- 期刊
疫情期間以立體定位放射治療非小細胞肺癌取代傳統放射治療－病例報告
Replacing Conventional Radiation Therapy with Stereotactic Body Radiation Therapy for Non-small Cell Lung Cancer during the Epidemic- Case Report
摘要
立體定位放射治療相較於傳統放射治療對早期非小細胞肺癌的疾病控制率較高，無法手術的情況、局部控制率、生存率及毒性都有不錯的表現。非小細胞肺癌的立體定位放射治療以3到5個分次較為常見，但單分次也是一種選擇。我們要介紹一名84歲的男性病例，在covid-19疫情期間，被診斷出左肺葉有兩顆腫瘤，分別在左上葉及左下葉，皆為早期非小細胞腺瘤。因年事已大無法手術及疫情期間需降低到院頻率情況下，使用Viewray MRIdian Linac配合呼吸調控給予左上葉34 Gy/1次及左下葉給予總劑量48 Gy/4次的放射治療。透過磁振造影導引提供較佳的軟組織對比、線上自適應治療計畫以及即時影像追蹤腫瘤位置，提高腫瘤劑量並減少PTV的範圍，進而降低病人的副作用。病人接受單分次治療時在治療室的時間為63分鐘，相較於其他文獻更有效率。在治療過程及治療後並無任何不適，且在單分次的治療部位經過一年並無復發。因此我們認為在疫情期間使用立體定位放射治療是有實質幫助的，不論是1次或4次相較於傳統放射治療，病人的到院次數有顯著下降，在治療過程所花費時間、毒性或是術後追蹤都沒有讓病人不適。藉由ViewRay MRIdian Linac的優勢，可以更大膽的執行立體定位放射治療以實現減少病人的到院次數。
並列摘要
Compared with conventional radiation therapy, stereotactic body radiation therapy has a higher disease control rate for early-stage non-small cell lung cancer, revealing good performance in inoperable conditions, local control rate, overall survival rate and toxicity. Stereotactic body radiation therapy for non-small cell lung cancer has been used in fractions of 3 to 5, but single fraction is also an option. Here we introduced the case of an 84-year-old male diagnosed with non-small cell lung cancer in the left lung lobe during the covid-19 epidemic, one in the left upper lobe and the other in the left lower lobe, both of which were early stage non-small cell lung adenocarcinoma. Due to his advanced age, he was unable to undergo surgery and the frequency of hospital visits had to be reduced during the epidemic. Viewray MRIdian Linac was used in conjunction with breathing control to deliver 34 Gy/1 fractions to the left upper lobe and 48 Gy/4 fractions of radiation therapy to the left lower lobe. By providing better soft tissue contrast through MRI guidance, online adaptive treatment planning and real-time image tracking of tumor location has been used while increasing the tumor dose and reducing the range of PTV, side effects were reduced. The patient's time in the treatment room was 63 minutes when receiving single fraction of treatment, which is more efficient than detailed in other literature. There was no discomfort during and after treatment, and no recurrence after one year at the single-fraction treatment site. As a result, we believe that the use of stereotactic body radiation therapy during the epidemic is of substantial help. Compared with conventional radiation therapy whether being 1 or 4 fractions, the number of patient visits to the hospital was significantly reduced and the time spent during the treatment process, toxicity or postoperative follow-up did not make the patient experience discomfort. With the advantages of ViewRay MRIdian Linac, stereotactic body radiation therapy can be performed more aggressively to reduce the number of patient visits.