| BackgroundLung cancer is the first malignant tumor with global morbidity and mortality.Most of them are non-small cell lung cancer.Early detection and treatment are the key to reducing mortality.Modern imaging technology is developing,and the rate of early detection of non-small cell lung cancer is increasing.The treatment is becoming more and more critical,and the main treatments currently include surgical resection and stereotactic radiotherapy.Stereotactic radiotherapy has long been used as an alternative treatment for inoperable patients,but more and more studies have pointed out that the clinical efficacy of SBRT is not inferior to surgical treatment.It is recommended that SBRT be the first-line standard treatment for early stage non-small cell lung cancer,but This conclusion lacks strong evidence to support it.ObjectiveThe main purpose of this study was to compare the efficacy of cyberknife and surgical treatment for early peripheral non-small cell lung cancer and to evaluate the clinical value of cyberknife in early peripheral non-small cell lung cancer,and to analyze the possible factors affecting the efficacy of SBRT MethodsEighty-five patients with stage T1N0M0-T1N0M0 lung cancer who underwent cyberknife treatment and surgical treatment from October 2010 to September 2016 were included,68 male patients and 17 females;aged 45 to 86 years old,the median is age 66,49 patients with adenocarcinoma,32 with squamous cell carcinoma,and 4 with adenosquamous carcinoma.Among them,46 were in the cyberknife group and 39 in the surgery group.The total dose of the cyber knifegroup is 36-60Gy(the median dose is48Gy),and the 64%-85% isodose line is used as the prescription dose to wrap the PTV.The number of divisions is 3-12 times,once a day,5 times a week.Times.Patients in the surgical group were confirmed by preoperative imaging and postoperative pathology,and a team of experienced surgeons evaluated concurrent thoracotomy or thoracoscopic lobectomy or sublobar resection combined with lymph node dissection.The basic and treatment-related data of the two groups of patients were retained,and the patients were regularly reviewed for chest enhancement CT to assess the short-term and long-term outcomes.The deadline for follow-up is August 1,2018.ResultsThe short-term efficacy of the cyberknife group was evaluated in 20 patients(43.5%)with CR,19 patients(41.3%)with PR,4 patients(8.7%)with SD,and 3 patients(6.5%)with PD.The median survival time was 43.0(95% CI: 40.1-57.3)months,and the 1-year local control rate was 91.3%.The 1-,3-,and 5-year overall survival rates were 91.3%,58.5%,and 26.3%,respectively;The short-term efficacy of the group was evaluated in 39patients(100%)with CR.The median survival time was 44.0(95% CI: 18.6-69.4)months,and the 1-year local control rate was 84.7%.The 1-,3-,and 5-year overall survival rates were 94.9%,53.3%,and 29.3%.There was no significant difference in the 1-,3-,and5-year overall survival and median survival time between the two groups(P>0.05).Multivariate analysis of Cox model showed that gross target volume(GTV)and biologic effective dose(BED)were independent factors influencing the overall survival of patients in the cyberknife group.Conclusion1.SBRT treatment of early peripheral non-small cell lung cancer has fewer treatments,less traumatic tolerance,high local control rate after treatment,no difference in long-term survival time and surgery,and mild side effects after treatment,which can be used as early non-small cell lung cancer.One of the important first-line treatment options for patients.2.Biologic effective dose(BED)and Gross target volume(GTV)are independentinfluencing factors affecting the efficacy of SBRT in the treatment of early peripheral lung cancer.SBRT is associated with higher local control rate and long-term survival rate when BED is greater than 100 Gy in early non-small cell lung cancer.The smaller the volume,the better the treatment. |
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