【摘要】：目的:觀察體部伽馬刀在腎上腺轉(zhuǎn)移癌治療中的療效與放療毒副反應(yīng),分析其近期療效的影響因素,并探討影響腎上腺轉(zhuǎn)移癌患者預(yù)后的相關(guān)因素。方法:回顧性分析從2008年1月至2014年1月空軍總醫(yī)院收治的32例腎上腺轉(zhuǎn)移癌患者的臨床資料,男性23例,女性9例,年齡42~80歲,中位年齡64歲,卡式評(píng)分均大于等于70分。原發(fā)腫瘤類型:肺癌20例(62.50%),肝癌3例(9.37%),腎癌3例(9.37%),結(jié)腸癌4例(12.50%),胃癌1例(3.12),胰腺癌1例(3.12%)。單側(cè)腎上腺轉(zhuǎn)移26例,其中左側(cè)15例,右側(cè)11例,雙側(cè)6例。轉(zhuǎn)移灶直徑:1.5~8.7cm,中位直徑4.0cm,其中≤3cm 12灶,3~5cm 17灶,≥5cm 9灶。采用OUR-QGD型體部伽馬刀治療,共計(jì)38個(gè)病灶,治療計(jì)劃要求50%的等劑量線覆蓋100%PTV,70%劑量線覆蓋90%GTV,單次劑量3~5Gy,1次/日,5次/周,共10~17次,治療總劑量40~52Gy,中位劑量為48Gy,生物有效劑量為56.0~75.0Gy,中位劑量66.3Gy。采用RTOG急性分級(jí)標(biāo)準(zhǔn)評(píng)價(jià)放療不良反應(yīng),采用RECIST標(biāo)準(zhǔn)評(píng)價(jià)近期療效,利用SPSS統(tǒng)計(jì)軟件進(jìn)行數(shù)據(jù)處理,計(jì)量資料比較采用t檢驗(yàn),計(jì)數(shù)資料比較采用?2檢驗(yàn),并繪制患者生存曲線,計(jì)算各組生存率。對(duì)患者預(yù)后行Log-rank法單因素分析,用Cox回歸法進(jìn)行多因素評(píng)估預(yù)后危險(xiǎn)因素。P0.05為差異有統(tǒng)計(jì)學(xué)意義。結(jié)果:治療后近期病灶完全緩解率、部分緩解率分別為36.84%(14/38)、50.00%(19/38),總有效率為86.84%(33/38)。治療前腰背疼痛8例,放療后疼痛完全緩解3例,疼痛減輕4例,疼痛緩解率為87.5%(7/8)。應(yīng)用卡方檢驗(yàn),結(jié)果示病灶近期療效與病灶直徑及放療BED有關(guān)(P0.05),而與性別、年齡、原發(fā)腫瘤類型及腫瘤位置因素?zé)o關(guān)(P≥0.05)。治療后全組患者1、2、3年局部控制率分別為100%(21/21)、90.91%(10/11)、83.33%(5/6)�；颊�1、2、3年生存率分別為64.52%(20/31)、37.93%(11/29)、20.69%(6/29)。放射不良反應(yīng)主要表現(xiàn)為I至II級(jí)消化道和血液不良反應(yīng),僅出現(xiàn)1例III級(jí)消化道反應(yīng)及2例III級(jí)血液學(xué)副反應(yīng),未出現(xiàn)治療中止及相關(guān)死亡事件。多因素分析結(jié)果表明轉(zhuǎn)移器官數(shù)目、原發(fā)病灶控制情況及轉(zhuǎn)移時(shí)間是腎上腺轉(zhuǎn)移癌患者生存率的獨(dú)立預(yù)后因素。結(jié)論:本研究表明體部伽馬刀治療腎上腺轉(zhuǎn)移癌,采用3~5Gy/次,5次/周,PTV邊緣總劑量40~52Gy的放療劑量分割模式是安全有效的,治療不良反應(yīng)輕,對(duì)于腎上腺轉(zhuǎn)移癌治療獲得較好局控率及生存率,并且能有效緩解患者疼痛癥狀。轉(zhuǎn)移器官數(shù)目、原發(fā)病灶控制情況及轉(zhuǎn)移時(shí)間是影響腎上腺轉(zhuǎn)移癌患者預(yù)后危險(xiǎn)因素,而其他因素影響不明顯。
[Abstract]:Objective: to observe the efficacy of body gamma knife in the treatment of adrenal metastatic carcinoma and the side effects of radiotherapy, to analyze the influencing factors of short-term curative effect and to explore the related factors affecting the prognosis of patients with adrenal metastatic carcinoma. Methods: the clinical data of 32 patients with adrenal metastatic carcinoma treated in Air Force General Hospital from January 2008 to January 2014 were retrospectively analyzed. There were 23 males and 9 females, aged 42 to 80 years, with a median age of 64 years. The primary tumor types were lung cancer in 20 cases (62.50%), liver cancer in 3 cases (9.37%), renal carcinoma in 3 cases (9.37%), colon cancer in 4 cases (12.50%), gastric cancer in 1 case (3.12%) and pancreatic cancer in 1 case (3.12%). There were 26 cases of unilateral adrenal metastasis, including 15 cases on left side, 11 cases on right side and 6 cases on bilateral side. The diameter of the metastatic foci was 1.5 ~ 8.7 cm, and the median diameter was 4.0 cm. The 3cm 鈮，

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