- 期刊
Cyberknife Robotic Radiosurgery for Limited Liver Metastates in Three Fractionation
三分次電腦刀立體定位放射線手術治療於侷限性肝轉移
摘要
目的：探討引用電腦刀立體定位放射線治療，以60 Gy分三分次治療侷限性肝腫瘤轉移的可行性與效果。材料與方法：我們回溯收集2009至2011年。共有7位無法開刀切除，侷限肝轉移病患於奇美醫學中心放射線瘤部接受電腦刀立體定位放射線治療。追蹤時間範圍從5～25個月（中位數為17個月）。4位病患為單顆腫瘤，另3位為多顆腫瘤（少於3顆）。最大腫瘤直徑為1.5～5 cm，原發腫瘤部位為直腸癌（2）、肺癌（2）、胰臟癌（1）、腎臟癌（1）、膀胱癌（1）。年齡範圍從60～80歲。病患接受以隔日三分次總劑量為60 Gy的電腦刀立體定位放射線治療，處方劑量為75～80%的等劑量曲線。結果：治療完畢3個月後以腹部電腦斷層或核磁共振掃描檢查顯示3例病患取得了完整緩解。4例病患取得了部分緩解，6個月後再以腹部電腦斷層或核磁共振掃描檢查，顯示6例病患已取得了完整緩解。治療並無嚴重副作用產生，僅有1例顯示一級急性肝炎與腸胃炎。1年存活率為71.4%，2年存活率為42.8%。存活率範圍為6～25個月（中位數17個月）[95% CI 6.75～27.26]，無進展生存率範圍為5～25個月（中位數9個月）[95% CI 1.3- 16.7]。結論：本研究顯示電腦刀立體定位放射線治療以60 Gy分三分次治療於無法開刀切除，侷限肝轉移是可行與有效的。治療可以實現良好的局部區域控制及無嚴重副作用。雖然我們的數據建立這種治療方法的安全性，但需要更嚴格的臨床研究， 以充分評估長期療效和可能產生的副作用。
並列摘要
Purpose: To determine the feasibility and efficacy of 60 Gy/3 fractions with Cyberknife image-guided robotic stereotactic radiosurgery for limited liver metastases.Materials and Method: Between 2009 to 2011, a total of 7 patients with inoperable, limited numbers of liver metastases underwent Cyberknife image-guided robotic stereotactic radiosurgery at our center. Follow-up time ranged from 5-25 months (median: 17 mo.). Four patients had a solitary lesion and 3 had small multiple lesions (Iess than 3 nodules), the maximum tumor diameter ranged from 1.5 cm. to 5 cm. Primary tumor sites were rectal cancer (n=2), lung Cancer (n=2), pancreatic cancer (n=1), renal cell cancer (n=1), bladder cancer (n=1). The ages ranged from 60-87 years old. The patients were treated with 60 Gy delivered in 3 fractions given every other day. Isodose value range from 75-80% of the prescribed dose.Results: A follow-up CT-scan of the abdomen done 3 months after Cyberknife image-guided robotic stereotactic radiosurgery showed complete response was attained in 3 patients and partial response in 4 patients. Six months after the treatment all patients achieved a complete tumor response. Only 1 patient shown grade 1 acute liver and gastrointestinal toxicity. No severe complication was attributed to the therapy. The l-and 2-year overall survival rate was 71.4% and 42.8%, respectively. Median survival was 17 months (6-26 months) [95% CI 6.75-27.26], and median progression-free survival was 9 months (5-26 months) [95% CI 1.3-16.7].Conclusion: Cyberknife image-guided robotic stereotactic radiosurgery in 60 Gy/3 fractions for limited liver metastases is feasible and effective. Excellent local control can be achieved with minimal toxicity. While our data established the safety of this treatment, more rigorous clinical studies are needed to fully evaluate long term efficacy and toxicity results.
延伸閱讀
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