立体定向放射治疗脊柱转移瘤疗效分析

目的观察立体定向放射治疗脊柱转移瘤的疗效与不良反应。方法应用全身伽玛刀治疗脊柱转移瘤24例，肿瘤组织照射剂量38．2～46．8Gy，10～13分次，13～17天完成。结果放疗后疼痛完全缓解（CR）7例，部分缓解（PR）12例，轻微疗效（MR）2例，止痛有效率90．5％。骨转移灶完全消失3例，明显缩小13例，治疗后生活质量评分较治疗前明显改善，消化道反应和骨髓抑制等不良反应轻微。结论立体定向放射治疗脊柱转移瘤止痛效果迅速持久，能明显改善患者的生活质量，控制肿瘤效果满意，值得推广。     

肺部寡转移瘤立体定向放疗疗效及安全性

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。     

立体定向放射治疗脊柱转移瘤疗效分析

目的观察立体定向放射治疗脊柱转移瘤的疗效与不良反应。方法应用全身伽玛刀治疗脊柱转移瘤24例,肿瘤组织照射剂量38.2~46.8 Gy,10~13分次,13~17天完成。结果放疗后疼痛完全缓解(CR)7例,部分缓解(PR)12例,轻微疗效(MR)2例,止痛有效率90.5%。骨转移灶完全消失3例,明显缩小13例,治疗后生活质量评分较治疗前明显改善,消化道反应和骨髓抑制等不良反应轻微。结论立体定向放射治疗脊柱转移瘤止痛效果迅速持久,能明显改善患者的生活质量,控制肿瘤效果满意,值得推广。     

肺寡转移瘤立体定向消融放疗的长期疗效观察

目的:评价立体定向消融放疗(SABR)在肺部寡转移瘤患者中的有效性和安全性。方法:回顾性分析2011—2018年行SABR的159例肺部转移瘤的患者资料,采用 Kaplan- Meier方法计算局控率(LCR)和总生存(OS),并采用 log- rank法单因素分析和 ...     

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。     

脊柱转移瘤立体定向放射治疗研究进展

脊柱是恶性肿瘤发生骨转移的最常见部位之一。多年来,放疗在脊柱转移瘤患者中发挥重要作用。近年来,立体定向放射治疗（SBRT）成为治疗脊柱转移瘤的有效方法之一,分割方式分单次与多次分割。本文就已发表文献中脊柱转移瘤立体定向放射治疗单次与多次分割的适应证与禁忌证、治疗技术、剂量及疗效、脊髓安全剂量分析、局部失败模式分析等方面做一综述。     

体部立体定向放疗治疗腹膜后转移瘤临床疗效观察

目的:观察全身γ刀立体定向放射治疗(SBRT)腹膜后转移瘤的近期疗效及不良反应.方法:采用超级γ刀（SGS-I型）立体定向放射治疗腹膜后转移癌65例,根据肿瘤的位置、临床靶体积、病人的身体状况与治疗目的,制定放射治疗计划及调整剂量分布.肿瘤体积8.7～1 352.3cm3,等剂量参考曲线50%～60%,周边照射总剂量40～48Gy,分割处方剂量4.0～6.0cGy,重复治疗8～10次,5次/周.结果:治疗前腰背部疼痛不适等40例,治疗结束后1至3个月,症状完全消失32例(80.0%),轻度缓解7例（17.5%）,部分缓解1例(2.5%),症状改善有效率为97.5%.65例病人治疗后2～3个月复查CT或MR,肿瘤消失36例(55.38%),缩小27例(41.54%),无变化2例(3.08%),总有效率96.92%.2级放射性消化系统反应为16.18%,无>2级放射性消化系统反应的发生.结论:全身γ刀治疗腹膜后转移癌临床效果确切,毒副反应较轻.     

体部伽马射线立体定向放疗治疗肺部原发及转移瘤的疗效及毒副反应

目的:回顾性分析伽马射线体部立体定向放射治疗(stereotactic body radiotherapy,SBRT)治疗肺部原发及转移瘤的急慢性毒副反应和有效性。方法:纳入2013年5月至2015年1月32例肺部原发及转移瘤患者共计47个病灶,中位随访时间9个月,所有患者均经4DCT定位后采用伽马射线体部立体定向放射治疗。处方剂量及分割模式为63 Gy/9 f（BED10>100 Gy）,50%等剂量曲线包绕。RECIST 1.1标准评价疗效,CTC 3.0标准评价急慢性毒副反应。结果:所有患者按计划完成处方,随访率100%,完全缓解（CR）89.4%（42个病灶）,部分缓解（PR）10.6%（5个病灶）,病灶有效反应率（CR+PR）为100%,6个月生存率为93.8%。无3级以上急慢性毒副反应。结论:采用伽马射线体部立体定向放疗治疗肺部原发及转移瘤病灶局部反应率高,急慢性毒副反应可接受。     

立体定向外科联合全脑放射治疗脑转移瘤疗效分析

肿瘤发生脑转移后，如果不进行有效地治疗，中位生存期仅为1个月。长期以来，尽管临床上给予了积极治疗，生存期有明显延长，但预后仍非常差。目前何种治疗方法最佳尚无明确定论。1975年Leksell教授采用通过高能射线聚焦一次性大剂量定向照射靶区治疗病灶并取得了成功，此即立体定向外科治疗（stereotatic radiosurgery，SRS）。近年来这一方法得到越来遗多地应用。但如何正确、合理地应用立体定向外科治疗，     

23例脑转移瘤的立体定向放射治疗疗效观察

我院于 2 0 0 0年 10月～ 2 0 0 2年 4月采有X刀立体定向放射外科 (stereotacticradiotherapytreatment,SRT)治疗 2 3例脑转移瘤 ,共 5 9个病灶 ,取得了较好的临床疗效 ,现报道如下。1　材料与方法1 1　一般资料　本组 2 3例脑转移瘤病人 ,其中男性 10例 ,女性 13例。年龄 30～ 73岁 ,平均 5 6岁。 7例为单发 ,16例为多发 ,最多者 5个病灶 ,共 5 9个病灶。1 2　治疗方法　治疗系统应用医科达 6MSli-precise直线加速器和STAR - 10 0 0三维治疗计划系统 (大恒公司产品 )。治疗前采用胶片曝光法进行检验 ,机械误差在± 0 5mm以内。对脑转…     

Advances of stereotactic body radiotherapy in pancreatic cancer

Pancreatic cancer (PCA) is one of the most aggressive tumors with few effective treatment modalities. It is the 4th and 7th leading cause of cancer death in the United States and China, respectively. At the time of diagnosis, only 20% of cases present with a resectable tumor, and about 40% with a locally advanced tumor that is considered unresectable. Even resected patients still have a poor prognosis, with an incidence of local recurrence ranging from 20% to 60%. It is also reported that up to 30% of PCA patients die from locally obstructive disease with few or no distant metastases. These findings have highlighted the importance of local radiation therapy in the treatment of PCA. As the role of conventional chemoradiotherapy remains controversial, the dawn of the pancreas stereotactic body radiation therapy (SBRT) era represents a potential paradigm shift in the management of PCA. SBRT delivers a higher biological effective dose to the tumor with sharp dose escalation in a shorter treatment time course. Pancreas SBRT is a novel therapeutic option to achieve local tumor control with minimal toxicity. Herein, we review the advancement of SBRT for PCA patients with different stages of pancreatic adenocarcinoma.     

体部立体定向放射治疗在颅外转移灶中的应用

在恶性肿瘤颅外转移灶的治疗中体部立体定向放射治疗(SBRT)已得到有效的应用.SBRT具有肿瘤靶区剂量分布集中、靶区周边剂量梯度变化大及靶区周边正常组织受量较小等特点.SBRT放射生物学特点、SBRT治疗机制、SBRT如何整合至全身系统性治疗均得到了进一步的探究.     

Potential of image-guidance, gating and real-time tracking to improve accuracy in pulmonary stereotactic body radiotherapy

Purpose

To evaluate the potential of image-guidance, gating and real-time tumor tracking to improve accuracy in pulmonary stereotactic body radiotherapy (SBRT).

Materials and methods

Safety margins for compensation of inter- and intra-fractional uncertainties of the target position were calculated based on SBRT treatments of 43 patients with pre- and post-treatment cone-beam CT imaging. Safety margins for compensation of breathing motion were evaluated for 17 pulmonary tumors using respiratory correlated CT, model-based segmentation of 4D-CT images and voxel-based dose accumulation; the target in the mid-ventilation position was the reference.

Results

Because of large inter-fractional base-line shifts of the tumor, stereotactic patient positioning and image-guidance based on the bony anatomy required safety margins of 12 mm and 9 mm, respectively. Four-dimensional image-guidance targeting the tumor itself and intra-fractional tumor tracking reduced margins to <5 mm and <3 mm, respectively. Additional safety margins are required to compensate for breathing motion. A quadratic relationship between tumor motion and margins for motion compensation was observed: safety margins of 2.4 mm and 6 mm were calculated for compensation of 10 mm and 20 mm motion amplitudes in cranio-caudal direction, respectively.

Conclusion

Four-dimensional image-guidance with pre-treatment verification of the target position and online correction of errors reduced safety margins most effectively in pulmonary SBRT.     

乳腺癌寡转移系统治疗联合SBRT的困惑和前景

转移性乳腺癌（metastatic breast cancer,MBC）被认为不可治愈,患者生存预后不佳。但在MBC中存在一部分人群,转移灶的数目和大小较局限,有潜在治愈可能,即寡转移乳腺癌（oligometastatic breast cancer,OMBC）。立体定向放射治疗（stereotactic body radiation therapy,SBRT）联合系统治疗有望延缓OMBC患者的疾病进展,改善生存。如何寻找真正的OMBC患者,SBRT是否覆盖所有转移病灶,联用何种系统治疗方式,都是当下值得探讨的问题。     

Central thoracic lesions treated with hypofractionated stereotactic body radiotherapy

Purpose

To investigate the toxicity and outcome after moderately hypofractionated stereotactic body radiotherapy (SBRT) for central thoracic lesions.

Methods

Fifty-three patients undergoing 63 courses of SBRT for central thoracic lesions were retrospectively reviewed. Ninety-eight lesions received 30-63 Gy in 2.5-5.0 Gy fractions using the Novalis ExacTrac^® patient positioning platform.

Results

The 2-year lesion local control was 73%. Larger lesion volume was associated with poorer local control. The 2-year overall survival of patients with Stage I NSCLC, Stages II-III NSCLC and limited metastatic disease was 72%, 12% and 49%, respectively. There were four patient deaths from pulmonary causes, potentially grade 5 toxicities, though three had comorbid pulmonary conditions which may have contributed to the cause of death. One patient died from hemoptysis after undergoing two courses of SBRT to a mediastinal lesion. Most other deaths were attributable to metastatic progression.

Conclusions

Moderately hypofractionated SBRT to central thoracic lesions is effective with respect to local control and toxicity. Further dose escalation can provide an opportunity for better tumor control. Even with less aggressive dose fractionation, pulmonary deaths can occur, though it is difficult to ascertain the extent to which SBRT contributed to the death of patients with comorbid pulmonary conditions.     

Regorafenib-induced transverse myelopathy after stereotactic body radiation therapy

Stereotactic body radiation therapy (SBRT) delivers large doses of radiation with great accuracy, but is known to have deleterious effects on the vascular compartment of irradiated tissues. Combining SBRT with targeted anti-angiogenesis agents, while able to increase therapeutic efficacy, may unexpectedly precipitate vascular-based toxicities. In this report, we describe a patient with colon cancer who developed transverse myelopathy from regorafenib 2 years after receiving SBRT for three metastatic liver lesions. Regorafenib (Stivarga), formerly BAY 73-4506, (Bayer HealthCare Pharmaceuticals, Montville, NJ) is a multiple receptor tyrosine kinase inhibitor with anti-angiogenic effects used in metastatic colon cancer. Its most common side effects are fatigue, diarrhea and hypertension. However, severe neurologic toxicity has not been previously recognized. Here, we illustrate a case in which the patient developed hyperalgesia and radicular pain 2 weeks after starting regorafenib. Several studies report an increased neurological toxicity when angiogenesis inhibitors are given after radiation therapy, and we postulate that the angioinhibitory effects of regorafenib accelerated subclinical microvascular injury from SBRT. This unexpected toxicity may be clinically relevant when giving targeted angiogenesis inhibitors after SBRT.