CyberKnife® radiosurgery for stage I lung cancer:: Results at 36 months
CyberKnife® radiosurgery for stage I lung cancer:: Results at 36 months
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DOI：
10.3816/clc.2007.n.033
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发表时间：
2007-09-01
影响因子：
3.6
通讯作者：
Schwade, James G.
中科院分区：
文献类型：
--
作者：
Brown, William T.;Wu, Xiaodong;Schwade, James G.
目的：本研究的目的是确定通过射波刀(R)放射外科系统使用消融辐射剂量的图像引导机器人立体定向放射手术是否能在医学上不能手术的早期非小细胞肺癌（NSCLC）患者中获得可接受的局部控制，并评估无病生存、毒性和失败。射波刀(R)可以通过在目标上使用许多不同的角度来提供规定的剂量，通过组合正交射线成像和光学运动跟踪系统（Synchrony (R)）实时跟踪目标。材料与方法：回顾了2004年3月至2007年3月迈阿密射波刀中心59例患者的治疗细节和结果，年龄从51岁到96岁不等，61例肿瘤经组织学证实，采用图像引导机器人立体定向放射手术治疗。目标定位和呼吸运动补偿是通过放置在肿瘤内的单一基准标记物以及X-Sight （TM）和Synchrony (R)系统来完成的。总剂量范围为15戈瑞至67.5戈瑞，分1-5次给药，等效剂量范围为24-110戈瑞，按2戈瑞分次给药（α / β = 20戈瑞）。结果：4例1A期NSCLC患者和2例113期NSCLC患者存在持续性或复发性疾病。所有患者对放射手术的耐受性良好，疲劳是主要的副作用。在接受治疗的59例患者中，51例（86%）在随访1-33个月时仍然存活。已有8名患者死亡，其中2人死于癌症以外的疾病。结论：低分割方式对有限治疗体积的肺肿瘤进行精确靶向消融放疗是可行且安全的。利用射波刀(R)对肺肿瘤进行图像引导机器人立体定向放射治疗，达到了极好的局部疾病控制率，对周围组织的毒性有限，在许多情况下，对于无法选择手术的患者可能是治愈的。
PURPOSE: The aims of this study were to determine if image-guided robotic stereotactic radiosurgery by CyberKnife (R) Radiosurgery System using ablative radiation doses achieves acceptable local control in medically inoperable patients with early non-small-cell lung cancer (NSCLC) and to evaluate disease-free survival, toxicity, and failure. CyberKnife (R) can deliver the prescribed dose by using many different angles converging on the target, with real-time target tracking through a combined orthogonal radiograph imaging and optic motion tracking system (Synchrony (R)). MATERIALS AND METHODS: A review of treatment details and outcomes for 59 patients, ranging in age from 51 years to 96 years, with 61 tumors with histologically proven cancers treated by image-guided robotic stereotactic radiosurgery at the CyberKnife Center of Miami between March 2004 and March 2007 is presented. Target localization and respiratory movement compensation were accomplished using a single fiducial marker placed within the tumor, and the X-Sight (TM) and Synchrony (R) systems. Total doses ranged from 15 Gy to 67.5 Gy delivered in 1-5 fractions with an equivalent dose range of 24-110 Gy normalized treatment dose in 2 Gy fractions ((alpha/beta = 20 GY). RESULTS: Four patients with stage 1A NSCLC and 2 patients with stage 113 NSCLC had persistent or recurrent disease. All patients tolerated the radiosurgery well, fatigue being the main side effect. Of the 59 patients treated, 51 (86%) were still alive at 1-33-month follow-up. Eight patients have died, 2 of diseases other than cancer progression. CONCLUSION: The results indicate that the delivery of precisely targeted ablative radiation doses with surgical precision to limited treatment volumes of lung tumors in a hypofractionated fashion is feasible and safe. Image-guided robotic stereotactic radiosurgery of lung tumors with CyberKnife (R) achieves excellent rates of local disease control with limited toxicity to surrounding tissues and, in many cases, might be curative for patients for whom surgery is not an option.