朱锡旭 Advances in Radiosurgery for Lung cancer

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1、肺癌立体定向放射外科新进展南京军区南京总医院放射治疗科朱锡旭AdvancesinRadiosurgeryforLungCancerZHUxixuDepartmentofRadiationOncologyNanjingGeneralHospitalDiseasedistribution2500patientsweretreatedwithCyberknifefrom2009to2014BrainLungLiverPancreasSpinalLesionOthersOutlineDefinitionofradiosurgeryRadi

2、osurgerytechnologyRoleofradiosurgeryinthetreatmentofearly–stagelungcancerdetectedbyscreenRadiosurgryforlungcancerinpatientswithsevereCOPDRadiosurgeryforcentrallungcancerWhatisRadiosurgeryPreciseirradiationSmallnumber(onetofive)High-dosefractions（≥10Gy/fx）Howtocomet

3、rueTechniquesandtechnologyCyberknifeTomotherapyGantrybasedLAγKnifeProtontherapyParticaltherapyChallengestotreatmentdeliveryRespiratorymotionGatedbreathingcontrolBreath-holdTumourtracking4DCTSet-uperrorsIGRTGantrybasedradiosurgeryandCyberknifeTUMORTUMORRoboticster

4、eotacticradiosurgerysystem-CyberKnifemaximizedose,minimizesideeffects,maximizepatientcomfortEssenceofradiosurgeryAccuratehitThehighdosesperfractionstrivetowardsanablativetumoureffectWhereasminimizingtheradiationdoseisdeliverytoadjacentnormaltissuesAschematicoftheproce

5、ssandRequirementsforradiosurgeryEffectivepatientimmobilisationPrecisetargetlocalisation(differentimagingmodalities)SophisticatedplanningsoftwareAccuratetreatmentdeliveryAbilitytoproduceasteepisodosegradientExtracraniallesionspose(tumourandcriticalorganmotion)Early-

6、stagelungcancerdetectedbyscreeningScreeningforlungcancerusingCTshowedasurvivalbenefitAreductioninlung-cancer-relatedmortalityof20·0%whenusinglow-doseCTinsteadofchestradiography(NLST)Screenpositivitywasdefinedbyagreatestnodulediameterof4mmorlarger,and24%ofallCTscreensw

7、erepositiveAlmostallofthesearebenignHowtodiagnosisInvasivediagnosticproceduresTrans-thoracicneedlebiopsySurgeryVolumedoublingtime(VDT)18F-FDGPETSurgeryforscreendetectedtumoursIfmalignancyisdiagnosedonfrozensection,ananatomicalresection,withanadequatelymphnodedissect

8、ionLocalrecurrenceincreasedbythreetimeswithlimitedresectioncomparedwithlobectomyinpatientswithstageIAN