立体定向放疗治疗早期非小细胞肺癌

目的探讨三维适形放射治疗早期非小细胞肺癌的疗效和放射反应。方法对51例临床I～Ⅱ期非小细胞肺癌行三维适形放射治疗，年龄45～81岁，临床I期29例（T1-2NOM0），Ⅱ期22例（T1-2N1M0），无T3N0M0病例。病灶〈3cm33例，3—5cm4例，〉5cm4例。采用剂量体积直方图评价靶区计划，要求95％以上明W体积接受50％以上剂量，放疗剂量：小于3cm病灶，8～10Gy／次，共4～5次；3cm以上病灶，5～7Gy／次，共7～10次。照射方法：每周3次。边缘剂量控制在40Gy／10次。结果全部患者近期疗效完全缓解（CR）率62．7％（32／51），部分缓解（PR）率31．4％（16／51），无稳定（SD）5．9％（3／51），进展（PD）0例。总有效率（CR＋PR）为94．2％（48／51）。肿瘤直径小于3cm，其CR率为81．8％（27／33），3cm以上者其CR率为50．0％（9／18），近期疗效与肿瘤大小T有关，两者差异有显著意义（r=5．78，P〈0．05）。结论立体定向放射治疗早期非小细胞肺癌是安全、有效的，具有较好的近期及远期疗效，毒副作用可耐受，失败原因主要为远处转移。

Clinical analysis of whole body gamma knife stereotactic radiotherapy of early stage nonsmall cell lung cancer

Objectives To evaluate the result and radiation reaction of three-dimensional conformal radiotherapy （3 DCRT） for non-small cell lung cancer. Methods From July 2002 to Januray 2005, 52 patients with stage I - Ⅱ non-small cell lung cancer werer treated with whole body gamma knife 3DCRT radiotherapy. 29 patients were at Stage I and 22 at Stage Ⅱ. 33 patients had tumore smal- ler than 3cm and 19 ≥3 cm. Dose-volume histogram was used to help develop treatment plans. Tumore, 3cm was given a dose 8 - 10 Gy/ f of totally 4 - 5 fi＇actions. Tumor ≥3 cm was given a dose 5 - 6 Gy/f of toally 7 - 10 fractons. The treatment plans required that more than 95% FIT volunm received more than 95% dose. Results The short term treatment results showed the following： the complete response （CR） rate was 62. 7%. The partical response （PR） rate was 31.4%. The overall response （ CR ＋ PR） rate was 89%. The CR, PR, SD rate for tumore 〈3 cm was 81.8%, 15.2% and 3.8%, respectively. For the patients with tumor 〉3 cm, the respective rates were 50%, 44. 4% and 5. 6%. The short tem efficacy was related to tumore size（A,2 ffi 5.78 ,P 〈0. 05）. Conclusions The Gamma knife 3DCRT for early state non-small cell lung cancer is safe and effective. The short tem and long term treatment results are significant with tolerable complications.