Collins Brian T, Erickson Kelly, Reichner Cristina A, Collins Sean P, Gagnon Gregory J, Dieterich Sonja, McRae Don A, Zhang Ying, Yousefi Shadi, Levy Elliot, Chang Thomas, Jamis-Dow Carlos, Banovac Filip, Anderson Eric D
Department of Radiation Medicine, Georgetown University Hospital, Washington, DC, USA.
Radiat Oncol. 2007 Oct 22;2:39. doi: 10.1186/1748-717X-2-39.
Recent developments in radiotherapeutic technology have resulted in a new approach to treating patients with localized lung cancer. We report preliminary clinical outcomes using stereotactic radiosurgery with real-time tumor motion tracking to treat small peripheral lung tumors.
Eligible patients were treated over a 24-month period and followed for a minimum of 6 months. Fiducials (3-5) were placed in or near tumors under CT-guidance. Non-isocentric treatment plans with 5-mm margins were generated. Patients received 45-60 Gy in 3 equal fractions delivered in less than 2 weeks. CT imaging and routine pulmonary function tests were completed at 3, 6, 12, 18, 24 and 30 months.
Twenty-four consecutive patients were treated, 15 with stage I lung cancer and 9 with single lung metastases. Pneumothorax was a complication of fiducial placement in 7 patients, requiring tube thoracostomy in 4. All patients completed radiation treatment with minimal discomfort, few acute side effects and no procedure-related mortalities. Following treatment transient chest wall discomfort, typically lasting several weeks, developed in 7 of 11 patients with lesions within 5 mm of the pleura. Grade III pneumonitis was seen in 2 patients, one with prior conventional thoracic irradiation and the other treated with concurrent Gefitinib. A small statistically significant decline in the mean % predicted DLCO was observed at 6 and 12 months. All tumors responded to treatment at 3 months and local failure was seen in only 2 single metastases. There have been no regional lymph node recurrences. At a median follow-up of 12 months, the crude survival rate is 83%, with 3 deaths due to co-morbidities and 1 secondary to metastatic disease.
Radical stereotactic radiosurgery with real-time tumor motion tracking is a promising well-tolerated treatment option for small peripheral lung tumors.
放射治疗技术的最新进展带来了一种治疗局限性肺癌患者的新方法。我们报告了使用立体定向放射外科结合实时肿瘤运动追踪治疗小的周围型肺肿瘤的初步临床结果。
符合条件的患者在24个月内接受治疗，并至少随访6个月。在CT引导下将3至5个基准标记物置于肿瘤内或肿瘤附近。生成了具有5毫米边缘的非等中心治疗计划。患者在不到2周的时间内分3次等量给予45至60 Gy的剂量。在3、6、12、18、24和30个月时完成CT成像和常规肺功能测试。
连续治疗了24例患者，其中15例为I期肺癌，9例为单发性肺转移瘤。7例患者在放置基准标记物时出现气胸，其中4例需要进行胸腔闭式引流。所有患者均在极少不适的情况下完成了放射治疗，急性副作用很少，且无与治疗相关的死亡病例。11例肿瘤位于距胸膜5毫米以内的患者中有7例在治疗后出现短暂的胸壁不适，通常持续数周。2例患者出现III级肺炎，1例既往接受过传统胸部放疗，另1例同时接受吉非替尼治疗。在6个月和12个月时观察到预测的平均DLCO百分比有统计学意义的小幅下降。所有肿瘤在3个月时均对治疗有反应，仅2例单发性转移瘤出现局部复发。无区域淋巴结复发。中位随访12个月时，粗生存率为83%，3例死于合并症，1例死于转移性疾病。
立体定向放射外科结合实时肿瘤运动追踪对于小的周围型肺肿瘤是一种有前景且耐受性良好的治疗选择。
