非小细胞肺癌的放射治疗ppt课件

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1、非小细胞肺癌-放射治疗LungCancerScreeningFromPresentationat:2011ASCOAnnualMeetingStageIncidenceTreatment5-YrSurvivalI15-20%SurgeryorSBRT60-80%II5-10%Surgery±Chemotherapy40-50%III30-35%Combined-ModalityTr15-40%IV35-40%Chemo±RT<5%SBRTvs.手术SBRT靶区勾画SBRT毒副反应I期NSCLC-放射治疗SBRT-Inope

2、rablestageINSCLCSBRT是无法耐受手术的外周型I期NSCLC的首选治疗JAMA.2010;303:1070-6.PhaseIItrialofSBRTformedicallyinoperablestageI/IINSCLC-RTOG023655patientsT≤5cm,N0,M020Gyin3fractionsover1.5to2weeksResults3-yearprimarytumorcontrolrate:97.6%Disease-freesurvivalat3years:48.3%Overallsu

3、rvivalat3years:55.8%Medianoverallsurvival:48.1months2012201220122012SBRTvs3DCRTSBRT-OperablestageINSCLCIntJRadiatOncolBiolPhys.2011;81:1352-8.SBRTissafeandpromisingtreatmentforoperableStageINSCLCThesurvivalrateforSBRTispotentiallycomparabletothatforsurgeryRetrospe

4、ctiveAnalysisSBRTVS.SurgeryTrialsClosedprematurelySlowlyaccruingSBRTvsSurgeryRTOGfoundationstudy3502iskickingoffsoon中方PI—于金明，山东省肿瘤防治研究院美国PI—Feng-Ming(Spring)Kong，美国密西根大学肿瘤中心ARandomizedTrialinPatientswithOperableStageINon-SmallCellLungCancer:RadicalResectionVsAblat

5、iveStereotaciticRadiotherapy(POSITLV)I期NSCLC-中心型中心型NSCLC（距离支气管树2cm内）可能对临近气管、食管及大血管造成损伤RTOG0813I/II期研究剂量爬坡(50Gy/5f）研究适合中心型NSCLC的分割模式及最大耐受剂量靶区勾画-SBRTGTV在肺窗进行勾画，纵膈窗可区分邻近血管或胸壁结构GTV不外扩，GTV=CTVGTV在水平面上外扩0.5cm，在头尾方向外扩1cm为PTV4DCT设备的中心使用呼气或吸气图像或最大密度投影(MIP)时可能会产生一个内靶区（IGTV）

6、无4D-CT，GTV勾画应建立在慢CT扫描的基础上PTV=IGTV+摆位误差(根据各肿瘤中心而定）SBRT毒副反应55inoperablepatientswithT1-2N0M0peripheralNSCLCRT：20Gy×3（RTOG0236）LogisticregressiontoinvestigaterelationshipbetweenPulmonaryFunction(PF)andpulmonarytoxicity.CoxproportionalhazardsmodelstoevaluatedbetweenPF

7、testandOS2012Results&ConclusionsBaselinePFwasnotpredictiveofradiationpneumonitisoranypulmonarytoxicityfollowingSBRTTheredidnotappeartobearelationshipbetweentheoccurrenceofradiationpneumonitisandnormallungtissuedosePoorbaselinePFalonedidnotappeartopredictdecreasedO

8、SPoorbaselinePFalonewithintherangedefiningtrialeligibilityshouldnotbeusedtoexcludeearlystageNSCLCptsfromSBRTII期NSCLC-放射治疗II期NSCLCII期NSCLC术后不推荐给予术后放疗不可手术