早期非小细胞肺癌患者立体定向放射治疗的预后分析

背景与目的 随着人口老龄化和肺癌筛查受重视程度的提高，近年来早期肺癌就诊量呈上升趋势。其病理类型以非小细胞肺癌(non-small cell lung cancer, NSCLC)为主，可被划分为可手术早期肺癌和不可手术早期肺癌。立体定向放射治疗(stereotactic body radiation therapy, SBRT)是不可手术早期NSCLC的首选治疗方法。本研究旨在探讨我院早期NSCLC患者行SBRT后的预后及其影响因素，以期提高早期NSCLC患者接受SBRT后的生存期。方法收集2010年8月-2020年8月在我院接受SBRT的早期NSCLC患者的临床资料及随访情况，采用Kaplan-Meier法评估预后，采用Cox比例风险模型进行多因素分析寻找影响预后的因素。结果 共纳入165例患者，中位随访时间为43.2(范围：4.8-132.1)个月。1年、2年、5年局部控制(local control, LC)率分别为98.1%、94.8%和86.5%，卡氏功能状态评分(Karnofsky performance status, KPS)>80分是LC的独立预后因素(P=0...     

局部复发性直肠癌的治疗进展

局部复发性直肠癌(locally recurrent rectal cancer,LRRC)的治疗是多学科综合治疗,包括手术、外放疗、术中放疗、放射性粒子植入治疗、热疗和射频消融治疗等,目前仍以手术和放疗为主。肿瘤完全切除(R0切除)是影响预后的独立因素。随着调强放疗(intensity modulated radiation therapy,IMRT)和立体定向放疗(stereotactic body radiotherapy,SBRT)的出现,既往接受过放疗的患者行再程放疗的疗效被肯定,不良反应在可接受的范围内。此外,随着更多治疗方式的出现,患者的生存率和局部控制率均得到提高,生存质量也得到改善。LRRC的治疗需要多学科医师的共同参与,如何选择适当有效的治疗仍需要更多的研究进行证实。本文就近年来LRRC的综合治疗进展及仍待解决的问题进行综述。     

经倾向评分匹配后立体定向放疗与手术治疗早期非小细胞肺癌预后比较

目的 评价立体定向放疗(SBRT)与手术治疗Ⅰ-Ⅱ期非小细胞肺癌患者的临床疗效。方法 回顾分析2012-2015年在浙江省肿瘤医院经SBRT或手术的120例早期非小细胞肺癌患者,对两组进行倾向得分匹配,各纳入60例符合要求病例。放疗组80%等剂量线作为处方剂量覆盖 95%PTV,100%等剂量线覆盖100% IGTV,每次5~15 Gy,中位生物等效剂量100 Gy (57.6~150.0 Gy);手术组VATS肺叶切除32例,楔形切除和肺段切除9例。结果 两组患者均顺利完成治疗,随访率100%,中位随访时间32.3个月。3例手术患者90 d内因感染发生治疗相关死亡,SBRT组无治疗相关死亡(P=0.079)。SBRT组3例患者随访期间因肿瘤外因素死亡(脑梗死、心脏病等)。12例患者出现局部区域复发,其中手术组5例,SBRT组7例(P=0.543)。17例远处转移,其中手术组11例,SBRT组6例(P=0.835)。中位无瘤生存期手术组38.4个月,SBRT组33.5个月(P=0.178);1、3年总生存率手术组分别为95%、83%,SBRT组分别为93%、83%(P=0.993)。结论 SBRT对早期原发性NSCLC总生存期与手术相当,二者局部控制率相近。     

立体定向放疗在超中央型肺癌治疗中的应用进展

立体定向放射治疗（stereotactic body radiation therapy,SBRT）可实现不可手术超中央型肺癌（ultra-central lung cancer,UCLC）患者的靶区高剂量照射并较好保护危及器官,是目前临床治疗的探索热点。接受SBRT治疗后UCLC患者可获得较好的局部控制率、中位生存时间和总生存率,但是由于UCLC紧邻或侵犯纵隔内重要脏器,SBRT治疗会常伴有一定的不良反应风险。本文就SBRT应用于UCLC患者的临床实践及研究进展进行综述。     

立体定向放疗与调强放疗治疗不适宜手术的Ⅰ期非小细胞肺癌患者的疗效对比分析北大核心

目的:回顾性对比分析接受立体定向放疗(stereotactic body radiation therapy, SBRT)与调强放疗(intensity modulated radiation therapy, IMRT)治疗不适宜手术的Ⅰ期非小细胞肺癌患者的治疗效果及不良反应。方法:回顾性分析接受SBRT或IMRT放射治疗的Ⅰ期非小细胞肺癌患者45例,其中,接受SBRT治疗者21例,接受IMRT治疗者24例。比较二者的局部控制率、区域控制率、无进展生存率、远处转移控制率、肿瘤特异性生存率、总生存率及治疗相关不良反应。结果:SBRT组对比IMRT组显著提高了肿瘤的局部控制率、区域控制率以及无进展生存率。两者的1年、2年、3年肿瘤局部控制率分别为(100%、94.4%、63.2%) vs (87.0%、52.2%、39.1%)(P=0.037)。1年、2年、3年的区域控制率分别为(90.3%、63.3%、45.3%) vs (65.5%、37.4%、 23.3%)(P=0.041)。1年、2年、3年无进展生存率分别为(80.4%、48.5%、43.1%) vs (52.5%、21.9%、17.5%)(P=0.042)。而SBRT组在远处转移控制率,肿瘤相关性生存率及总生存率上对比IMRT组未体现出优势。两者的1年、2年、3年远处转移控制率分别为(85.2%、64.2%、48.1%) vs (91.4%、54.9%、41.2%)(P=0.803)。1年、 2年、 3年总生存率分别为(95.2%、81.0%、61.9%) vs (95.8%、83.3%、66.7%)(P=0.735)。1年、2年、3年肿瘤特异性生存率分别为(100%、89.5%、68.4%) vs (100%、90.9%、72.7%)(P=0.75)。治疗期间,两组间治疗相关不良反应相当,无明显差别。结论:在I期非小细胞肺癌的放射治疗上,SBRT对比IMRT具有提高局部控制率、区域控制率及无进展生存率的优势,但在远处转移控制率、肿瘤相关性生存率及总生存率上,两者无明显差别。临床医师可根据患者的不同状况选择适合的放射治疗方法。     

纵隔放疗引起的心脏并发症

纵隔放疗（mediastinal radiation therapy,MRT）是食管癌、乳腺癌、肺癌和纵隔受累淋巴瘤的主要治疗方式。在手术、放化疗、免疫治疗等多模式综合治疗方面上述恶性肿瘤疗效佳且生存期较长,放疗引起的远期心血管不良反应成为影响患者远期生存和生存质量的重要因素。本文对纵隔放疗后心脏并发症的常见临床表现类型、诊断和治疗的选择进行综述。      

立体定向体部放疗联合靶向药物治疗转移性肾癌的研究进展

立体定向体部放疗(Stereotactic body radiotherapy, SBRT)是近年来放疗取得的一个突破性进展,具有分次剂量高、生物学效应高、分割次数少等优势,可显著提高肾癌的放疗敏感性。分子靶向治疗显著延长了部分患者的无进展生存期和总生存期,但在大多数情况下产生全身用药的耐药性仍不可避免。近年来,SBRT联合靶向药物治疗转移性肾癌初步显示了有效性和安全性,有可能成为一种更有效的治疗方案。本文针对SBRT联合靶向药物治疗转移性肾癌研究进展进行综述。     

调强放疗在非小细胞肺癌中的应用

调强放疗(intensity modulated radiation therapy,IMRT)是在传统的三维适形放疗(3-dimensional conformal radiation therapy,3DCRT)基础上,随着计算机发展和放疗设备改进而产生的更为先进的放疗技术。相比于3DCRT,IMRT可形成更好的适形于肿瘤的物理剂量分布,从而能提高肿瘤靶区的剂量和更好的保护正常组织。近年来,IMRT已越来越多的     

前列腺癌自适应放疗研究进展

放射治疗是前列腺癌的主要治疗手段之一,既往多项临床研究表明,前列腺癌的局控率与放疗剂量成正相关。近年来,随着三维适形放疗（three dimensional conformal radiation therapy,3D-CRT）和调强放疗（intensity modulated radiation therapy,IMRT）技术的应用,在正常组织受到较好的保护的情况下,靶区的照射剂量也能得到有效的提高。     

骨盆区域复发骨与软组织肿瘤手术加术中放疗的围手术期安全性评价北大核心CSCD

目的探讨骨盆复发骨与软组织肿瘤手术联合术中放疗(intra-operative radiation therapy,IORT)的安全性。方法随机选取在郑州大学附属肿瘤医院住院的骨盆复发骨与软组织肿瘤患者40例,将其分为两组:手术联合IORT组(n=20),行骨盆肿瘤手术联合IORT;术前放疗联合手术组(n=20),术前常规放疗后行肿瘤扩大切除手术。比较两组患者术中、术后指标及并发症发生情况等。结果手术联合IORT组20例患者中发生术后直肠、膀胱并发症1例,明显少于术前放疗联合手术组(6例),差异有统计学意义(P<0.05);手术联合IORT组患者术中出血量为(946.33±66.27)ml,略多于术前放疗联合手术组患者(750.66±56.19)ml;但手术联合IORT组患者住院时间和切口拆线时间分别为(8.27±0.64)d和(13.53±0.65)d,明显短于对照组(10.67±1.15)d和(16.17±0.76)d,差异均具有统计学意义(P<0.05)。手术时间、术后血液白细胞计数、术后创腔引流量、切口液化及口感染,两组比较,差异无统计学意义(P>0.05)。结论骨盆复发性骨与软组织肿瘤手术联合IORT具有术后易恢复、安全性好、常规放疗相关并发症少等优点,在临床应用中是安全可行的。     

26例术后复发性胆管细胞癌射波刀SBRT疗效分析

目的 评价射波刀SBRT在复发性胆管细胞癌治疗中的效果及安全性。方法 回顾分析2010-2015年26例术后复发的胆管癌射波刀SBRT的患者,中位术后复发时间10个月,中位肿瘤直径为2.8 cm。中位处方剂量45 Gy,中位分割次数5次。基于增强CT或MRI评估肿瘤进展。采用Kaplan-Meier法计算OS、PFS及LC。使用CTCAE4.0版评估不良反应。结果 中位随访29.3个月,其中位OS和PFS分别为13.5个月和6.5个月,1、2年OS和PFS率分别为52%、21%和28%、15%。4例患者出现肿瘤原位进展。3例患者发生3级不良反应,包括1例胃肠道反应、1例肝功能减退、1例胆道感染;仅1例患者在晚期出现了≥4级消化道出血。结论 射波刀SBRT术后复发性胆管癌可获得较好的疗效且不良反应可耐受。     

Stereotactic Body Radiotherapy for Kidney Cancer: Ready for Prime Time?

The standard treatment for renal cell carcinoma (RCC) is surgery. However, a number of patients will not be candidates for surgical treatment or will reject this therapeutic approach. Therefore, alternative approaches are required. Historically, radiotherapy has been considered an ineffective treatment for RCC due to the radioresistance of renal tumour cells to conventional fractionation and the increased rate of toxicity. Stereotactic body radiotherapy (SBRT) is a radiotherapy technique that provides a non-invasive ablative treatment with remarkable rates of local control in both primary tumours and metastases in several locations, with a low associated morbidity due to the highly conformal dose and the use of image-guided techniques. Current evidence shows that a higher dose per fraction, achieving a higher biological effective dose, can overcome the radioresistance of RCC cells. Therefore, SBRT, as well as the combination of SBRT and new emerging immune therapies, has a potential role in the local treatment of primary RCC and oligometastatic RCC patients.     

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。     

A rapid and systemic complete response to stereotactic body radiation therapy and pembrolizumab in a patient with metastatic renal cell carcinoma

Stereotactic body radiation therapy (SBRT) of local tumor would induce an abscopal effect that has been observed in several kinds of human cancers; one important mechanism may involve the improved activation of the host immune system. The immune checkpoint inhibitor can overcome immune tolerance and enhance the activation of antitumor T cells. The combined treatment of SBRT and checkpoint inhibitor may represent a new promising therapeutic approach. Herein, we reported a patient with metastatic renal cell carcinoma (RCC) treated with concurrent SBRT and anti-PD-1 antibody, pembrolizumab, by which the patient achieved an amazingly systemic complete response in only 2.2 months after starting treatment. This case report indicates that the advanced RCC may benefit from the combining treatment of local SBRT and PD-1 inhibitor and provide a useful paradigm worthy of establishing a clinical trial for patients with advanced renal cell carcinoma.     

立体定向放射治疗在肝细胞癌治疗中的应用进展

立体定向放射治疗(stereotactic body radiation therapy,SBRT)是一种高精度的放射治疗技术,可以通过较少分次的照射提供高剂量、高精度的放射治疗。SBRT能够显著改善肝细胞癌(hepatocellular carcinoma,HCC)患者的局部控制和生存,对于等待肝移植的患者来说,SBRT也可以是一种有效和安全的桥接治疗。此外,SBRT已经显示出联合免疫检查点抑制剂应用的潜在作用。本文将就SBRT治疗HCC的有效性和安全性,并对SBRT联合免疫治疗进行综述。     

Re-irradiation with stereotactic body radiation therapy as a novel treatment option for isolated local recurrence of pancreatic cancer after multimodality therapy: experience from two institutions

Limited treatment options exist for isolated local recurrence of pancreatic ductal adenocarcinoma (PDA) following surgical resection accompanied by neoadjuvant or adjuvant chemoradiation therapy (CRT). While select patients are eligible for re-resection, recurrent lesions are often unresectable. Stereotactic body radiation therapy (SBRT) represents a possible minimally invasive treatment option for these patients, although published data in this setting are currently lacking. This study examines the safety, efficacy, and palliative capacity of re-irradiation with SBRT for isolated local PDA recurrence.All patients undergoing SBRT at two academic centers from 2008-2012 were retrospectively reviewed to identify those who received re-irradiation with SBRT for isolated local recurrence or progression of PDA after previous conventionally fractionated CRT. Information regarding demographics, clinicopathologic characteristics, therapies received, survival, symptom palliation, and toxicity was obtained from patient charts. Kaplan-Meier statistics were used to analyze survival and the log-rank test was used to compare survival among patient subgroups.Eighteen patients were identified. Fifteen had previously undergone resection with neoadjuvant or adjuvant CRT, while 3 received definitive CRT for locally advanced disease. Median CRT dose was 50.4 Gy [interquartile range (IQR), 45.0-50.4 Gy] in 28 fractions. All patients subsequently received gemcitabine-based maintenance chemotherapy, but developed isolated local disease recurrence or progression without evidence of distant metastasis. Locally recurrent or progressive disease was treated with SBRT to a median dose of 25.0 Gy (range, 20.0-27.0 Gy) in 5 fractions. Median survival from SBRT was 8.8 months (95% CI, 1.2-16.4 months). Despite having similar clinicopathologic disease characteristics, patients who experienced local progression greater than vs. less than 9 months after surgery/definitive CRT demonstrated superior median survival (11.3 vs. 3.4 months; P=0.019) and progression-free survival (10.6 vs. 3.2 months; P=0.030) after SBRT. Rates of freedom from local progression at 6 and 12 months after SBRT were 78% (14 of 18 patients) and 62% (5 of 8 patients), respectively. Effective symptom palliation was achieved in 4 of 7 patients (57%) who reported symptoms of abdominal or back pain prior to SBRT. Five patients (28%) experienced grade 2 acute toxicity; none experienced grade ≥3 acute toxicity. One patient (6%) experienced grade 3 late toxicity in the form of small bowel obstruction.In conclusion, re-irradiation with hypofractionated SBRT in this salvage scenario appears to be a safe and reasonable option for palliation of isolated local PDA recurrence or progression following previous conventional CRT. Patients with a progression-free interval of greater than 9 months prior to isolated local recurrence or progression may be most suitable for re-irradiation with SBRT, as they appear to have a better prognosis with survival that is long enough for local control to be of potential benefit.Key Words: Stereotactic body radiation therapy (SBRT), pancreatic cancer, local recurrence, re-irradiation     

Radiotherapy With Curative Intent in Patients With Early-stage,Medically Inoperable,Non–Small-cell Lung Cancer: A Systematic Review

Patients with early-stage non–small-cell lung cancer (NSCLC) who are unable to undergo surgery can be offered radiation therapy (RT). Previously, conventional RT was offered; however, newer techniques such as stereotactic body RT (SBRT) have become available. The objective of the present systematic review was to investigate the effectiveness of RT with curative intent in patients with early-stage medically inoperable NSCLC. MEDLINE, EMBASE, and the Cochrane Library were searched for studies comparing stereotactic RT with curative intent compared with observation or other types of RT for early-stage, medically inoperable, NSCLC. Comparisons of radiation dosing or fractionation schedules for SBRT were included. We include 4 systematic reviews and 52 observational studies. The evidence suggests that SBRT compared with observation or other forms of RT, such as accelerated hypofractionated RT, 3-dimensional conformal RT, conventional fractionated RT, external beam RT, proton beam therapy, and carbon ion therapy, could have similar or improved results in survival or local control, with similar or fewer adverse effects. Evidence also suggests that local tumor control and survival were associated with the biologically effective dose (BED) for SBRT. Several studies suggested a cutoff of approximately 100 BED correlated significantly with patient outcomes. The presented evidence suggests that SBRT compared with other forms of RT is a reasonable treatment option for patients with medically inoperable early-stage NSCLC.     

Stereotactic Radiosurgery for Postoperative Spine Malignancy: A Systematic Review and International Stereotactic Radiosurgery Society Practice Guidelines

PurposeTo determine safety and efficacy of postoperative spine stereotactic body radiation therapy (SBRT) in the published literature, and to present practice recommendations on behalf of the International Stereotactic Radiosurgery Society.Methods and MaterialsA systematic review of the literature was performed, specific to postoperative spine SBRT, using PubMed and Embase databases. A meta-analysis for 1-year local control (LC), overall survival (OS), and vertebral compression fracture probability was conducted.ResultsThe literature search revealed 251 potentially relevant articles after duplicates were removed. Of these 56 were reviewed in-depth for eligibility and 12 met all the inclusion criteria for analysis. 7 studies were retrospective, 2 prospective observational and 3 were prospective phase 1 and 2 clinical trials. Outcomes for a total of 461 patients and 499 spinal segments were reported. Ten studies used a magnetic resonance imaging (MRI) scan fused to computed tomography (CT) simulation for treatment planning, and 2 investigations reported on all patients receiving a CT-myelogram at the time of planning. Meta-analysis for 1 year LC and OS was 88.9% and 57%, respectively. The crude reported vertebral compression fracture rate was 5.6%. One case of myelopathy was described in a patient with a previously irradiated spinal segment. One patient developed an esophageal fistula requiring surgical repair.ConclusionsPostoperative spine SBRT delivers a high 1-year LC with acceptably low toxicity. Patients who may benefit from this include those with oligometastatic disease, radioresistant histology, paraspinal masses, or those with a history of prior irradiation to the affected spinal segment. The International Stereotactic Radiosurgery Society recommends a minimum interval of 8 to 14 days after invasive surgery before simulation for SBRT, with initiation of radiation therapy within 4 weeks of surgery. An MRI fused to the planning CT, or the use of a CT-myelogram, are necessary for target and organ-at-risk delineation. A planning organ-at-risk volume (PRV) of 1.5 to 2 mm for the spinal cord is advised.     

Combining Stereotactic Body Radiotherapy and Microwave Ablation Appears Safe and Feasible for Renal Cell Carcinoma in an Early Series

Microwave (MW) ablation and stereotactic body radiation therapy (SBRT) are both used in treating inoperable renal cell carcinoma (RCC). MW ablation and SBRT have potentially complementary advantages and limitations. Combining SBRT and MW ablation may optimize tumor control and toxicity for patients with larger (> 5 cm) RCCs or those with vascular involvement.Seven patients with RCC were treated at our institution with combination of SBRT and MW ablation, median tumor size of 6.4 cm. Local control was 100% with a median follow-up of 15 months. Four patients experienced grade 2 nausea during SBRT. Three patients experienced toxicities after MW ablation, 2 with grade 1 hematuria and 1 with grade 3 retroperitoneal bleed/collecting system injury. Median eGFR (estimated glomerular filtration rate) preceding and following SBRT and MW ablation was 69 mL/min/1.73 m² and 68 mL/min/1.73 m² (P = .19), respectively.In patients who are not surgical candidates, larger RCCs or those with vascular invasion are challenging to treat. Combination treatment with SBRT and MW ablation may balance the risks and benefits of both therapies and demonstrates high local control in our series. MW ablation and SBRT have potentially complementary advantages and limitations.