食管癌的放疗.ppt

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1、食管癌放疗1.流行病学2.食管癌同期放化疗3.食管癌靶区勾画5.不能手术切除食管癌综合治疗6.食管癌术后放疗主要内容4.可切除食管癌术前新辅助治疗1.流行病学Worldwideesophagealcanceristhesixthleadingcauseofcancer(406,800deathcases)Overthepast15years,theincidenceratehaveincreased15%WhitepatientsadenocarcinomaexceedsSCCInmen,theincidenceishighestinChina(21.6/100,000)流行病

2、学EsophagealCarcinomaRiskfactorsforE-caRiskfactorSCCADTobaccouse+++Alcoholuse++++obesity++Bodymassindex-+Gastroesophagealrefluxdisease+barret’sesophagus+Others：age,malegenderetal.Treatmentimprovementoverthepast30yearsAn11%improvementinsurvivalTreatment:fromsingle-modalitytherapytocombined-mod

3、alitytherapy5-yearsurvivalratesremainlowat10%ArleneA:Forastiere,Esophagus(2010)7:1-6.Surgeryalone:StandardoptionRTalone:LesseffectivePreoperativeradiotherapy:NosurvivalbenefitPreoperativechemoradiotherapy:standardofcarePreoperativechemotherapy:infrequentlyused,mayhaveagreaterroleingastriccan

4、cerChemoradiationalone:standardoptionPostoperativeradiotherapy:NosurvivalbenefitPostoperativechemoradiotherapy：NotyetrigorouslystudiedTreatmentoptionsintheUnitedStatesforesophagealcancer2.食管癌同期放化疗CancurrentCRT单纯放疗疗效非常差放化疗联合明显优于单纯放疗，不管是同期或序贯RTOG8501是里程碑式的研究，奠定了同期放化疗在食管癌治疗中的地位，特别是对于局部晚期Ⅲ/Ⅳa患者R

5、TOG85-01国外三期临床研究：CCRTVSRTalone直接杀灭肿瘤细胞，放射增敏杀灭微小转移灶抑制放疗后肿瘤细胞亚致死损伤及潜在致死损伤修复作用不同细胞周期时相，起协同作用同期放化疗可能机理合理的放疗方案：剂量及分割方式同期放化疗放疗剂量HDarm（64.8Gy）CDarm（50.4Gy）Mediansurvival（95%CI）（months）12.9（10.5-19.3）18.1（15.0-23.1）2yearsurvival（%）3039Treatmentrelateddeath112高剂量组产生具有统计学意义的获益几乎没有可能，研究提前终止Alterationof

6、radiationdose（fractionation）在放射治疗的后期发生肿瘤细胞加速再增殖，影响肿瘤局控率同期放化疗毒副反应，很多患者延长了治疗时间，每延长治疗时间1天需增加0.59Gy放疗剂量克服加速分割方法能在短期内给予患者相同或更高的等效生物剂量LiuCX.ChinJCancer.2010Oct;29(10):889-99.From58%to89.6%From24%to57.5%Fewerreported,upto40%in2reportsconclusionLACHFRcombinedwithFPchemotherapycanimprovethesurvivalra

7、teandlocalcontrolrateofesophagealcancercomparedwithLACHFRalone,withshort-termtoxicitiessignificantlyincreased,andlong-termnotincreasedbutneedingmoreobservation.同期放化疗毒副反应放射性肺炎和DVH参数（V5-V50及MLD）明显相关当V20分别为24%，25-36%和大于37%，Ⅱ级以上放射性肺炎发生率分别为13%，33%和78%As