早期非小细胞肺癌的体部立体定向放射治疗进展

体部立体定向放射治疗（stereotactic body radiotherapy,SBRT）成为医学上不能手术的早期非小细胞肺癌（non-small cell lung cancer,NSCLC）的标准治疗方式。近十年的临床证据表明SBRT替代手术治疗效果可观。由于毒副作用小,SBRT同样适用于肺功能差、患有某些严重并发症的老年患者。最近针对可手术早期NSCLC患者的对比研究中发现SBRT可能同样适用于这一群体,但这些可观的结果仍需要长期随访的前瞻性实验的验证。本文就SBRT治疗早期非小细胞肺癌的临床进展做一综述。     

早期非小细胞肺癌的立体定向体部放射治疗

颅外立体定向体部放射治疗(stereotactic body radiation therapy,SBRT)是指应用单次照射或少数分次对靶区给予高剂量照射的治疗方法,在体内具有高度精确性.SBRT最初应用于颅内肿瘤的治疗,其主要优势在于克服了常规剂量治疗不良反应大以及局部控制率低的缺点.近年来较多研究表明.SBRT应用于早期非小细胞肺癌(non-small cellhng cancer,NSCLC)具有无创、可门诊治疗、避免了术后并发症以及可同时治疗多处病变的优点,缺点是缺乏治疗前病理分期、放射性损伤大和无剂量分割标准等.     

早期非小细胞肺癌立体定向放射治疗最新进展

早期非小细胞肺癌(non-small cell lung cancer,NSCLC)的标准治疗仍然为手术切除,但因内科原因不适合手术的患者在很多治疗指南中,体部立体定向放射治疗(stereotactic body radiation therapy,SBRT)成为根治性治疗的首选.SBRT也称为立体定向消融放射治疗(stereotactic ablative radiotherapy,SABR),作为新的治疗方法被应用于多种体部肿瘤的治疗.尤其针对Ⅰ期NSCLC目前已经较多报道,其中不少是精心设计、控制良好的临床试验[1-2].现对目前临床放射生物学的理念、治疗技术以及临床实验结果进行综述.     

体部立体定向放射治疗早期可手术非小细胞肺癌

体部立体定向放疗是指应用单次或少数多次给予靶区高剂量照射的治疗方式。和常规放疗相比,该技术具有分割剂量大、精度高等特点。对于因高龄或合并严重心肺等内科疾病不能手术或不愿接受手术的早期非小细胞肺癌患者,SBRT已被确立为标准治疗。对于可手术病灶,SBRT能达到与手术相似的局部控制率。本研究将对SBRT用于早期可手术NSCLC患者的研究进展作一综述。     

非小细胞肺癌体部立体定向放射治疗的质量管理

目的:完善非小细胞肺癌患者体部立体定向放射治疗（stereotactic body radiotherapy,SBRT）的质量控制和管理,提高治疗精度。方法:针对我院2014年1月至2016年4月期间临床确诊的30例行SBRT治疗的非小细胞肺癌患者,回顾性分析CT模拟定位,靶区勾画,治疗计划评估,剂量验证,治疗摆位验证,完成治疗过程中的质量管理。结果:通过严格的质量管理,减少了患者治疗过程中的误差,危及器官受量均在限定范围内,摆位误差小于等于3 mm。结论:通过完善非小细胞肺癌SBRT的质量管理,可提高治疗精度。     

早期非小细胞肺癌立体定向放射治疗并发症的研究进展

体部立体定向放疗(SBRT)成为因医学原因不能手术或拒绝手术的早期非小细胞肺癌的标准治疗.SBRT具有较高的局部控制率同时不良反应远低于手术或其他治疗.近年来选择SBRT治疗的患者日益增多,关于SBRT的并发症越来越受到重视.本文针对SBRT治疗肺癌常见的并发症如:中央气道损伤、放射性肺炎、食管不良反应、血管损伤、臂丛神经损伤、迷走神经损伤等进行全面综述,并对减少这些并发症提出策略.     

立体定向放射治疗非小细胞肺癌的临床分析

背景与目的：立体定向放射治疗能提高肿瘤的局控率，降低正常组织反应。目前，越来越多地应用于临床。本研究观察立体定向放射治疗非小细胞肺癌的疗效及副反应：方法：对40例不能手术的非小细胞肺癌患者进行放射治疗，对纵隔淋巴结阳性的患者，先常规外照射30～40Gy，然后对肿瘤局部用立体定向放疗追加照射剂量，每次2．5～4．85Cy，照射10～12次；对无纵隔淋巴结转移且肿瘤直径小于6cm的患者单用立体定向放射治疗，单次剂量3～8Gy，每日一次，共照射5～18次。结果：40例患者均顺利完成治疗，近期疗效为完全缓解（CR）11例，部分缓解（PR）24例，总有效率（CR＋PR）为87．5％（33／40），1、2年生存率分别为85．4％和45．1％，放疗期间无急性放射性肺炎发生。肿块较大及年龄大于70岁为影响生存率的危险因素。结论：立体定向放射治疗对非小细胞肺癌有良好的治疗效果，并发症较低，大部分患者能够耐受。     

体部立体定向放射治疗112例非小细胞肺癌近期疗效观察

目的观察立体定向放射治疗（SBRT）非小细胞肺癌的近期疗效和放射副反应。方法 112例非小细胞肺癌患者行伽玛刀放疗,50%的处方剂量线完全覆盖PTV,60%～70%剂量线包裹95%以上GTV,照射剂量以50%剂量线作为处方剂量,3～12 Gy/次,总剂量40～60 Gy,1～3周完成治疗。结果治疗后3～16个月所有患者得到随访,中位随访时间11个月,其中完全缓解（CR）率29.5%（33/112）,部分缓解（PR）率为60.7%（68/112）,总有效率为90.2%（101/112）。6个月和1年的局控率分别为98.8%（80/81）、92.3%（36/39）,生存率分别为100%（81/81）、94.9%（37/39）;放射性肺炎为其主要并发症,发生率为9.8%（11/112）。结论 LUNATM-260型伽玛刀作为1种新的SBRT设备,能够有效地提高非小细胞肺癌的局部控制率和生存率,且并发症发生率低。     

早期非小细胞肺癌放射治疗：从常规放疗到立体定向放疗

放疗是不能耐受或拒绝手术非小细胞肺癌（NSCLC）患者的另一选择,立体定向放疗技术的出现与应用使得放疗可与手术取得相似的疗效。全文对立体定向放疗治疗早期NSCLC研究进展作一综述。     

体部立体定向放疗的放射生物学进展

相比常规照射方式,SBRT照射次数少(1~5次),单次剂量较高(8~30 Gy)。然而在低剂量、多分割方案中适用的LQ模型并不能准确评价大剂量射线的放射生物效应。有学者提出了USC、LQL、gLQ等修正模型,希望能更好地预测SBRT的放射生物学效应。目前SBRT成为肺部、肝脏、脊柱、胰腺等部位原发病灶或少发转移病灶的重要治疗手段之一。放射生物学的进展可以更深入地探索SBRT的临床应用,对提高肿瘤放疗疗效有重要作用。     

Oligometastatic breast cancer treated with curative-intent stereotactic body radiation therapy

Purpose Prospective pilot study to assess patient outcome after stereotactic body radiation therapy (SBRT) for limited metastases from breast cancer. Methods Forty patients with ≤5 metastatic lesions received curative-intent SBRT, while 11 patients with >5 lesions, undergoing SBRT to ≤5 metastatic lesions, were treated with palliative-intent. Results Among those treated with curative-intent, 4-year actuarial outcomes were: overall survival of 59%, progression-free survival of 38% and lesion local control of 89%. On univariate analyses, 1 metastatic lesion (versus 2–5), smaller tumor volume, bone-only disease, and stable or regressing lesions prior to SBRT were associated with more favorable outcome. Patients treated with palliative-intent SBRT were spared morbidity and mortality from progression of treated lesions, though all developed further metastatic progression shortly (median 4 months) after enrollment. Conclusions SBRT may yield prolonged survival and perhaps cure in select patients with limited metastases. Palliative-intent SBRT may be warranted for symptomatic or potentially symptomatic metastases.     

立体定向放疗联合免疫治疗晚期恶性肿瘤进展

晚期肺转移癌或黑素瘤中放疗联合免疫检测点抑制剂,封闭免疫抑制通路,增强抗肿瘤免疫应答,在临床上明显改善生存。体部立体定向放疗大剂量精准照射到肿瘤靶区,最大程度避免周围正常组织损伤,同时还诱导相关细胞因子和免疫分子表达,较常规放疗更能诱导强烈的免疫反应及远隔效应,更适合与免疫联合。已有研究表明总剂量和分割模式是调节放疗免疫反应的重要参数;放疗与免疫序贯时机显著影响疗效,肿瘤浸润淋巴细胞、PD-L1表达水平和MMR缺陷可能是预测放疗免疫治疗的重要指标。采用合理的放疗剂量和分割模式,选择最佳序贯时机和有效的预测标记物,SBRT联合免疫可以最大程度激活全身免疫反应,发挥远隔效应协同作用晚期恶性肿瘤。     

Characterization of FDG-PET images after stereotactic body radiation therapy for lung cancer

Background and purpose

The purpose was to characterize ¹⁸F-fluorodeoxyglucose-positron emission tomography (FDG-PET) findings after stereotactic body radiation therapy (SBRT) for lung cancer.

Materials and methods

This was a retrospective review of 32 FDG-PET scans from 23 patients who underwent SBRT for lung cancer and who showed no evidence of local recurrence. The FDG uptake by lesions was assessed visually using a 3-point scale (0, none or faint; 1, mild; or 2, moderate to intense), and the demarcation (ill- or well-defined) was evaluated. For semi-quantitative analysis, the maximum standardized uptake value (SUVmax) was calculated.

Results

Grade 2 intensity was observed in 70%, 33%, 30%, and 0% of PET scans performed <6, 6-12, 12-24, and >24 months, respectively, after SBRT; well-defined demarcation was observed in 80%, 33%, 40%, and 17%, respectively, and the respective means of the SUVmax were 4.9, 2.6, 3.0, and 2.3. The SUVmax was significantly higher for scans performed at <6 months than at 6-12 or >24 months.

Conclusions

FDG uptake tended to be intense and well-defined at early times after SBRT, especially within 6 months, and was faint and ill-defined at later periods. Moderate to intense FDG uptake observed soon after SBRT does not always indicate a residual tumour.     

Low rate of thoracic toxicity in palliative paraspinal single-fraction stereotactic body radiation therapy

Background

There has been an increase in the utilization of single-fraction stereotactic body radiation therapy (SBRT) to treat thoracic structures, but there have been few reports describing toxicity outcomes with this treatment.

Methods

We evaluated 119 sites (114 patients) with no prior history of thoracic radiation were treated from 10/1/2003 to 10/27/2008 with single-fraction SBRT to thoracic structures. The median dose to the gross tumor volume was 2400 cGy (range 1800-2400 cGy), as was the median dose to the planning target volume (range 1600-2400 cGy). A detailed review of thoracic toxicities was performed to include pneumonitis or Grade 2 or higher esophageal and bronchial toxicity. In addition, we retrospectively contoured the esophagus and bronchus of 48 patients treated in 2004-2005, prior to the establishment of dose constraints to determine the range of doses that these structures received.

Results

Of the contoured patients, the median dose to the hottest 1 cc (D1cc) of the esophagus was 1250 cGy (range 158-2572 cGy). The median bronchial D1cc was 1101 cGy (range 260-2211 cGy). At a median follow-up of 11.6 months, there were seven Grade 2 or higher esophageal toxicities, including one Grade 3 and one Grade 4 toxicities. There were two bronchial toxicities, one Grade 2 and one Grade 3. There were no cases of pneumonitis.

Conclusions

High-dose single-fraction SBRT is well tolerated to the thoracic region, with most patients tolerating high doses to central structures without significant toxicity.     

非共面放疗技术的实现方式

非共面放疗是采用多个非共面固定野或者多个非共面弧照射的放疗技术。非共面射野是各个照射野的射野中心轴不在同一平面内,而非共面弧是指每个弧形成的轨迹不在同一个平面内。与共面放疗相比,非共面放疗技术实现立体多角度或多弧度的照射,提高了射线聚焦程度,有利于拉开靶区和周围正常组织受量;其剂量学优势已在多种肿瘤上得到证实,如颅内肿...     

立体定向放射治疗肝脏转移瘤的临床疗效

目的探讨立体定向放射(stereotactic body radiation therapy,SBRT)治疗肝脏转移瘤的临床疗效。方法回顾性分析2016年12月至2020年5月同济大学附属东方医院收治的43例肝脏转移瘤患者的临床资料。所有患者均采用4D⁃CT或呼吸门控技术进行CT模拟定位,共58个病灶接受SBRT治疗,总剂量为36~70 Gy,分割次数为5~10次,1天1次,1周5次。结果43例患者均顺利完成全程放疗,中位随访时间为15.6个月(范围:2.0~31.9个月)。2年总生存率、局部控制率和无进展生存率分别为55.4%、86.0%和5.9%。常见的Ⅰ~Ⅱ级不良反应为食欲减退(6例)、疲劳(6例)、骨髓抑制(3例)和肝脏疼痛(1例),未发现Ⅲ级及以上不良反应。EQ⁃5D⁃5L生活质量量表的平均效用得分为0.848(标准差=0.277)。结论立体定向放射治疗肝脏转移瘤局部控制率良好且不良反应较少,其远期疗效和安全性值得开展随机对照研究进一步探索。