肺转移瘤X线立体定向放射治疗的临床价值

目的 探讨大剂量分割X线立体定向放射治疗肺转移瘤的临床价值.方法 采用大剂量分割X线立体定向放射治疗肺转移瘤67例.共88个转移灶,肿瘤体积≤15cm<'3>的55个,>15cm<'3>的33个.每次处方剂量4～12Gy(中位10Gy),隔日1次,共4～10次(中位6次),处方总剂量30～75Gy(中位48Gy).结果 全组88个转移病灶,CR39.77%(35/88),PR45.45%(40/88),总有效率(CR PR)为85.23%(75/88).肿瘤体积≤15cm<'3>的有效率为90.91%,明显高于体积>15cm<'3>的75.76%(P=0.03).全组1年、2年、3年生存率分别为77.61%(52/67)、49.25%(33/67)、29.85%(20/67).生存率与原发肿瘤有密切关系,不同原发肿瘤的生存率有显著性差异(P<0.05),其中3年生存率以妇科肿瘤(80%)和头颈肿瘤(61.54%)较好,以肺癌最差(15.63%),P=0.01.结论 大剂量分割X线立体定向放射治疗是肺转移瘤的有效治疗方法.近期疗效与肿瘤体积相关,而生存率与原发肿瘤相关.

The clinical value of lung metastases treated by fractionated stereotactie radiotherapy

Objective To investigate the clinical value of lung metastases treated by fractionated stereotactic radiotherapy.Methods 67 cases with lung metastases treated by fractionated stereotactic radiotherapy.The total number of the metastases was 88.The volume of the metastases less than 15cm3 in 55,and more than 15cm3 in 33. Per prescribed dose was 4~12Gy (media was 10Gy), give one time every other day, 4~10 times total (media was 6 times), the total prescribed dose was 30Gy~75Gy (media was 48Gy).The margin of the PTV was 70%~100% in isodose curve.Results There were 88 metastases in this group,CR39.77%(35/88),PR45.45%(40/88),and the overall effective rate (CR PR)was 85.23%(75/88).The effective rate for the volume of the metastases less than 15cm3 was 90.91%, especially higher than which more than 15cm3(75.76%)(P=0.03). The survival rate of this group in 1,2 and 3 years was 77.61%(52/67), 49.25% (33/67) and 29.85% (20/67) respectively. The survival rate significantly related to primartumor,the difference of different primartumor was conspicuous (P<0.05). Conclusion Fractionated stereotactic radiotherapy could treat the lung metastases effectually.The curative effect in the near future relate to the volume of tumor. Survival rate significantly related to primartumor.