射波刀治疗腹膜后淋巴结转移癌81例

目的 探讨射波刀治疗腹膜后淋巴结转移癌的疗效和不良反应。 方法 81例恶性肿瘤术后出现腹膜后淋巴结转移的患者,其中 33例伴腹痛或腰背部疼痛,7例伴一侧肾积水、输尿管扩张,8例伴单侧或双侧下肢肿胀。采用射波刀立体定向精确放疗,DT33~45 Gy分 3~6次,观察患者症状的改善情况、肿瘤客观反应率和放射不良反应。 结果 所有患者治疗后4周,疼痛、下肢肿胀症状完全缓解,肾积水完全消失;每隔 2~3个月行增强CT或MRI复查1次,随访至6个月时,完全缓解率为 77%(62/81),部分缓解率为21%(17/81),稳定率为3%(2/81),无进展病例,有效率98%。不良反应主要为肠道损伤,1级16%(13/81),2级9%(7/81)。多因素分析显示肿瘤完全缓解率与原发肿瘤类型、肿瘤大小无关(P>0.05),而与肿瘤和肠管间距离>0.5 cm、肿瘤生物等效剂量(α/β=10)>70 Gy相关(P<0.01);不良反应发生率与肿瘤最大径>5 cm、肿瘤与肠管间距离<0.5 cm相关(P<0.01)。 结论 射波刀治疗恶性肿瘤术后腹膜后淋巴结转移疗效显著,不良反应轻微。

Application of cyberknife in treatment of retroperitoneal lymph node metastatic tumors in 81 cases

Objective To evaluate the clinical efficacy and side effects of cyberknife therapy in the treatment of retroperitoneal lymph node metastatic tumor. Methods Among the 81 patients presenting with postoperative retroperitoneal lymph node metastases,33 cases suffered from abdominal pain or low back pain,7 had unilateral hydronephrosis and ureteral dilatation,and 8 developed unilateral or bilateral lower limb swelling. Using stereotactic radiotherapy with a cyberknife,DT was delivered at 33-45 Gy/3-6 F.The improvement of symptoms,objective tumor response rate,and irradiation-induced side effects were observed. Results At 4 weeks after treatment,pain and swelling of the lower extremities were completely mitigated,and hydronephrosis was fully healed in all patients. Enhanced CT or MRI was performed every 2 to 3 months. After 6-month follow-up,the complete response (CR) rate was calculated as 77%(62/81),21%(17/81) for the partial response (PR) rate,3%(2/81) for the stable disease (SD) rate and the effective rate (CR+PR) was 98%.No case progressed. The main side effect was intestinal injury,including grade 1 in 16%(13/81),grade 2 in 9%(7/81).Multivariate analysis demonstrated the CR rate was not correlated with the type of the primary tumor or the size of the tumor (P>0.05),but was significantly associated with the distance of>0.5 cm between the tumor and intestine and the BED (α/β=10)>70 Gy of the tumor irradiation (P<0.01).The incidence of irradiation-related side effects was correlated with the maximum diameter of tumor>5 cm and the distance of<0.5 cm between the tumor and intestine (P<0.01). Conclusions Cyberknife is an efficacious and safe approach in the treatment of retroperitoneal lymph node metastatic tumors.