CAJ | 학술논문

目的评价立体定向放射治疗(SBRT)在结直肠癌肝转移(CLM)中的治疗效果,为合理选择治疗手段提供依据.方法解放军306医院收治的28例患者,包括男17例,女11例,中位年龄63.8岁(31 ～ 86岁),共计54个病灶,行立体定向放射治疗.平静呼吸状态下的CT增强扫描影像分别进行大体肿瘤体积(GTV)、临床靶区体积(CTV)和计划靶区体积(PTV)的勾画,CTV为GTV外放5 mm,GTV为CTV外放5～ 10 mm.以50％～ 60％等剂量曲线作为处方剂量曲线,单次3 ～6 Gy,总剂量39 ～45 Gy,等效生物剂量50.7～65.3 Gy.治疗后3个月开始复查,以增强CT或MR显示的病灶体积的变化做为评价疗效的依据.根据RTOG毒性诊断标准对不良反应进行诊断和分级,比较局控率和生存率.结果所有患者均顺利完成治疗,中位随访时间为15.1个月(3～30个月),随访终点有7例患者存活.局控率为79.2％,1年和2年的总生存率分别为82.7％和48.6％.病灶体积与局控率关系密切,当体积小于14 cm3时,肿瘤局控率明显高于病灶体积大于65cm3时(x2=4.17,P＜0.05).病灶体积大于180 cm3时,肿瘤局控率为零.不良反应包括治疗后乏力(60.7％),1、2级消化道反应(28.6％),一过性1、2级骨髓抑制(46.4％),一过性转氨酶增高(17.8％).全组未发生3级以上及晚期不良反应.结论立体定向放射治疗可做为选择性病例尤其是不能手术的结直肠癌肝转移患者的首选局部治疗手段.
목적 평개입체정향방사치료(SBRT)재결직장암간전이(CLM)중적치료효과,위합리선택치료수단제공의거.방법 해방군306의원수치적28례환자,포괄남17례,녀11례,중위년령63.8세(31 ～ 86세),공계54개병조,행입체정향방사치료.평정호흡상태하적CT증강소묘영상분별진행대체종류체적(GTV)、림상파구체적(CTV)화계화파구체적(PTV)적구화,CTV위GTV외방5 mm,GTV위CTV외방5～ 10 mm.이50％～ 60％등제량곡선작위처방제량곡선,단차3 ～6 Gy,총제량39 ～45 Gy,등효생물제량50.7～65.3 Gy.치료후3개월개시복사,이증강CT혹MR현시적병조체적적변화주위평개료효적의거.근거RTOG독성진단표준대불량반응진행진단화분급,비교국공솔화생존솔.결과 소유환자균순리완성치료,중위수방시간위15.1개월(3～30개월),수방종점유7례환자존활.국공솔위79.2％,1년화2년적총생존솔분별위82.7％화48.6％.병조체적여국공솔관계밀절,당체적소우14 cm3시,종류국공솔명현고우병조체적대우65cm3시(x2=4.17,P＜0.05).병조체적대우180 cm3시,종류국공솔위령.불량반응포괄치료후핍력(60.7％),1、2급소화도반응(28.6％),일과성1、2급골수억제(46.4％),일과성전안매증고(17.8％).전조미발생3급이상급만기불량반응.결론 입체정향방사치료가주위선택성병례우기시불능수술적결직장암간전이환자적수선국부치료수단.
Objective To evaluate the efficacy of stereotactic body radiation therapy (SBRT) for hepatic metastases from colorectal cancer,and to collect data for the application of this technique.Methods A total of 28 patients from No.306 Hospital of PLA,including 17 male and 11 female with median age of 63.8 (range from 31 to 86),were treated with SBRT for colorectal cancer with liver metastases with 54 lesions in total.The GTV,CTV and PTV were delineated above the enhanced CT scans acquired during normal quiet respiration.CTV was obtained by adding 5 mm isotropic margin from GTV,and PTV was obtained by adding 5 to 10 mm isotropic margin from CTV.Prescription dose line covered 50％-60％ of isodose curve at 3-6 Gy/fraction.The total dose was 39-45 Gy and the biologically equivalent doses(BED)was 50.7-65.3 Gy.The patients were followed-up beginning at 3 months after SBRT.The change in size of the lesion based on enhanced CT or MR scans was evaluated.Toxicity was evaluated and scored according to the RTOG criteria.Local control rate and survival rate were analysed.Results All patients completed the treatment.With median follow-up of 15.1 months (range frome 3 to 30 months),7 patients survived at the end of follow-up.The local control rate (LC) was 79.2％,and 1-and 2-year overall survival rate(OS) were 82.7％ and 48.6％,respectively.There was a close corelation between the size of lesion and the LC.The LC (PR + CR) was much better at the size of lesion less than 14 cm3 than that at the size more than 65 cm3(x2 =4.17,P＜0.05).When the size was more than 180 cm3,the LC was zero.Toxicity included fatigue (60.7％),grade 1 and 2 digestive system toxicity (28.6％),a transient grade 1 and 2 bone marrow suppression (46.4％) and a transient increase in transaminase(17.8％).No grade 3 toxicity and above and late toxicity were observed.Conclusions Stereotactic body radiation therapy could be suggested as the first choice for the selected patients who suffer form colorectal liver metastases,especially for those who cannot undergo surgery.