肺转移瘤的放射治疗

肺转移瘤是最常见的转移性肿瘤之一,手术仅适用于局限性肺转移的治疗,并且大部分患者不适合行手术治疗。化疗是主要治疗方法,但是疗效欠佳。研究证实,随着三维适形放疗、体部立体定向放射治疗等精确放疗的不断发展,放疗对于肺转移患者有效,尤其对于局限性转移,体部立体定向放射治疗可以取得较好的生存期,但仍需大规模前瞻性研究。     

脑转移瘤的综合治疗

脑转移是目前肿瘤治疗的难点之一,既往治疗主要以全脑放疗为首选,但全脑放疗后疗效差以及明显影响治疗后长期存活患者的生活质量。所以脑转移的治疗应根据不同预后行个体化治疗。目前基于RTOG研究的Graded Prognostic Assessment评分在国内外广泛使用。对于GPA高的患者,建议采用积极的治疗手段,如全脑放疗联合手术或者立体定向放射治疗,部分患者可考虑使用手术联合立体定向放射治疗;对于GPA低的患者,仍以全脑放疗为首选,部分患者可考虑采用联合分子靶向药物治疗。考虑到全脑放疗的脑功能损伤与海马结构照射有关,越来越多研究开始探索全脑放疗中保护海马的新策略。     

脑转移瘤的立体定向放射治疗

单纯立体定向放射外科能取得全脑放疗联合立体定向外科治疗相同的生存率,对于局部控制来说,结果有冲突。全脑放疗较局部治疗（立体定向放射外科和手术）减少颅内新发病灶。单纯立体定向放射外科组颅内治疗病灶外以及颅内总体复发率均增加,而且联合全脑放疗不增加认知功能损伤。对于1-3个脑转移瘤患者,单纯立体定向放射外科生存好于单纯全脑放疗。全脑放疗联合立体定向外科治疗较全脑放疗能改善局部控制,并在不增加并发症的基础上改善KPS评分。对于单发脑转移灶,联合治疗有生存获益。但2个及2个以上的脑转移灶是否有生存优势,尚有争论。对于多发脑转移瘤、KPS〈70分的患者联合治疗能改善生存。全脑放疗联合立体定向外科治疗和手术联合全脑放射治疗两组无生存差异。     

放射治疗肺癌脑转移的预后因素分析

[目的]探讨不同放射治疗方法对肺癌脑转移的疗效及影响肺癌脑转移的预后因素.[方法]46例肺癌脑转移患者采用放射治疗,共分2组,全脑放疗(WBRT)和全脑放疗加立体定向放射治疗(WBRT CRT).CRT治疗单次靶区平均周边剂量3Gy～8Gy,总剂量16Gy～32Gy,WBRT(2～3)Gy/次,总剂量(30～40)Gy/(3～4)w.同时对卡氏评分、合并治疗、颅外有无转移等进行多因素分析.[结果]2组病例局部控制率分别为42.3%、85%.中位生存期分别为5、12.5个月.经多因素分析显示生存率与卡氏评分、合并治疗、颅外有无转移呈正相关.[结论]对于肺癌脑转移,全脑放疗组加立体定向放射治疗(WBRT CRT)在肿瘤局部控制率及提高生存率方面均优于全脑放疗(WBRT).对卡氏评分高、合并其它治疗且不存在颅外转移的患者,应采取积极的治疗.     

非小细胞肺癌脑转移全脑及病灶局部大分割放射治疗

高达40%的非小细胞肺癌患者在疾病进程中出现脑转移,且非小细胞肺癌脑转移常为多发转移。脑转移患者的预后较差,中位生存期不到1年。脑转移的放射治疗已经从全脑放疗逐渐发展到多种放射治疗策略广泛应用的时代。目前已证实单纯全脑放疗、手术+全脑放疗、立体定向放射治疗+全脑放射治疗、同步调强全脑放射治疗等对比未治疗患者能提高总生存期。近年来,全脑放疗对认知功能的损害受到广泛关注,针对预期生存时间较长的患者,采取何种放疗模式尚存在争议。本文将分别论述非小细胞肺癌脑转移不同的全脑放射治疗策略及治疗副作用。     

立体定向放射治疗肺癌脑转移疗效分析

目的探讨不同放射治疗方法对肺癌脑转移的疗效.方法176例由病理学证实的肺癌脑转移患者分为4组:单纯全脑放疗(WBRT)组、全脑放疗加立体定向放射外科(WBRT SRS)组、单纯立体定向放射治疗(SRT)组、全脑放疗加立体定向放射治疗(WBRT SRT)组.SRS治疗单次靶区平均周边剂量8～20Gy,总剂量20～32Gy;SRT治疗单次靶区平均周边剂量2～5Gy,总剂量25～60Gy;WBRT1.8～2Gy/次,总剂量30～40Gy.结果四组的局部控制率分别为47.0%、87.7%、86.5%和78.0%;中位生存期分别为5.0,11.0,11.5和10.0个月;局部无进展生存期分别为3.33,8.33,9.33和7.67个月;颅脑无新病灶生存期分别为4.11,8.57,9.03和6.12个月.在死因分析中,WBRT组死于脑转移的比率为57.6%,较其他三组高.而WBRT SRS组的晚期放射反应的发生率为12.2%,较其他组高.结论肺癌单发脑转移瘤患者的最佳治疗方式是单纯立体定向放射治疗,治疗失败后再行挽救性全脑照射或立体定向放疗.对于多发脑转移,全脑放疗加立体定向放射治疗(WBRT SRT)在提高生存率以及减少并发症方面优于其他治疗方法.     

肝细胞癌脑转移瘤的立体定向放射治疗

目的探讨立体定向放射治疗加或不加全脑放疗对肝细胞癌有限数目脑转移瘤治疗的疗效.方法回顾性分析2008年8月-2018年7月武警部队上海肿瘤放射诊疗中心及海军军医大学附属东方肝胆外科医院肿瘤放疗中心收治的肝细胞癌脑转移瘤(1~4枚)患者75例,其中行立体定向放射治疗的患者45例,立体定向放射治疗加全脑放疗的患者30例.分析两组患者治疗的肿瘤客观缓解率、总生存期、放射治疗后的不良反应情况并行多因素分析.结果立体定向放射治疗组与立体定向放射治疗加全脑放疗组的客观缓解率分别为88.9%和80.0%,未见统计学差异(P=0.537);全组患者的中位总生存期为5.7个月,其中立体定向放射治疗组为6.2个月,立体定向放射治疗加全脑放疗组为5.4个月,未见统计学差异(P=0.380);多因素分析显示病灶数目(P=0.041)、病灶总体积(P=0.012)及肝内病灶的控制情况(P=0.006)是影响脑转移瘤患者总生存期的主要因素;两种治疗方式均未见严重不良反应.结论立体定向放射治疗是肝细胞癌有限数目脑转移瘤患者安全有效的治疗方式,单纯立体定向放射治疗可取得与立体定向放射治疗加全脑放疗相似的疗效.     

后程立体定向放射治疗体部恶性肿瘤

目的 :探讨后程立体定向放射治疗对体部恶性肿瘤的治疗价值。方法 :选择 80例体部恶性肿瘤 ,包括原发癌 6 3例 ,转移癌 17例。先给予常规外照射DT4 0～ 5 0Gy 4～ 5W ,休息 7～ 10d后 ,行后程立体定向放射治疗补量治疗 ,分次治疗方法为DT4～ 8Gy F ,隔日 1次 ,4～ 6次为 1个疗程 ,平均补量为DT30Gy(2 4～ 4 0Gy)。结果 :治疗后 3～ 6个月 ,CT及MRI复查示 :6 3例原发癌中 ,5 5例肿瘤缩小或消失 ,占 87% ;17例转移癌中有 14例肿块明显缩小 ,占 82 %。 73例患者KPS评分有提高 ,占91%。全部病例均未出现明显放疗并发症。结论 :立体定向放射治疗体部恶性肿瘤疗效肯定 ,后程立体定向放射治疗结合常规放疗对于改善患者预后是有益的。     

立体定向放射治疗胰头癌的剂量分割方式探讨

立体定向放射治疗是近10年来迅速发展起来的放疗新技术,在体部肿瘤的治疗上发挥着越来越重要的作用.为探讨立体定向放射治疗晚期胰头癌的疗效,我们自1999年4月至2002年5月随机分组治疗不能手术切除的晚期胰头癌患者47例,采用两种剂量分割方式实施立体定向放射治疗,现报告如下.     

肺癌立体定向放射治疗临床应用初探

近年来,国内外已广泛开展高能Ｘ线立体定向大剂量分割放射治疗颅内肿瘤,此项治疗的效果优于常规分割放疗。随着治疗技术的改进和临床经验的积累,立体定向大剂量分割放疗已扩大到颅外的病变。我院自1997年7月引进体部立体定向放射治疗(ｓｔｅｒｅｏｔａｃｔｉｃｒａｄｉｏｔｈｅｒａｐｙ,ＳＲＴ)系统至1998年12月已治疗肺癌39例,现将治疗方法及近期疗效报告如下。1　临床资料1.1　一般资料　39例患者中男性34例,女性5例,年龄38～88岁,中位年龄64岁。所有患者均经病理细胞学证实,鳞癌21例,腺癌11例,腺鳞癌3例,未分化癌4例。按ＵＩＣＣ1997ＴＮ…     

Stereotactic body radiation therapy for metastasis to the adrenal glands

Many primary cancers can metastasize to the adrenal glands. Adrenalectomy via an open or laparoscopic approach is the current definitive treatment, but not all patients are eligible or wish to undergo surgery. There are only limited studies on the use of conventional radiation therapy for palliation of symptoms from adrenal metastasis. However, the advent of stereotactic body radiation therapy (SBRT) – also named stereotactic ablative radiotherapy for primary lung cancer, metastases to the lung, and metastases to the liver – have prompted some investigators to consider the use of SBRT for metastases to the adrenal glands. This review focuses on the emerging data on SBRT of metastasis to the adrenal glands, while also providing a brief discussion of the overall management of adrenal metastasis.     

Stereotactic Body Radiotherapy Versus Metastasectomy in Patients With Pulmonary Metastases From Soft Tissue Sarcoma

The lung is the preferred site of metastasis from soft tissue sarcoma (STS). This systematic review aims to evaluate the outcomes of stereotactic body radiotherapy (SBRT) and metastasectomy (MTS) for the treatment of lung metastases from STS. A systematic review was carried out according to the PRISMA protocol. PubMed, Medline, EMBASE, Cochrane Library, Ovid and Web of Knowledge databases were searched for English-language articles to December 2018 using a predefined strategy. Retrieved studies were independently screened and rated for relevance. Data were extracted by two researchers. In total, there were 1306 patients with STS: 1104 underwent MTS and 202 had SBRT. The mean age ranged from 40 to 55.8 years in the MTS group and from 47.9 to 64 years in the SBRT group. The cumulative death rate was 72% (95% confidence interval 59–85%) in the MTS group and 56% (38–74%) in the SBRT group. The cumulative mean overall survival time was 46.7 months (36.4–57.0%) in the MTS group and 47.6 months (33.7–61.5%) in the SBRT group. The cumulative rate of patients alive with disease was 5% (2–9%) in the MTS group and 15% (6–36%) in the SBRT group. Finally, the cumulative rate of patients alive without disease in the two groups was 19% (9–29%) and 20% (10–50%), respectively. Our study showed that local treatment of pulmonary metastases from STS with SBRT, compared with surgery, was associated with a lower cumulative overall death rate and similar overall survival time and survival rates without disease. By contrast, SBRT was associated with a higher survival rate with disease than MTS. Large randomised trials are necessary to confirm these findings and to establish whether SBRT may be a reliable option for early stage disease.     

肺癌肾上腺转移30例分析

目的 探讨肺癌肾上腺转移的综合治疗效果。方法 回顾性分析1995年2月-2001年4月间收治的30例肺癌肾上腺转移患者资料，其中小细胞肺癌14例，非小细胞肺癌16例，患者均采用化疗和（或）放疗，18例化疗 放疗综合治疗，12例单纯化疗。结果 全组患者中位生存期8个月，12例单纯化疗者中部分缓解3例，有效率为25.0%；18例化疗 放疗综合治疗者中完全缓解1例，部分缓解7例，有效率为44.4%，有疼痛症状者放疗后疼痛明显缓解。结论 肺癌肾上腺转移的化疗 放疗的综合治疗比单一化疗效果更好。     

The evolving role of radiotherapy in treatment of oligometastatic NSCLC

Non-small cell lung cancer (NSCLC) patients with metastases limited in site and number, termed oligometastases, may represent a unique subpopulation of advanced NSCLC with improved prognosis. The optimal management of these patients remains unclear with the treatment approach currently undergoing a paradigm shift. The potential benefit of aggressive metastasis directed local treatment with surgery and/or radiotherapy (RT) in combination with systemic therapy is bolstered predominantly by retrospective analyses but also by a growing number of non-randomized prospective studies regarding the use of ablative RT techniques including stereotactic body radiotherapy (SBRT), alternatively termed stereotactic ablative radiotherapy (SABR), directed at the primary tumor (if present) and all metastatic sites. Long-term survival is possible in a subset of patients treated aggressively in this manner. The challenge for the clinical oncology community moving forward is appropriately selecting patients for this treatment approach based on clinical, imaging, and molecular features and increasing enrollment of patients to prospective clinical trials to more definitively determine the added benefit and appropriate timing of aggressive metastasis directed therapy in the oligometastatic setting.     

104例肺癌脑转移临床分析

目的本研究通过分析肺癌脑转移的临床特点, 探讨其综合治疗的疗效及预后因素。方法 回顾分析了2001年3月-2006年7月104例我院肺癌脑转移患者经不同方法治疗后的生存期与生存率。104例患者治疗方式为手术加放疗9例, 单纯放疗51例, 单纯化疗15例, 放疗加化疗26例, 未治疗3例。采用Kaplan-Meier分析及Log-Rank进行预后生存分析。结果 确诊者中以腺癌最多见, 占45%, 依次是小细胞肺癌25%, 鳞癌30%, 脑转移最常见的症状是头痛, 脑实质为最常受累部位。综合治疗后神经系统症状减轻或消失, 可延长生存2-8个月。全组患者中位生存时间7.2个月。单发转移及无颅外转移者生存期明显高于多发转移及伴颅外血行转移者(P＜0.01)。结论 脑转移预后差, 及时发现和合理治疗可减轻神经系统症状, 改善患者的生存质量。目前治疗仍以全脑放疗为主, 化疗的作用还需进一步研究。     

榄香烯乳注射液联合放疗治疗肺癌脑转移的临床观察*

目的　探讨榄香烯乳注射液联合放疗治疗肺癌脑转移的疗效及安全性。方法　４８例肺癌脑转移患者分为放射治疗组２６例（单放组）和榄香烯乳联合放疗治疗组２２例（联合组）,比较两组的有效率、中位生存期、１年生存率以及不良反应。结果　单放组和联合组的有效率（ＣＲ＋ＰＲ）分别为２３.０％和５４.５％（Ｐ＜０.０５）,中位生存期分别为１０.９个月和１５.０个月（Ｐ＜０.０５）。主要不良反应包括：放疗后脑组织水肿症状和骨髓抑制,联合组发生白细胞减少低于单放组。结论　榄香烯乳注射液联合放疗治疗肺癌脑转移效果优于单纯放射治疗,提高了患者生存质量,延长了生存期。     

2017第二届全国放疗靶区勾画学习班在北京成功举办

目的 评价SBRT肺部肿瘤的安全性及临床疗效。方法 回顾分析2012—2015年在浙江省肿瘤医院经SBRT的200例肺部肿瘤患者。早期原发性NSCLC 118例,肺孤立转移82例,80%等剂量线作为处方剂量覆盖95%PTV,100%等剂量线覆盖100%IGTV,4.0~18.0 Gy/次,每天或隔天1次,BED为40.0~151.2 Gy (中位数100 Gy)。结果 所有患者均完成治疗,随访率96.0%。原发瘤组CR率14.8%(17/115),PR率65.2%(75/115)。转移瘤组组CR率25%(19/77),PR率38%(29/77)。2、3级急性RP发生率分别为4.7%、3.1%。中位随访时间14.9个月,1、2年原发和转移瘤组LC率分别为95.7%、84.3%和92%、73%,OS率分别为94.5%、92.0%和85%、62%。结论 SBRT对早期原发性NSCLC和肺孤立转移瘤的1、2年LC、OS率较高且发症低,是一种安全有效的治疗手段。     

200例肺部肿瘤SBRT的经验和疗效

目的 评价SBRT肺部肿瘤的安全性及临床疗效。方法 回顾分析2012—2015年在浙江省肿瘤医院经SBRT的200例肺部肿瘤患者。早期原发性NSCLC 118例,肺孤立转移82例,80%等剂量线作为处方剂量覆盖95%PTV,100%等剂量线覆盖100%IGTV,4.0~18.0 Gy/次,每天或隔天1次,BED为40.0~151.2 Gy (中位数100 Gy)。结果 所有患者均完成治疗,随访率96.0%。原发瘤组CR率14.8%(17/115),PR率65.2%(75/115)。转移瘤组组CR率25%(19/77),PR率38%(29/77)。2、3级急性RP发生率分别为4.7%、3.1%。中位随访时间14.9个月,1、2年原发和转移瘤组LC率分别为95.7%、84.3%和92%、73%,OS率分别为94.5%、92.0%和85%、62%。结论 SBRT对早期原发性NSCLC和肺孤立转移瘤的1、2年LC、OS率较高且发症低,是一种安全有效的治疗手段。     

Stereotactic body radiation therapy in the re-irradiation situation – a review

Although locoregional relapse is frequent after definitive radiotherapy (RT) or multimodal treatments, re-irradiation is only performed in few patients even in palliative settings like e.g. vertebral metastasis. This is most due to concern about potentially severe complications, especially when large volumes are exposed to re-irradiation. With technological advancements in treatment planning the interest in re-irradiation as a local treatment approach has been reinforced. Recently, several studies reported re-irradiation for spinal metastases using SBRT with promising local and symptom control rates and simultaneously low rates of toxicity. These early data consistently indicate that SBRT is a safe and effective treatment modality in this clinical situation, where other treatment alternatives are rare. Similarly, good results have been shown for SBRT in the re-irradiation of head and neck tumors. Despite severe late adverse effects were reported in several studies, especially after single fraction doses >10 Gy, they appear less frequently compared to conventional radiotherapy. Few studies with small patient numbers have been published on SBRT re-irradiation for non-small cell lung cancer (NSCLC). Overall survival (OS) is limited by systemic progression and seems to depend particularly on patient selection. SBRT re-irradiation after primary SBRT should not be practiced in centrally located tumors due to high risk of severe toxicity. Only limited data is available for SBRT re-irradiation of pelvic tumors: feasibility and acceptable toxicity has been described, suggesting SBRT as a complementary treatment modality for local symptom control.