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目的探讨射波刀Cyberknife在中晚期高难肿瘤患者治疗中的应用价值,分析大剂量、短疗程精确放疗的量效关系。方法对160例中晚期高难肿瘤患者、347个肿瘤病灶、219个治疗靶区计划行射波刀治疗,并与曾在我院行适形放射治疗的160例中晚期高难肿瘤患者治疗后的近期疗效进行比较。总剂量为18～60Gy,分割1～6次,处方剂量线范围为85%～95%。治疗后随访1～3个月,按照世界卫生组织客观疗效评价标准评定近期疗效,并对肿瘤标志物及Zubrod-ECOG-WHO(ZPS)评分的变化进行分析比较。结果射波刀治疗后客观疗效有效率高达66.88%,高于适形放疗的客观疗效有效率(42.50%),且差异具有统计学意义(P<0.01);放射免疫RIA检测方面,射波刀治疗后治疗有效率为50.00%,高于适形放疗的RIA指标治疗有效率(43.47%);ZPS评分方面,射波刀治疗后ZPS评分改善情况优于适形放疗,且差异具有统计学意义(P<0.05)。结论 Cyberknife由于其实时影像追踪、高度精确、快速短程等优点使中晚期高难肿瘤患者损伤小、见效快,变不治为可治,值得临床推广应用。
Objective To investigate the application value of Cyberknife in the treatment of patients with advanced refractory tumors and to analyze the dose-effect relationship between high-dose and short-course radiotherapy. Methods One hundred and sixty-six patients with advanced and refractory tumors, 347 tumor lesions and 219 therapeutic targets were planned to be treated with radiosurgery and were compared with those treated with conformal radiotherapy in 160 patients with advanced or advanced refractory tumors Efficacy comparison. The total dose of 18 ~ 60Gy, divided into 1 to 6 times, the prescription dose line range of 85% to 95%. The patients were followed up for 1 to 3 months. The short-term curative effect was evaluated according to the objective evaluation standard of World Health Organization. The changes of tumor markers and Zubrod-ECOG-WHO (ZPS) scores were analyzed and compared. Results The effective rate of objective curative effect was 66.88% after radiosurgery treatment, higher than that of conformal radiotherapy (42.50%), and the difference was statistically significant (P <0.01). In RIA of radioimmunoassay, The treatment effective rate was 50.00%, which was higher than that of conformal radiotherapy (43.47%). ZPS score was better than conformal radiotherapy after radiosurgery treatment, and the difference was statistically significant (P <0.05). Conclusion Due to its advantages of real-time image tracking, high accuracy, rapid short-range and other advantages, Cyberknife is less invasive and effective in treating patients with advanced refractory tumors. It is worthy of clinical application.