| Objective: Currently, the preferred treatment for early (I, II) stage non-small celllung cancer (NSCLC) patients remains surgery, the survival rate in5-year of NSCLC instage I is43%to50%. However, a considerable portion of patients refused or can notbe tolerated by operation, then radiation therapy is often used. The therapeutic effectwith traditional radiation therapy is poor, and the survival rate in5-year is below30%,many scholars studied on different time-dose-split mode through research and practice,so that the treatment effect of radiotherapy for early stage NSCLC has been greatlyimproved. As the development of medical imaging technology and computertechnology, stereotactic radiation therapy (X-knife, γ-knife) began to be used in clinicaland developed gradually. Many clinical studies have been confirmed that stereotacticradiation therapy is an effective treatment for early stage NSCLC patients who areineligible for surgery, compared with conventional radiation therapy, it is characteredwith a small target area, a high single dose, a mild damage for surrounding normaltissue and so on. The study is to analyze prognostic factors of body γ-knife (stereotacticbody γ-ray treatment system) on early-stage NSCLC patients after the interventiontreatment and evaluate the clinical significance of stereotactic radiotherapy (γ-knife).Methods:102inoperable early stage NSCLC patients with systemic γ-knifetreatment from January2004to January2006of the hospital were selected for analyzedretrospectively, using SPSS16.0statistical software for survival factor analysiscalculation，single-line and Cox multivariate analysis of prognosis. OUR body gammaknife treatment machines, vacuum pads and three-dimensional coordinates of astereotactic body frame were used to fix position, CT simulator were used forenhancement scanning every3-5mm, and the images were transferred to a computer workstation via the LAN for TPS treatment plan design. On the average，GTV wasenlarged0.6-0.8cm outward to become CTV, GTV included images of tumor andlymph nodes. According to the distance from the primary tumor，the metastatic lymphnodes were designed individually or designed in whole, all patients were done withoutadditional preventive exposure for the mediastinal area.50%of the dose curve for theprescription dose. Single dose of5～6Gy,5times a week, a total of10～12times.Prescription dose of50～60Gy, the highest dose point is located within the tumor. Allthe patients used CT scan for re-X at the moment of2to3months after treatment, thefollow-up date as of May2011.Results: After2to3months,102cases are checked by CT again. CR is67.6%,PRis28.4%,SD is3.9%,PD is none. CR+PR is96.1%.The patient’s3-year,5-year overallsurvival rate was59%,47%.Cancer-specific survival rate was72%and70%.Univariateanalysis showed that survival rate is associated with age, the location of thetumor,clinical stage, T stage, N stage, complications, Karnofsky performance score,pathological type, dose size, independent on sex, radiation reaction. Cox multivariateanalysis showed that prognosis: survival and age, tumor T stage, a merger of the cardiacdisease, other factors not obvious.Conclusion: Stereotactic radiation therapy (γ-knife), whose clinical efficacy ispositive, adopting high dose per fraction and short-course of treatment modalities, witha high rate of local control and little damage to the normal tissues nearby, is the primarymeans of non-surgical treatment and an ideal choice for early stage non-small cell lungcancer patients who can not tolerate or refuse surgery. Aggressive treatment forcomplications is the containable factor to extend the survival time. |
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