CAJ | 학술논문

目的　探讨立体定向放射治疗（X线刀）肺癌的适应症、禁忌症和近期疗效。方法　用体部X线刀治疗计划系统和立体定位框架，结合SL-75直线加速器对56例肺癌患者进行了立体定向放射治疗（治疗组）。以同期53例常规放射治疗的原发性肺癌为对照。治疗组中42例为外照射上纵隔、同侧肺门、隆突下及原发灶50 Gy/25F后加用X线刀治疗原发灶5 Gy/次×5次；14例为肺转移癌或手术后外周孤立性复发病灶行单纯立体定向放射治疗，8～12 Gy/次×5次。结果　56例患者共78个病灶，X线刀治疗后1、3、6、12个月复查有效率（病灶消失、病灶缩小）分别为79.5%(62/78)、89.8%(70/78)、 87.2%(68/78) 和78.2%(61/78)，3个月以后出现病灶复发，3、6、12 个月病灶增大比率分别为2.6%(2/78)、5.1%（4/78）和9%（7/78）。2个治疗后无变化的病灶(肾癌术后肺转移)又行第2次X线刀治疗。治疗组原发性肺癌初次治疗36例，1年生存率89.1%，2年生存率53.9%，显著高于对照组（77.4%和39.6%，P<0.05)。结论　立体定向放射治疗肺癌有广泛的临床应用前景，适应症包括：①用于初次病例外照射后原发灶缩小在5 cm以下者补量，以减少肺组织受量和放射性肺炎的发生；②用于放疗后、手术后肺内复发的病灶高姑息性治疗；③用于转移性病灶（2～3个合适），大小在5 cm以下者，行根治性放疗。选择以上治疗时要注意肺癌的综合治疗，原发灶的大小及全身情况，既达到治疗的目的，又能提高病人的生存质量。
목적　탐토입체정향방사치료（X선도）폐암적괄응증、금기증화근기료효。방법　용체부X선도치료계화계통화입체정위광가，결합SL-75직선가속기대56례폐암환자진행료입체정향방사치료（치료조）。이동기53례상규방사치료적원발성폐암위대조。치료조중42례위외조사상종격、동측폐문、륭돌하급원발조50 Gy/25F후가용X선도치료원발조5 Gy/차×5차；14례위폐전이암혹수술후외주고립성복발병조행단순입체정향방사치료，8～12 Gy/차×5차。결과　56례환자공78개병조，X선도치료후1、3、6、12개월복사유효솔（병조소실、병조축소）분별위79.5%(62/78)、89.8%(70/78)、 87.2%(68/78) 화78.2%(61/78)，3개월이후출현병조복발，3、6、12 개월병조증대비솔분별위2.6%(2/78)、5.1%（4/78）화9%（7/78）。2개치료후무변화적병조(신암술후폐전이)우행제2차X선도치료。치료조원발성폐암초차치료36례，1년생존솔89.1%，2년생존솔53.9%，현저고우대조조（77.4%화39.6%，P<0.05)。결론　입체정향방사치료폐암유엄범적림상응용전경，괄응증포괄：①용우초차병예외조사후원발조축소재5 cm이하자보량，이감소폐조직수량화방사성폐염적발생；②용우방료후、수술후폐내복발적병조고고식성치료；③용우전이성병조（2～3개합괄），대소재5 cm이하자，행근치성방료。선택이상치료시요주의폐암적종합치료，원발조적대소급전신정황，기체도치료적목적，우능제고병인적생존질량。
Objective　To study the indication, contraindication and short-term clinical effects of stereotactic radiotherapy (X-knife) in lung cancer. Methods　A total of 56 cases (Treatment group) of lung cancer were treated with X-knife composing of the modern 3-D treatment planning system and the stereotactic body frame, and SL-75 accelerator. And another 53 cases only treated with routine external radiation served as the control. In treatment group, 42 cases received 50 Gy radiation, at 2 Gy per day, 5 d per week in the upper mediastinum, hilus of lung, below the primary focus first and then underwent X-knife for the primary focuses, and other 14 recurrent and metastatic cases received irradiation of 8-12 Gy per day, 5 d by X-knife alone. Results　The actually reexamination rate for 1, 3, 6, and 12 months after X-knife treatment in 78 focuses from 56 cases was 79.5% (62/78), 89.8% (70/78), 87.2% (68/78) and 78.2% (61/78) respectively. The focuses reappeared in 3 months after the treatment and the growth rates of focus in 3, 6, and 12 month after the treatment were 2.6% (2/78), 5.1% and 9% (7/78) respectively. There were 2 focuses received a second treatment with X-knife because no change after the first one. Both the 1-and 2-year survival rates of 36 cases of the primary lung cancer in the treatment group were higher than that of control group (89.1%, 53.9% and 77.4%, 39.6%). Conclusion　The stereotactic radiotherapy is of applicable and prospective in the treatment of lung cancer. The indications include: ①As a boost dose in case when primary focus is less than 5 cm after the first external radiotherapy may reduce the exposure of lung tissue to x-ray and the occurrence of radiation pneumonia; ②Treatment for the recurrence after radiotherapy and operation; ③Radical treatment for the metastatic focus less than 5 cm. Attention must be paid to when multiple treatment is carried on the volume of the focus, the Karnofsky scores and the general condition when stereotactic radiotherapy combined with X-knife for lung cancer.