lesions; 60 Gy in 8 fractions for centrally located lesions) or CRT (60 Gy in 15 fractions). The primary outcome of the study is 3-year local control, which we hypothesize will improve from 75% with CRT to 87.5% with SBRT. With 85% power to detect a difference of this magnitude (hazard ratio = 0.46), a 2-sided α = 0.05 and a 2:1 randomization, we require a sample size of 324 patients (216 SBRT, 108 CRT). Important secondary outcomes include overall survival, disease-free survival, toxicity, radiation-related treatment death, quality of life, and cost-effectiveness. A robust radiation therapy quality assurance program has been established to assure consistent and high quality SBRT and CRT delivery.Despite widespread interest and adoption of SBRT, there still remains a concern regarding long-term control and risks of toxicity (particularly in patients with centrally located lesions). The OCOG-LUSTRE study is the only randomized phase III trial testing SBRT in a medically inoperable population, and the results of this trial will attempt to prove that the benefits of SBRT outweigh the potential risks.     

Systemic review of the patterns of failure following stereotactic body radiation therapy in early-stage non-small-cell lung cancer: Clinical implications

Purpose

To analyze the patterns of failure, the toxicity profile, and the factors influencing efficacy of stereotactic body radiation (SBRT) for early-stage non-small-cell lung cancer (NSCLC).

Methods and materials

A search was based on PubMed electronic databases. All searches were conducted in May, 2009.

Results

The local control ranged from 80% to 100% in most studies with adequate isocentric or peripheral biologically effective dose (BED). Recurrences were associated with increased tumor size. The main pattern of failure after SBRT was distant metastasis. Grades 3-5 toxicity occurred mostly in centrally located tumors, and adjuvant chemotherapy may further decrease all recurrences; possibly translating to a survival benefit in large or centrally located tumors where high BED cannot be safely reached.

Conclusion

SBRT is an excellent treatment option for early-stage, and mostly medically inoperable, NSCLC. BED at both the isocenter and the tumor periphery is very important for optimal tumor control; higher doses are required for large (?T2) lesions; SBRT for centrally located tumors can be feasible with a much less aggressive dose regimen than 60-66 Gy/3 fractions and adjacent critical structures excluded from the target volume; chemotherapy may optimize the clinical outcome in large or centrally located lesions.     

射波刀SBRT治疗肝门区肝癌临床疗效观察

目的 评价射波刀在肝门区肿瘤治疗中的疗效及安全性。方法 回顾分析2009—2015年间天津医科大学肿瘤医院收治的接受射波刀SBRT的 36例肝门区肝癌患者的病历资料。36例患者(37个病灶)的肿瘤直径为 15~55 mm (中位数30 mm),其中 20例患者(21个病灶)采用金标呼吸同步追踪技术,16例患者(16个病灶)采用椎体追踪技术。通过增强CT和(或) MRI评价肿瘤进展,Kaplan-Meier法计算LC、OS并Logrank检验和单因素分析。结果 中位随访时间为12.7个月。术后1、2年LC率分别为90%、76%,术后 1年OS、PFS分别为63%、39%,中位OS、PFS时间分别为15.2、10.0个月。3级不良反应为11%。结论 射波刀SBRT是肝门区肝癌的一种安全有效的治疗方式。     

肺瘢痕癌的CT诊断及误漏诊分析

目的探讨肺瘢痕癌的CT表现,分析其误诊原因,以便提高早期诊断率。方法回顾性分析经病理或临床随访证实的31例肺瘢痕癌的CT表现。结果 31例瘢痕癌均为单发病灶,位于左上肺12例,左下肺3例,右上肺8例,右下肺5例,右肺中叶2例,同时累及右上下肺1例。31例患者X线诊断肺癌8例,误诊率74.2%(23/31);CT首次检查,主要表现纤维条索状,或模糊斑片状,或不成形云雾样阴影,或结节状及球形病灶等,准确诊断15例,误诊率为51.6%(16/31),早期病灶主要误诊为陈旧性或活动性肺结核、结核球、慢性感染、肺纤维化等。结论肺瘢痕癌因与原有瘢痕组织部位重叠、影像学表现相似而容易误诊,密切注意患者的临床症状及病灶的CT影像变化,有助于提高早期诊断。     

小细胞肺癌胸内淋巴结转移规律对确定放疗范围的意义

目的 通过分析小细胞肺癌(small cell lung cancer,SCLC)胸内淋巴结转移方式和规律,探讨SCLC放疗靶区的合理范围.方法 对本院150例接受根治性切除及系统性淋巴结清扫的局限期SCLC患者的胸内淋巴结进行分组及病理检查,分析胸内各组淋巴结的转移方式和规律.结果 150例SCLC患者共清扫胸内631个组的2372个淋巴结,经病理证实188个组(29.8％)的413个淋巴结(17.4％)存在转移,88例(58.7％)患者存在胸内淋巴结转移.胸内淋巴结转移率较高的是11、10、7、5、4组,中央型、T分期晚的患者更易发生淋巴结转移(x2 =15.32、39.72,P=0.000、0.000).右肺上叶和中下叶肺癌淋巴结高危转移区域分别为4、7、10组和4、7、10、11组,左肺上叶和下叶肺癌淋巴结高危转移区域分别为4、5、6、10组和4、7、9、10、11组.纵隔淋巴结转移72例,其中无肺门淋巴结转移的跳跃性转移29例(肺上叶癌主要向上纵隔淋巴结,肺中下叶癌可向上、下纵隔淋巴结).结论 SCLC胸内淋巴结遵循由肺内经肺门向纵隔依次转移的规律,但存在部分跳跃性转移;对不同肺叶肺癌对应的高危淋巴结转移区域给予预防照射有可能提高SCLC的放疗增益比.     

CTVision 图像引导下非小细胞肺癌立体定向放疗的精确性分析

目的 探讨CTVision引导下非小细胞肺癌立体定向放疗的精确性。方法 2010—2012年应用西门子ONCOR CTVision加速器对10例非小细胞肺癌患者行立体定向放疗,采集每位患者每次放疗前后CT图像并与治疗计划CT图像进行匹配,在线调整并分析患者放疗前后位移误差。通过离线勾画每位患者每次放疗前后(共8次)大体肿瘤体积,融合8次靶区得到内靶体积,通过比较内靶体积和计划靶体积进行离线验证治疗过程准确性。配对样本t检验差异。结果 分析10例肺癌患者放疗前后80次CT扫描数据,结果显示放疗前和后在左右、上下、前后方向位移误差均相似,分别为(－0.10±1.30) mm和(－0.15±1.31) mm (P=0.720)、(0.18±1.32) mm和(0.18±1.43) mm (P=1.000)、(－0.08±1.19) mm和(－0.13±1.18) mm (P=0.750)。内靶区的体积均小于计划靶区体积,分别为13.53 cm³和37.84 cm³(P=0.000)。结论 CTVision加速器能够确保肺癌患者立体定向放疗的准确性和安全性。