Early Experience of Stereotactic Body Radiotherapy in Patients with Primary and Metastatic Lung Tumors

使用立體定位體部放射治療於原發性和轉移性肺腫瘤病患之早期經驗

李欣倫(Hsin-Lun Lee) ； 蔡若婷(Jo-Ting Tsai) ； 陳尚文(Shang-Wen Chen) ； 林家瑋(Jia-Wei Lin) ； 留偉順(Wilson Tiu Lao) ； 王孔民(Kum-Min Wang) ； 陳秋萍(Chiu-Ping Chen) ； 邱仲峰(Jeng-Fong Chiu) ； 鍾道生(Tao-Sang Chung)

《放射治療與腫瘤學》 18卷2期 (2011/06) Pp. 111-124

https://doi.org/10.6316/TRO/201118(2)111

摘要

目的：探討使用電腦刀立體定位體部放射治療(SBRT)於原發性和轉移性肺腫瘤病患之臨床結果。方法：回溯性探討自2005年11月至2008年6月間於萬芳醫院接受SBRT之19位病患的醫療記錄。SBRT是運用電腦刀之腫瘤追蹤系統來實行治療。治療後腫瘤反應和相關之副作用是以追蹤影像進行評估。治療相關副作用則以Common Terminology Criteria for Adverse Events version 3.0分級來記錄副作用之嚴重程度。結果：於接受電腦刀SBRT之19位肺腫瘤病患（共47顆肺腫瘤）中，8位（11顆腫瘤）為原發，11位（36顆腫瘤）為轉移。9顆腫瘤位於中央，其餘位於週邊。腫瘤體積介於1.1至110.5毫升（中位數，9.5毫升）。放射治療之劑量介於22至60Gy，歸一化於76%至85%之等劑量曲線，分2至4次給予。於12個月之中位追蹤時間中，共有3位病患發生2級放射性肺炎，另有2位病患發生3級放射性肺炎。分析其風險因子，女性(p=0.038)和中央型肺腫瘤(p=0.042)於單變項分析中有統計學上之差異。在兩位為復發中央型肺腫瘤且先前己接受過肺部體外放射治療之病患中，觀察到氣管食道瘺管及支氣管壞死之治療相關副作用。於16位可供分析局部控制率的病患中，4位(25%)為complete response，7位(43.8%)為partial response，2位(12.5%)為stable disease，3位(18.7%)為progressive disease。病人一年之整體存活率為63%，一年之局部無病存活率為84.2%。比較原發性和轉移性肺癌之一年局部無病存活率(87.5% vs. 81.8%, p=0.87)，以及中央型和週邊型肺腫瘤之一年局部無病存活率(80% vs. 85.7%, p=0.63)，並無統計學上之差異。結論：於我們的早期經驗中，電腦刀立體定位體部放射治療能有效局部控制原發性和轉移性肺腫瘤，然而，治療中央型或先前己照射過放射線之復發肺腫瘤時，應特別謹慎以避免較嚴重之副作用。

關鍵字

電腦刀 ； 立體定位體部放射治療 ； 肺腫瘤 ； 放射性肺炎

並列摘要

Purpose: To investigate the clinical outcomes of patients with primary and metastatic lung tumors treated by CyberKnife(superscript ®) (CK) stereotactic body radiotherapy (SBRT).Methods: Between November 2005 and June 2008, we treated 19 patients with SBRT at Taipei Medical University-Wan Fang Hospital. The SBRT was delivered by CK tumor tracking system. Tumor response and treatment-related toxicity were evaluated by follow-up image study. Treatment-related toxicities were scored by Common Terminology Criteria for Adverse Events version 3.0. In this study, we reviewed their medical records retrospectively.Results: We treated 47 lung tumors in 19 patients using CK SBRT. Eleven tumors in 8 patients were primary lung cancer, and 36 tumors in 11 patients were metastatic lung cancer. The locations of 9 tumors were central, whereas the others were peripheral. The tumor volumes were ranged from 1.1 to 110.5 ml (median, 9.5 ml). The radiation doses were ranged from 22 to 60 Gy, given in 2 to 4 fractions. The prescribed doses were normalized at 76% to 85% of the planned isodose. With a median follow-up interval of 12 months, we observed that grade 2 radiation pneumonitis (RP) occurred in 3 patients (1 central; 2 peripheral), whereas we found that grade 3 RP occurred in 2 patients with central lesions. According to the univariate analysis, female (p=0.038) and central lesion (p=0.042) were two predictive factors to the occurrence of grade≥2 RP. One grade 4 tracheal complication (tracheoesophageal fistula) and one grade 5 bronchial complication (bronchial necrosis) were observed in two patients who had centrally located recurrent tumors and had been previous treated with external beam radiotherapy. Four of the evaluable patients (16 patients) had responded completely (25%), seven exhibited partial response to treatment (43.8%), and two had stable disease (12.5%). Three patients had tumor progression after SBRT (18.7%). The 1-year overall survival (OS) was 63%, and the 1-year local progression-free survival (PFS) was 84.2%. The 1-year local PFS was 87.5% for primary lung cancer and 81.8% for metastatic lung cancer (p=0.87). The 1-year local PFS for central and peripheral lesions was 80% and 85.7%, respectively (p=0.63).Conclusion: Our study showed that SBRT using the CK system was effective for treating primary and metastatic lung tumors, providing better local control and shorter treatment course compared with those treated with conventional fractionated radiotherapy. Our study also showed two predicting factors for RP. Finally, using SBRT to treat centrally located tumor or re-irradiate recurrent tumor require additional caution due to higher risk of having complication. Thus, we suggest that more studies are needed in the future to confirm those findings in this study.

並列關鍵字

CyberKnife(superscript ®) ； Stereotactic body radiotherapy ； Lung tumor ； Radiation pneumonitis