Brown William T, Wu Xiaodong, Fowler John F, García Silvio, Fayad Fahed, Amendola Beatriz E, de la Zerda Alberto, Schwade James G
CyberKnife Centers of Miami, Miami, FL, USA.
South Med J. 2008 Apr;101(4):376-82. doi: 10.1097/SMJ.0b013e318167ad8d.
Based on the reported success of stereotactic body radiotherapy in treating extracranial tumors, we used CyberKnife (Accuray Incorporated, Sunnyvale, CA) to treat patients with metastatic lung cancer.
This is a retrospective report of treatment details and outcomes of 35 patients, ranging in age from 33 to 91 years, with 69 histologically proven pulmonary metastases, treated by image-guided robotic stereotactic radiosurgery at the CyberKnife Center of Miami, between March 2004 and August 2007. Tumor volumes ranged from 0.7 mL to 152 mL. Total doses ranged from 5 to 60 Gy delivered in one to four fractions with an equivalent dose range from 6 to 110 Gy NTD delivered in 2-Gy fractions assuming an alpha/beta of 20 Gy.
All patients tolerated radiosurgery well with fatigue as the main side effect. Grade 3 and grade 4 pulmonary toxic reactions were observed in one patient who had undergone a repeat treatment. Of the 35 treated patients, 27 (77%) were still alive at a median 18-month (range 2-41 mo) follow-up. Local control was 71% with 25 tumors showing a complete response, 16 a partial response, and 7 stable with disease. Eight had progressive disease.
The delivery of precisely targeted radiation doses to lung tumors in a hypofractionated fashion is feasible and safe. Image-guided robotic stereotactic radiosurgery of pulmonary metastases with the CyberKnife achieves good rates of local disease control with limited toxicity to surrounding tissues and in many cases may be beneficial for patients for whom surgery is not an option.
基于立体定向体部放射治疗在治疗颅外肿瘤方面已报道的成功案例，我们使用射波刀（Accuray Incorporated，加利福尼亚州桑尼维尔）治疗转移性肺癌患者。
这是一份回顾性报告，涵盖了2004年3月至2007年8月期间在迈阿密射波刀中心接受影像引导机器人立体定向放射外科治疗的35例患者的治疗细节和结果，患者年龄在33岁至91岁之间，共有69个经组织学证实的肺转移瘤。肿瘤体积从0.7毫升至152毫升不等。总剂量范围为5至60 Gy，分1至4次给予，等效剂量范围为6至110 Gy NTD，以2 Gy分次给予，假设α/β为20 Gy。
所有患者对放射外科治疗耐受性良好，主要副作用为疲劳。1例接受重复治疗的患者出现了3级和4级肺部毒性反应。在35例接受治疗的患者中，27例（77%）在中位18个月（范围2至41个月）的随访时仍存活。局部控制率为71%，25个肿瘤完全缓解，16个部分缓解，7个病情稳定。8例病情进展。
以大分割方式向肺部肿瘤精确输送靶向辐射剂量是可行且安全的。使用射波刀对肺转移瘤进行影像引导机器人立体定向放射外科治疗可实现良好的局部疾病控制率，对周围组织毒性有限，在许多情况下，对于不适合手术治疗的患者可能有益。
