恶性胶质瘤靶区勾2016课件

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1、2016ESTRO-ACROP指南：恶性胶质瘤靶区勾画蔡文杰福建医科大学附属泉州第一医院放疗科2016-03Radiotherapyhasbeenthemainstayoftreatmentforgliomasincethe1980’swhenitwasestablishedthatpostoperativetreatmentimprovessurvival全脑3ＤＣＲＴ　ＩＭＲＴ　ＶＭＡＴTheexperiencewithindividualcasereviewoftheEORTC/NCICtr

2、ialshowedthatmorerigorousdefinitionofvolumes,OARsandtechniquesisrequiredThisguidelinearticleaimstoprovideanoverviewofexistingdelineationstrategies,theirtherapeuticvaluetodateandrecurrencepatternanalysesTheultimateaimistodefinetheoptimalstrategyfortarget

3、delineationinGBM.背景资料LaperriereN,ZurawL,CairncrossG.Radiotherapyfornewlydiagnosedmalignantgliomainadults:asystematicreview.RadiotherOncol2002;64:259–73.Imagingtechniques影像学技术TargetdelineationshouldbeperformedusingcontrastenhancedT1+T2/FLAIRsequencesCa

4、utionshouldhoweverbeadvocatedwhenusingthelatterforplanningpurposes慎重采用T2/FLAIR！T2/FLAIR信号受肿瘤容积效应与术后水肿影响明显完全采用T2/FLAIR勾画CTV而未缩野推量，常导致脑受量超过正常组织受量限制功能影像（ill-defined）perfusion-anddiffusion-weightedMRI,withorwithoutspectroscopy（prospectivetrialsandnotinrout

5、ine）PETimaging(METorFET)----maybeusefulinthecontextofre-irradiationbecauseoftheextensivepost-therapeuticimagingchangeswhichmightbedifferentiatedmoreaccuratelybyPET.ThisrolehasnotbeenfullyvalidatedFETPETimagingPatientcaseshowingperipheralcontrastagente

6、nhancementaroundtheresectioncavityinthepostoperativeMRIwithadditionalFET-PET/CTmetabolicallyactiveparafalcialtumorresiduesModificationoftheMRI-basedclinicaltargetvolume(CTV,green)withintegrationofFET-utilizingareas(red)Generaltargetdelineationstrategy

7、一般靶区勾画策略术后残存患者，肿瘤以局部复发为主肉眼切除的肿瘤，肿瘤复发沿白质束浸润over80%ofrecurrenceswithina2cmmarginofthecontrastenhancedlesiononCT-orMRIscansHalperinEC,BentelG,HeinzER,BurgerPC.Radiationtherapytreatmentplanninginsupratentorialglioblastomamultiforme:ananalysisbasedonpostmo

8、rtemtopographicanatomywithCTcorrelations.IntJRadiatOncolBiolPhys1989;17:1347–50FredH.Hochberg，AmyPruitt，Assumptions in the radiotherapy of glioblastoma[J].Neurology,1980,30(9):907-911.WallnerKE,GalicichJH,KrolG,ArbitE,MalkinMG.Patternsoffailur