Brown William T, Wu Xiaodong, Amendola Beatriz, Perman Mark, Han Hoke, Fayad Fahed, Garcia Silvio, Lewin Alan, Abitbol Andre, de la Zerda Alberto, Schwade James G
CyberKnife Center of Miami, Miami, FL 33156, USA.
Cancer J. 2007 Mar-Apr;13(2):87-94. doi: 10.1097/PPO.0b013e31803c5415.
To evaluate the efficacy of using image-guided robotic stereotactic radioablation as an alternative treatment modality for patients with surgically resectable, but medically inoperable, T1 N0 M0, stage IA non-small cell lung cancer.
Between January 2004 and May 2006, 19 patients, 11 women and 8 men ranging in age from 52 to 88 years, with stage IA non-small cell lung cancer were treated. Tumor volume ranged from 1.7 to 13 mL. Total doses ranged from 24 to 60 Gy delivered in 3 fractions. Eleven patients received 60 Gy. Real-time target localization was accomplished by radiographic detection of fiducial marker(s) implanted within the tumor combined with respiratory motion tracking.
All patients tolerated radioablation well with fatigue as the main side effect. Fourteen patients are alive from 1 to 25 months posttreatment. Four patients died: 2 of comorbid disease and 2 of cancer progression (status post 60 and 55.5 Gy). Three patients developed grade I radiation pneumonitis. Two patients have stable disease. In 3 patients, cancer recurred in the planning treatment volume: in 2 patients after treatment with 60 Gy and in 1 patient after treatment with 55.5 Gy. One patient had local control in the target volume but developed metastasis to the ipsilateral hilum. Nine patients had a complete response and show no evidence of disease.
In our early experience, stereotactic radioablation using the CyberKnife system appears to be a safe, minimally invasive, and effective modality for treating early stage lung cancer in patients with medically inoperable disease. Dose escalation and/or increasing the treatment volumes, with the aid of the high conformality of this technique, may help to achieve further improvements in these promising results.
评估影像引导下的机器人立体定向放射消融术作为手术可切除但因医学原因无法手术的T1 N0 M0 ⅠA期非小细胞肺癌患者的替代治疗方式的疗效。
2004年1月至2006年5月，对19例年龄在52至88岁之间的ⅠA期非小细胞肺癌患者进行了治疗，其中女性11例，男性8例。肿瘤体积为1.7至13毫升。总剂量为24至60 Gy，分3次给予。11例患者接受了60 Gy的剂量。通过对植入肿瘤内的基准标记进行射线检测并结合呼吸运动跟踪来实现实时靶区定位。
所有患者对放射消融耐受性良好，主要副作用为疲劳。14例患者在治疗后1至25个月存活。4例患者死亡：2例死于合并症，2例死于癌症进展（分别接受60 Gy和55.5 Gy治疗后）。3例患者发生Ⅰ级放射性肺炎。2例患者病情稳定。3例患者在计划治疗体积内出现癌症复发：2例接受60 Gy治疗后复发，1例接受55.5 Gy治疗后复发。1例患者靶区实现局部控制，但发生同侧肺门转移。9例患者完全缓解，无疾病证据。
根据我们的早期经验，使用射波刀系统进行立体定向放射消融术似乎是治疗因医学原因无法手术的早期肺癌患者的一种安全、微创且有效的方式。借助该技术的高适形性增加剂量和/或扩大治疗体积，可能有助于进一步改善这些令人鼓舞的结果。
