恶性肿瘤立体定向放射治疗48例疗效分析

目的探讨分次立体定向放射治疗恶性肿瘤的近期疗效。方法对48例肿瘤直径为3.0～8.0cm的恶性实体瘤患者,采用分次立体定向放射治疗,6-MVX,4～8Gy/次,6～10次,每周3次,总剂量为30～56Gy,观察其疗效。结果完全缓解18例,部分缓解20例,总有效率为79.2%。结论立体定向放射治疗对中晚期恶性肿瘤患者的疗效较好,不良反应轻,可明显改善和缓解临床症状,提高局部控制率,是1种较安全的治疗方法。     

后程立体定向放射治疗肺癌的近期疗效观察

目的：观察后程立体定向放射治疗肺癌的近期疗效和毒副作用。方法：对2l例肺癌患者先予常规外照射，肿瘤量达40Gy／20次，4周后改为立体定向适形放疗，分割剂量为3Gy／次-4Gy／次，1次／d，共5次-10次。放疗后1个月-3个月进行近期疗效评价。结果：完全缓解率为19％(4／21)，部分缓解率为71％(15/21)，总有效率为90％。急性放射反应主要有放射性肺炎和放射性食管炎，发生率分别为23．8％和62％。结论：后程立体定向放射治疗肺癌的近期疗效满意，毒副作用轻，可作为肺癌放疗的推量方法。     

立体定向适形放射治疗肺癌的临床研究

42例肺癌患者接受立体定向放疗4～8Gy/次，1次/d，总量30～45Gy,结果治疗后，CR为14.3%(6/42),CR PR76．2％(32/42),NC16．7％(7/42)。主要不良反应为放射性食管炎及放射性肺炎．反应程度较轻。初步研究结果提示．立体定向适形放疗治疗肺癌近期疗效令人满意。     

立体定向放射治疗非小细胞肺癌的临床分析

背景与目的：立体定向放射治疗能提高肿瘤的局控率，降低正常组织反应。目前，越来越多地应用于临床。本研究观察立体定向放射治疗非小细胞肺癌的疗效及副反应：方法：对40例不能手术的非小细胞肺癌患者进行放射治疗，对纵隔淋巴结阳性的患者，先常规外照射30～40Gy，然后对肿瘤局部用立体定向放疗追加照射剂量，每次2．5～4．85Cy，照射10～12次；对无纵隔淋巴结转移且肿瘤直径小于6cm的患者单用立体定向放射治疗，单次剂量3～8Gy，每日一次，共照射5～18次。结果：40例患者均顺利完成治疗，近期疗效为完全缓解（CR）11例，部分缓解（PR）24例，总有效率（CR＋PR）为87．5％（33／40），1、2年生存率分别为85．4％和45．1％，放疗期间无急性放射性肺炎发生。肿块较大及年龄大于70岁为影响生存率的危险因素。结论：立体定向放射治疗对非小细胞肺癌有良好的治疗效果，并发症较低，大部分患者能够耐受。     

立体定向体部放射治疗联合射频热疗治疗非小细胞肺癌的近期疗效观察

目的:观察立体定向体部放射治疗联合射频热疗治疗非小细胞肺癌的近期疗效和毒副反应。方法:21 例患者均采用少分次、大分割的立体定向放射治疗。肿瘤直径＜3cm者,70%～80% 等剂量线覆盖靶区,单次周边剂量7～9Gy,总剂量36～42Gy,分5～6次;肿瘤直径3～5cm者,60%～70%等剂量线覆盖靶区,单次周边剂量5～8Gy,总剂量40Gy,分5～8次;肿瘤直径＞5cm者,50%～60%等剂量线覆盖靶区,单次周边剂量4～6Gy,总剂量40～42Gy,分7～10次。隔日治疗,总时间不超过2周。疗程中同步行射频热疗,在放疗前或后45min内实施,时间为60min,每周1～2次,次间间隔72h以上,共6～8次。结果:治疗后2～3个月所有患者得到随访。其中完全缓解率为19.0%（4/21）,部分缓解率为71.4%（15/21）,总有效率为90.5%（19/21）。骨髓抑制为主要并发症,发生率为61.9%（13/21）。结论:立体定向体部放射治疗联合射频热疗治疗非小细胞肺癌近期疗效好,毒副反应轻可耐受,值得临床推广。     

立体定向放射治疗局部晚期肺癌48例疗效分析

目的：评价X-刀立体放疗在局部晚期肺癌治疗中的价值。方法：对48例患者采用高剂量分割治疗，每周3次，分5～8次进行，处方剂量6Gy～8Gy，总量40Gy～48Gy。结果：完全缓解(CR)20例，部分缓解(PR)22例，无变化(NC)4例，总有效率87．5％，控制率为95．8％。结论：立体定向放射治疗局部晚期肺癌有肯定的近期疗效。     

分次立体定向放射治疗全脑放疗后肺癌脑转移瘤52例疗效分析

[目的]分析分次立体定向放射治疗全脑放疗后肺癌脑转移瘤的疗效及不良反应.[方法]2007年12月至2010年12月对KPS＞60分的52例全脑放疗后的肺癌脑转移(病灶数目少于4个)患者给予分次立体放射治疗,单次靶区周边剂量为3～5Gy,总剂量为15～25Gy,分3～5次完成,50％等剂量曲线包绕PTV.[结果]截至2011年12月,46例患者死亡.自再次放疗开始算起,全组中位生存期为10.7个月(95％CI为8.5～12.9),1年及2年生存率分别为28.4％和7.2％.全组临床症状缓解率为73.1％,肿瘤局部控制率为90.4％.仅1例患者出现放射性脑坏死.[结论]分次立体定向放射治疗用于全脑放疗后疾病进展的肺癌脑转移患者,可以提高生存质量、延长患者生存期,安全性较好,但需严格掌握适应证.     

59例头颅疾患的分次立体定向放射治疗疗效探讨

目的　初步探讨分次立体定向放射治疗头颅疾患近期疗效、急性副反应及相关因素。方法　 5 9例不同部位的头颅疾患应用分次立体定向放射治疗。 6MV -X射线总剂量DT 2 5～ 2 8Gy ,1～ 5个中心 ,60 %～ 90 %等剂量曲线包绕肿瘤边缘 ,限光筒直径 0 72～4.3 4cm。分割方式 :4 4～ 12 .5Gy/次 ,2～ 3次 /周。结果　临床症状改善为 79 7% ;影像学有效率为 93 2 % ;D >2 .86cm副反应较重 ;总生物剂量相同时 ,每周 2次或 3次疗效无差别 ;脑转移的近期疗效高于胶质瘤。结论　分次立体定向放射治疗头颅疾患近期疗效肯定 ,临床值得应用推广     

立体定向适形放射治疗肺癌的临床研究

42例肺癌患者接受立体定向放疗 ,4～ 8Gy/次 ,1次 /d ,总量 3 0～ 45Gy。结果治疗后 ,CR为 14 3 % ( 6/4 2 ) ,CR PR 76 2 % ( 3 2 /4 2 ) ,NC 16 7% ( 7/4 2 )。主要不良反应为放射性食管炎及放射性肺炎 ,反应程度较轻。初步研究结果提示 ,立体定向适形放疗治疗肺癌近期疗效令人满意。     

立体定向放射治疗局部晚期肺癌48例疗效分析

目的:评价X-刀立体放疗在局部晚期肺癌治疗中的价值.方法:对48例患者采用高剂量分割治疗,每周3次,分5～8次进行,处方剂量6Gy～8Cy,总量40Gy～48Gy.结果:完全缓解(CR)20例,部分缓解(PR)22例,无变化(NC)4例,总有效率87.5%,控制率为95.8%.结论:立体定向放射治疗局部晚期肺癌有肯定的近期疗效.     

A phase II trial of accelerated radiotherapy using weekly stereotactic conformal boost for supratentorial glioblastoma multiforme: RTOG 0023

PURPOSE: This phase II trial was performed to assess the feasibility, toxicity, and efficacy of dose-intense accelerated radiation therapy using weekly fractionated stereotactic radiotherapy (FSRT) boost for patients with glioblastoma multiforme (GBM). METHODS AND MATERIALS: Patients with histologically confirmed GBM with postoperative enhancing tumor plus tumor cavity diameter <60 mm were enrolled. A 50-Gy dose of standard radiation therapy (RT) was given in daily 2-Gy fractions. In addition, patients received four FSRT treatments, once weekly, during Weeks 3 to 6. FSRT dosing of either 5 Gy or 7 Gy per fraction was given for a cumulative dose of 70 or 78 Gy in 29 (25 standard RT + 4 FSRT) treatments over 6 weeks. After the RT course, carmustine (BCNU) at 80 mg/m(2) was given for 3 days, every 8 weeks, for 6 cycles. RESULTS: A total of 76 patients were analyzed. Toxicity included: 3 Grade 4 chemotherapy, 3 acute Grade 4 radiotherapy, and 1 Grade 3 late. The median survival time was 12.5 months. No survival difference is seen when compared with the RTOG historical database. Patients with gross total resection (41%) had a median survival time of 16.6 months vs. 12.0 months for historic controls with gross total resection (p = 0.14). CONCLUSION: This first, multi-institutional FSRT boost trial for GBM was feasible and well tolerated. There is no significant survival benefit using this dose-intense RT regimen. Subset analysis revealed a trend toward improved outcome for GTR patients suggesting that patients with minimal disease burden may benefit from this form of accelerated RT.     

Achievement of long-term local control in patients with craniopharyngiomas using high precision stereotactic radiotherapy

BACKGROUND: The long-term outcome in patients with craniopharyngiomas treated with fractionated stereotactic radiotherapy (FSRT) was evaluated. METHODS: A total of 40 patients with craniopharyngiomas were treated between May 1989 and July 2006 with FSRT. Most patients were treated for tumor progression after surgery. A median target dose of 52.2 grays (Gy) (range, 50.4-56 Gy) was applied in a median conventional fractionation of 5 x 1.8 Gy per week. Follow-up examinations included thorough clinical assessment as well as contrast-enhanced magnetic resonance imaging scans. RESULTS: After a median follow-up of 98 months (range, 3-326 months), local control was 100% at both 5 years and 10 years. Overall survival rates at 5 years and 10 years were 97% and 89%, respectively. A complete response was observed in 4 patients and partial responses were noted in 25 patients. Eleven patients presented with stable disease during follow-up. Acute toxicity was mild in all patients. Long-term toxicity included enlargement of cysts requiring drainage 3 months after FSRT. No visual impairment, radionecrosis, or development of secondary malignancies were observed. CONCLUSIONS: The long-term outcome of FSRT for craniopharyngiomas is excellent with regard to local control as well as treatment-related side effects.     

Steep dose-response relationship for stage I non-small-cell lung cancer using hypofractionated high-dose irradiation by real-time tumor-tracking radiotherapy

PURPOSE: To investigate the clinical outcomes of patients with pathologically proven, peripherally located, Stage I non-small-cell lung cancer who had undergone stereotactic body radiotherapy using real-time tumor tracking radiotherapy during the developmental period. METHODS AND MATERIALS: A total of 41 patients (25 with Stage T1 and 16 with Stage T2) were admitted to the study between February 2000 and June 2005. A 5-mm planning target volume margin was added to the clinical target volume determined with computed tomography at the end of the expiratory phase. The gating window ranged from +/-2 to 3 mm. The dose fractionation schedule was 40 or 48 Gy in four fractions within 1 week. The dose was prescribed at the center of the planning target volume, giving more than an 80% dose at the planning target volume periphery. RESULTS: For 28 patients treated with 48 Gy in four fractions, the overall actuarial survival rate at 3 years was 82% for those with Stage IA and 32% for those with Stage IB. For patients treated with 40 Gy in four fractions within 1 week, the overall actuarial survival rate at 3 years was 50% for those with Stage IA and 0% for those with Stage IB. A significant difference was found in local control between those with Stage IB who received 40 Gy vs. 48 Gy (p = 0.0015) but not in those with Stage IA (p = 0.5811). No serious radiation morbidity was observed with either dose schedule. CONCLUSION: The results of our study have shown that 48 Gy in four fractions within 1 week is a safe and effective treatment for peripherally located, Stage IA non-small-cell lung cancer. A steep dose-response curve between 40 and 48 Gy using a daily dose of 12 Gy delivered within 1 week was identified for Stage IB non-small-cell lung cancer in stereotactic body radiotherapy using real-time tumor tracking radiotherapy.     

Fractionated stereotactic radiotherapy of small intracranial malignancies

Purpose: To retrospectively evaluate the effectiveness of fractionated stereotactic radiotherapy (FSRT) in patients with small intracranial malignancies.

Methods and Materials: From July 1991 to March 1997, 80 patients with a total of 121 brain or skull-base tumors were treated with FSRT alone, and were followed for periods ranging from 3 to 62 months (median 9.8). The majority of patients received 42 Gy in 7 fractions over 2.3 weeks, but in July 1993, protocols using smaller fraction doses were introduced for patients whose radiation-field diameters were larger than 3 cm or whose tumors were close to critical normal tissues.

Results: For 64 patients with metastatic brain tumors the overall median survival was 8.3 months and 1-year actuarial survival rate was 33%. Significant prognostic factors were: the presence of extracranial tumors, pre-treatment performance status, and the lung as a primary site. Patients without extracranial tumors prior to FSRT had a median survival of 21.2 months. For seven patients with high-grade glioma, 1-year actuarial local control rate was 75%, with a median survival of 10.3 months. For patients with skull-base tumors the local control was achieved in 6 of 6 patients (100%), with a median survival of 30.7 months. No one suffered from acute complications, but three patients, two of whom had undergone FSRT as the third course of radiotherapy, developed late radiation injuries.

Conclusion: Overall high local control and low morbidity rates suggest that FSRT is an effective and safe modality, even for those with a history of prior irradiation. However, patients with risk factors should be treated with smaller fraction doses.     

Single dose versus fractionated stereotactic radiotherapy for recurrent high-grade gliomas

Purpose: To evaluate the efficacy of stereotactic radiotherapy (SRT) in patients with recurrent high-grade gliomas by comparing two different treatment regimens, single dose or fractionated radiotherapy.

Methods and Materials: Between April 1991 and January 1998, 71 patients with recurrent high-grade gliomas were treated with SRT. Forty-six patients (65%) were treated with single dose radiosurgery (SRS) and 25 patients (35%) with fractionated stereotactic radiotherapy (FSRT). For the SRS group, the median radiosurgical dose of 17 Gy was delivered to the median of 50% isodose surface (IDS) encompassing the target. For the FSRT group, the median dose of 37.5 Gy in 15 fractions was delivered to the median of 85% IDS.

Results: Actuarial median survival time was 11 months for the SRS group and 12 months for the FSRT group (p = 0.3, log-rank test). Variables predicting longer survival were younger age (p = 0.006), lower grade (p = 0.0006), higher Karnofsky Performance Scale (KPS) (p = 0.0005), and smaller tumor volume (p = 0.02). Patients in the SRS group had more favorable prognostic factors, with median age of 48 years, KPS of 70, and tumor volume of 10 ml versus median age of 53 years, KPS of 60, and tumor volume of 25 ml in the FSRT group. Late complications developed in 14 patients in the SRS group and 2 patients in the FSRT group (p < 0.05).

Conclusion: Given that FSRT patients had comparable survival to SRS patients, despite having poorer pretreatment prognostic factors and a lower risk of late complications, FSRT may be a better option for patients with larger tumors or tumors in eloquent structures. Since this is a nonrandomized study, further investigation is needed to confirm this and to determine an optimal dose/fractionation scheme.     

Fractionated stereotactic radiation therapy for extracranial head and neck tumors

BACKGROUND: This study is to report the clinical experiences of fractionated stereotactic radiation therapy (FSRT) for extracranial head and neck tumors. METHODS AND MATERIALS: Between the period of July 1995 and November 1998, 48 patients with extracranial head and neck tumors were given FSRT as a boost and sole modality. Individualized treatment planning was performed using XKnife-3 system with relocatable Gill-Thomas-Cosman frame. In 24 patients, FSRT was applied as a boost technique following the 2-dimensional conventional external radiation therapy (ERT); in 24 patients FSRT was the sole radiotherapy modality. The primary diseases in the boost group consisted of nasopharynx cancer (19), lacrimal gland adenoid cystic carcinoma (3), orbital lymphoma (1), and skull-base recurrence of maxillary sinus adenoid cystic carcinoma (1). The primary diseases in the sole modality group consisted of recurrent nasopharynx cancer (12), orbital pseudotumor (4), skull-base recurrence of maxillary sinus, submandibular gland, and hypopharynx cancers (3), orbital rhabdomyosarcoma (2), orbital lymphoma (1), orbital metastasis of neuroblastoma (1), and nasal cavity melanoma (1). The fractionation schedule was to give 5 treatments per one week and the fractional doses were 2.0-3 Gy depending on the treatment aim and the FSRT volume. The FSRT doses varied depending on the nature of the primary diseases. RESULTS: The local tumor response in nasopharynx cancer patients was excellent compared to retrospective data without occurrence of unexpectedly severe complication. FSRT to other regions was well tolerated by the patients and resulted in good to excellent local tumor responses with no unacceptable side effects as expected by the authors. CONCLUSION: Based on the current observations, FSRT is a very effective and safe modality in the treatment of extracranial head and neck tumors.     

389例脑胶质瘤立体定向放射治疗效果评价(英文)

目的探讨脑胶质瘤立体定向放射治疗的疗效及放疗副反应。方法从1995年6月到1998年12月,用立体定向放射治疗的方法共治疗脑胶质瘤病人389例,其中用立体定向放射外科(ster-eotactic radiosurgery,SYS)方法治疗151例,分次立体定向放射治疗(fractionated stereotatic radiotherapy,FSRT)方法治疗238例。SRS组单次周边剂量20～30Gy,靶点1～6个,平均2.48个,照射弧5～21个,平均8.45个;FSRT 组每日或隔日照射,每次周边剂量8～12Gy,共照射2～5次,靶点1～6个,平均2.53个,照射弧6～20个,平均8.25个。结果治疗结束后3个月,SRS 组完全缓解(CR)21例,占13.9%,部分缓解(PR)69例,占45.7%,稳定(SD)26例,占17.2%,进展(PD)35例,占23.2%,总有效率(PR+CR+SD)为76.8%;FSRT 组完全缓解(CR)47例,占19.7%,部分缓解(PR)114例,占47.9%,稳定(SD)49例,占20.6%,进展(PD)28例,占11.8%,总有效率(PR+CR+SD)为88.2%,两组差别有显著性(X~2=9.874,P=0.020)。全部病人的1、3、5年生存率分别为54.3%、29.3%、16.5%;SRS 组和 FSRT 组的1、3、5年生存率分别为52.3%、26.5%、11.9%和55.5%、31.1%、19.3%,两组差别没有显著性意义(X~2=2.16,P=0.1417);放射治疗的主要副反应为脑水肿,SRS组较 FSRT 组为重(X~2=4.916,P=0.027)。结论立体定向放射治疗对脑胶质瘤有较好的疗效,FSRT 与 SRS 相比,具有疗效好副作用小的优点。     

389例脑胶质瘤立体定向放射治疗效果评价

Objective： To investigate the treatment effectiveness and side effects of stereotactic radiotherapy for brain glioma. Methods： From Jun. 1995 to Dec. 1998, 389 cases of brain gliomas were treated by stereotactic radiotherapy, among which 151 cases were treated by stereotactic radiosurgery （SRS） and the other 238 cases, by fractionated stereotactic radiotherapy （FSRT）. In the SRS group, the marginal tumor dose was 20 to 30 Gy （median, 2.6 Gy）. One to 6 isocenters （median, 2.48） and 5 to 21 irradiation arcs （median, 8.45） were applied. In the FSRT group, the per-fraction marginal tumor dose was 8 to 12 Gy with 1 to 6 isocenters （median, 2.53）, 6 to 20 irradiation arcs （median, 8.25） and 2-5 fractions delivered everyday or every other day. Results： Three months after treatment, the complete and partial response rates were 13.9% and 45.7% in SRS group respectively. The stable disease rate was 17.2%. The total effective rate was 76.8%. In FSRT group, the complete and partial remission rates were 19.7% and 47.9% respectively. The stable disease rate was 20.6%. The total effective rate was 88.2%. The total effective rate of FSRT group was higher than that in SRS group （X^2=9.874, P=0.020）. The 1-year, 3-year and 5-year survival rate of all patients was 54.3%, 29.3%, 16.5% respectively. The 1-year, 3-year and 5-year survival rate in SRS group and FSRT group was 52.3% vs 26.5%, 11.9% vs 55.5%, and 31.1 vs 19.3% respectively. There was no significant difference between the two groups （X^2=2.16, P=0.1417）. The brain edema caused by the main radiation was more severe in the SRS group than in FSRT group （X^2=4.916, P=0.027）. Conclusion： It is effective for brain glioma to be treated by stereotactic radiotherapy. Compared with SRS, the FSRT has the advantage of good effect and less side response.     

Integration of surgery with fractionated stereotactic radiotherapy for treatment of nonfunctioning pituitary macroadenomas

OBJECTIVE: To evaluate the efficacy of fractionated stereotactic radiotherapy (FSRT) after surgery in the management of residual or recurrent nonfunctioning pituitary adenomas with respect to tumor control and the development of complications. METHODS AND MATERIALS: The clinical records of patients with nonfunctioning pituitary adenomas who underwent FSRT were retrospectively analyzed. For newly diagnosed tumors, transsphenoidal surgery was performed, and, if residual tumor was identified at 3 months, FSRT was performed. If significant tumor volume persisted, transcranial surgery was performed before FSRT. We originally initiated FSRT with 2-Gy fractions to 46 Gy. We escalated the dose to 50.4 Gy thereafter. As a final modification, we dropped the daily dose to 1.8-Gy fractions delivered within 6 weeks. High-dose conformality and homogeneity was achieved with arc beam shaping and differential beam weighting. The radiographic, endocrinologic, and visual outcomes after FSRT were evaluated. RESULTS: The 68 patients included 36 males and 32 females with an age range of 15-81 years. The median follow-up was 30 months (range, 2-82 months), and the median tumor volume was 6.2 cm(3). Of the 68 patients, 20 were treated to 46 Gy and 48 to 50-52.2 Gy. Most were treated to 50.4 Gy. Eleven patients had recurrent tumors, 54 had residual tumors, and no surgery was performed in 3 patients before FSRT. We noted no radiation-induced acute or late toxicities, except for radiation-induced optic neuropathy in 2 patients. At latest follow-up, the tumor had decreased in size in 26 patients and remained stable in 41 of the 42 remaining patients. Of the 68 patients, 4 (6%) developed hypopituitarism at 6, 11, 12, and 17 months after FSRT. Reviewing available serial Humphrey visual fields, visual fields were objectively improved in 28 patients, and remained stable in 24 patients, and worsened in 2 patients. CONCLUSION: The findings of this analysis support the use of surgery followed by FSRT as a safe, effective, and integrated treatment for nonfunctioning pituitary adenomas. Additional follow-up is needed to document the long-term tumor control rates, preservation rates for vision and pituitary function, and neurocognitive outcomes.