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1、肺癌的放射治療 與其副作用中山醫學大學附設醫院放射腫瘤科劉文山主任INTRODUCTIONS肺癌是胸腔腫瘤最多的癌症肺癌高居臺灣男性與女性癌病的第二與第四位吸煙者罹患此癌症的機會為非吸煙者的二十倍以上治癒早期肺癌的機會遠比中晚期高INCIDENCEInUSA,approximately96,300newmalepatientsand79,800femalediagnosedannuallyinUSA.Drainageoflymphatics肺癌吸煙與肺癌35歲男性每天吸25支以上在75歲以前會有13%
2、機會罹患肺癌，10%冠狀動脈疾病吸煙量、時間、開始年齡、吸入深淺、焦油含量、尼古丁量、二手煙等職業：石棉、鉻、鎳、砷、氡、芳香族烴等肺癌飲食與肺癌胡蘿蔔素、維生素C,E、及硒等有減少游離基的作用遺傳：3p21肺癌上皮癌(squamouscellcarcinoma)近端支氣管，keratinpearlformation腺癌(adenocarcinoma)30-40%,peripheralinorigin,bronchoalveolarcarcinomaarisefromtypeIIpneumocytes
3、肺癌大細胞癌(largecellcarcinoma)10-15%小細胞癌(smallcellcarcinoma)15-25%,oatcellcarcinoma肺癌症狀咳嗽(75%)、痰中帶血(40%)、胸痛(40%)、氣喘(40%)、體重減輕、厭食、虛弱等等特殊症狀左肺腫瘤:聲音沙啞右肺腫瘤:SVCsyndrome肺尖腫瘤:手臂麻診斷及期別病史及身體檢查痰細胞學檢查80%近端腫瘤，20%遠端或較小腫瘤影像檢查chestx-ray,CTscan,MRI,bonescan,支氣管鏡檢查2nd,3rdsub
4、segmentaldivision,診斷及期別縱隔腔鏡檢查superiormediastinalLNs正子攝影(PET)IAT1N0M0IBT2N0M0IIAT1N1M0IIBT2N1M0IIIAT1-2N2M0,T3N0-2M0IIIBT1-3N3M0,T4N0-3M0肺癌的治療StageI-II手術/放射治療StageIIIA手術/放射治療/化療StageIIIB化療=>放射治療Non-smallcelllungcancerResectabletumor:about20%Surgery:stage
5、I(T1-2N0)53-70%at5yrsstageII(T1-2N1)48-56%stageIII(T3N0-1,N2)0-33%Mortality:2.7%,complication13%AdjuvantTreatmentTheroleofpost-opXRTLocalrecurrencep=0.188UnresectabletumorsDefinitiveRadiationTherapyChemo-radiotherapyforLocalAdvancedStageIIINSCLCFrenchtr
6、ial:inductionC/T3cyclesvindestine,lomustine,cisplatin,cyclophosp<0.02Chemo-radiotherapyforLocalAdvancedStageIIINSCLCEORTC:concurrentcisplatinsplitcourseofRTSmallCellCarcinomaHighgrowthfraction,widelydisseminatedSensitivetomanychemtherapeuticagentsSurger
7、y:<10%oflimitedsmallcellca.Smallcellca.:DFS&LCSC/Talonevs.C/T+XRTTheRoleofRadiotherapyforLimitedSmallCellLungCancerRadiationTherapyTechniquesPID:8139350,lungCTV:CTV-rSumplanRadiationToleranceof NormalTissueinChestAffectingfactorsIntrinsicradiosensitivit
8、yofnormaltissuesTotalgivendoseDoseperfractionVolumebeenirradiatedRadiotherapyRelatedReactionand/orComplicationsAcuteReactions0-6monthsReversible!LateReactions>6monthsIrreversible!!RadiationToleranceof NormalTissueinChestTotalGive
