Lv Yanling, Wang Zhen, Zhu Xixu, Shen Zetian, Yuan Dongmei, Miao Xiaohui, Shi Yi, Song Yong
Department of Respiratory Disease, Nanjing Clinical school of Southern Medical University, Nanjing General Hospital Of Nanjing Military Command, Nanjing, China.
Zhongguo Fei Ai Za Zhi. 2011 Apr;14(4):329-34. doi: 10.3779/j.issn.1009-3419.2011.04.05.
Recently, Cyberknife is a new flame-less stereotactic radiation therapy technology, which has several advantages, such as large dose, high precision and minimizing exposure to the surrounding normal tissue or adjacent vital structures, so it is successful in the treatment of non-small cell lung cancer (NSCLC). The aim of this study is to determine the effectiveness and safety of robotic stereotactic radiotherapy-Cyberknife with image guidance and realtime respiratory tracking against clinical stage III-IV peripheral NSCLC.
A review of treatment details and outcomes for 31 patients, with 34 tumors with histologically proven cancers treated by Cyberknife at the CyberKnife Center of Nanjing general hospital of Nanjing military command between March 2009 and March 2010 is presented. Of the 31 patients, 15 were adenocarcinoma and 12 were squamous cell cancer. Twenty-eight patients received other forms of antineoplastic therapy such as chemotherapy. A total dose of 36 Gy-60 Gy was prescribed to the 65%-85% isodose line and given in two to five fractions in less than 1 week using the CyberKnife radiosurgery system. CT scans were performed after one-two months, then patients were followed every 3 months.
Two patients had complete radiographic responses, 16 patients showed PRs, 7 patients showed SDs. Two patients showed PRs (reduction in tumor size), but developed distant metastases. Response rate was 58% and disease control rate was 81%. All patients tolerated the radiosurgery well, fatigue being the main side effect. No grade 4 or above toxicity was encountered.
In this small cohort of patients with advanced peripheral NSCLC, Cyberknife seems to be a safe and has good therapeutic effects with slight adverse reaction, but long time follow-up is necessary to evaluate the survival data and late toxicity.
近期，射波刀是一种新型的无火焰立体定向放射治疗技术，具有大剂量、高精度以及使周围正常组织或相邻重要结构受照剂量最小化等诸多优势，因此在非小细胞肺癌（NSCLC）的治疗中取得了成功。本研究的目的是确定具有图像引导和实时呼吸追踪功能的机器人立体定向放射治疗——射波刀治疗临床Ⅲ - Ⅳ期周围型NSCLC的有效性和安全性。
回顾了2009年3月至2010年3月期间在南京军区南京总医院射波刀中心接受射波刀治疗的31例患者、34个经组织学证实为癌症的肿瘤的治疗细节及结果。31例患者中，15例为腺癌，12例为鳞状细胞癌。28例患者接受了如化疗等其他形式的抗肿瘤治疗。使用射波刀放射外科系统，向65% - 85%等剂量线处方总剂量为36 Gy - 60 Gy，在不到1周的时间内分2至5次给予。在1 - 2个月后进行CT扫描，然后每3个月对患者进行随访。
2例患者影像学完全缓解（CR），16例患者部分缓解（PR），7例患者疾病稳定（SD）。2例患者出现PR（肿瘤大小缩小），但发生了远处转移。缓解率为58%，疾病控制率为81%。所有患者对放射外科治疗耐受性良好，疲劳是主要副作用。未出现4级及以上毒性反应。
在这一小群晚期周围型NSCLC患者中，射波刀似乎是安全的，具有良好的治疗效果且不良反应轻微，但需要长期随访以评估生存数据和晚期毒性。
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