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ID:38972059
大小:1.34 MB
页数:11页
时间:2019-06-22
《2015年协和放疗论坛:外阴癌放射治疗及综合治疗-魏丽春》由会员上传分享,免费在线阅读,更多相关内容在行业资料-天天文库。
1、2015/12/4外阴癌的综合治疗(手术+术后放疗)外阴癌放射治疗及综合治疗第四军医大学西京医院放疗科5y‐OS:76.7%5y‐DFS:67.9%魏丽春主任医师、教授Xijinghospital:35例,FIGO Stage I-IIIc;鳞癌坛根治性或姑息放疗,疗效待提高FIGO IVB, 肿瘤负荷大、感染论疗放瘤肿失败+死亡/全部病例=22/35=62.8%和协分期早、体积小问题•目前外阴癌的治疗方案、技术?•影响治疗结果的因素?12015/12/4流行病学特点学习内容•流行病学特点,预后因素分析•外阴癌
2、术后辅助放化疗•外阴癌根治性放化疗Vulvarcancerisararedisease15%ofpatientshaveasecondprimarytumorinthecervix,vagina,oranus“olderpopulation”(over55yearsofage)“elderly”(65-74years)“veryelderly”(over75years)坛影响预后的临床病理特点HPV 感染是重要的致病原因论•age•40–60%ofvulvarcancerand90%ofVINcasesare
3、•tumor grade, thickness 疗associatedwithHPV•histologicpattern (warty(疣状)/basaloid(基地细胞样)or •mainlynon‐keratinizing;multifocalcarcinomas放keratinizing角化型)•predominantlyHPV16and18,precededbyVIN•pattern of invasion (blunt/nested, infiltrative, or mixed)•generallyy
4、oungerandusuallybetterprognosis瘤•stromalresponse (fibromyxoidor inflammatory) •human papillomavirus(HPV) status和肿•pathologic stage,lymph node status 协重视:cancer specific survival (CSS)年龄高,肿瘤特异性生存低•elderlywomenaremorelikelytodieofcausesotherthantheirvulvarcance
5、r,resultinginanapparentdecreaseinsurvival.•Five-yearprogressionfreesurvival(PFS),overallsurvival(OS)andcancerspecificsurvival(CSS)were35.8%,27.4%and41.1%,respectivelyRadiatOncolJ2015;33(3):198-2068553women,between1988and2009BJOG.2014May;121(6):719-2722015/12/
6、4在各分期,年龄与肿瘤特异性生存高龄患者,淋巴结切除对生存有意义Fig.3.OSwithbilaterallymphadenectomy.GynecolOncol.2015Jun;137(3):373‐9BJOG.2014May;121(6):719-27坛三种浸润形式、两种间质反应浸润性病灶,纤维粘液反应比例高论疗FMX‐SRInflammatorystromalresponse放IfilInfiltratiive8%87%39%Solid/pushingNestedInfiltrative瘤noninfilt
7、rative16%74%肿p<0.001<0.001AmJSurgPathol.2015;39(9):1226-33协Fibromyxoid和Inflammatory有基质纤维粘液反应,预后不良FIGO 分期,2009没有淋巴结转移:I-II 期Oldstagingsystem(vulva only; vulva + perineum)StageI:5yOS97.4%stageII:5yOS96.3%腹股沟淋巴结转移:III-IVA 期StageIII:OS34%‐100%1个: IIIA; 2个: IIIB;
8、 包膜外侵犯: IIIC腹股沟淋巴结固定、溃疡:IVA期盆腔淋巴结转移:IVB期Ln(-),即使原发灶达直径8Cm,5年生存率仍可达88%32015/12/4盆腔淋巴结转移,现代放疗可治愈201520patientswithgrosslypositivePLNs64Gycouldbesafelydelivered.Thispatientiscurrentlywithout
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