111例鼻咽癌初程放療殘存灶SRT推量照射課件

2009昆明會(huì)議鼻咽癌殘存推量照射111例鼻咽癌初程放療殘存灶

SRT推量照射

2009昆明會(huì)議鼻咽癌殘存推量照射研究背景鼻咽癌放療殘存灶能經(jīng)推量照射獲益采用SRT多中心臨床研究已證實(shí)本研究報(bào)道首程放療后殘存病灶推量結(jié)果

(2000年1月至2006年12月)2009昆明會(huì)議鼻咽癌殘存推量照射殘存病變推量照射前瞻性研究:

CancerHospitalofCAMS&PUMC患者殘存病變經(jīng)病理證實(shí)YanJH,etal.IntJRadiatOncolBiolPhys,18:295-8,1990

70Gy70Gy+Boost(20Gy)Localrecurrencerate36%6%P<0.055-yearoverallsurvival33%75%P<0.05 Patientswithresiduallesionbenefitfromhighdoseboost2009昆明會(huì)議鼻咽癌殘存推量照射常規(guī)放療局部控制率局部控制率T1-T2 65-95%T3-T4 44-68%2009昆明會(huì)議鼻咽癌殘存推量照射存在問(wèn)題常規(guī)放療難以避開(kāi)正常組織并發(fā)癥重生存質(zhì)量低推量受限復(fù)發(fā)率高生存率低2009昆明會(huì)議鼻咽癌殘存推量照射立體定向放射治療（X刀）優(yōu)勢(shì)定位精確高劑量集中于腫瘤靶區(qū)周邊劑量低利于保護(hù)周?chē)＝M織提高治療增益比2009昆明會(huì)議鼻咽癌殘存推量照射目的

前瞻性研究鼻咽癌初程放療后殘存腫瘤采用分次立體定向放射治療(SRT)的療效,評(píng)價(jià)其臨床應(yīng)用價(jià)值。

2009昆明會(huì)議鼻咽癌殘存推量照射入組標(biāo)準(zhǔn)原發(fā)腫瘤病理證實(shí)殘存病灶表淺-經(jīng)活檢病理證實(shí)深部-經(jīng)核磁共振片診斷無(wú)遠(yuǎn)處轉(zhuǎn)移無(wú)頸鞘受侵2009昆明會(huì)議鼻咽癌殘存推量照射臨床資料

性別例

男87

女 24

年齡例

15-50 7251-77 392009昆明會(huì)議鼻咽癌殘存推量照射臨床資料UICCstageNoI 1IIa 5IIb 21III 57IVa20IVb 7total

1112009昆明會(huì)議鼻咽癌殘存推量照射殘存部位鼻咽和咽旁間隙44%(49/111)鼻咽腔37%(41/111)咽后/頸深淋巴結(jié)10%(11/111)伴顱底骨質(zhì)破壞29%(34/111)2009昆明會(huì)議鼻咽癌殘存推量照射SRT資料Isocenter(s) 1 592 443 8Volume(cm3) ≤10 3910-30 6130-77.1 112009昆明會(huì)議鼻咽癌殘存推量照射鼻咽癌初程放療劑量DoseofEBRT/IMRT(Gy) 60-69 16例

70-76 95例DoseofEBRT60-76Gy81例DoseofIMRT70-74Gy30例2009昆明會(huì)議鼻咽癌殘存推量照射SRT臨床資料DosefractionationofFSRT

16-18Gy/2F 13例

24Gy/3-4F 11例

15-20Gy/4-5F 87例2009昆明會(huì)議鼻咽癌殘存推量照射劑量分割相關(guān)因素外放療劑量殘存病變部位

危及器官和結(jié)構(gòu):頸內(nèi)動(dòng)脈頸段腦干

殘存腫瘤體積正常組織外放療后反應(yīng)2009昆明會(huì)議鼻咽癌殘存推量照射結(jié)果中位隨診33(8-92)

月.完全緩解98%(109/111例)未控

2%(2/111例)

2009昆明會(huì)議鼻咽癌殘存推量照射N(xiāo)PC殘存病灶SRT推量照射長(zhǎng)期結(jié)果

1-y 2-y 3-y4-y 5-yOS(%) 98.1 92.1 86.0 86.0 83.7DFS(%) 87.2 83.7 82.1 80.1 80.1LRFS(%)98.2 95.9 94.3 92.1 92.12009昆明會(huì)議鼻咽癌殘存推量照射N(xiāo)PC殘存病灶SRT推量照射長(zhǎng)期結(jié)果2009昆明會(huì)議鼻咽癌殘存推量照射N(xiāo)PC殘存病灶SRT推量照射長(zhǎng)期結(jié)果2009昆明會(huì)議鼻咽癌殘存推量照射毒性反應(yīng)

7例發(fā)生晚期并發(fā)癥

6例一側(cè)聲帶麻痹,舌輕度萎縮(殘存灶緊臨頸鞘)1例鼻咽潰瘍(鼻咽部嚴(yán)重感染)2009昆明會(huì)議鼻咽癌殘存推量照射死亡原因共有14例死亡7例死于遠(yuǎn)處轉(zhuǎn)移2例死于局部復(fù)發(fā)2例死于并發(fā)癥3例死于其它原因2009昆明會(huì)議鼻咽癌殘存推量照射劑量分布（立體定向放射治療)2009昆明會(huì)議鼻咽癌殘存推量照射采用BrainLA小多葉光柵更好的適形度有利正常組織保護(hù)2009昆明會(huì)議鼻咽癌殘存推量照射強(qiáng)調(diào)避免血管神經(jīng)晚期損傷：?jiǎn)未蝿┝坎灰诉^(guò)高鼻咽大出血的主要因素：腫瘤侵及頸內(nèi)動(dòng)脈頸段;不利因素鼻咽感染、高齡、糖尿病、粘膜反應(yīng)重避免晚期并發(fā)癥2009昆明會(huì)議鼻咽癌殘存推量照射采用BrainLA小多葉光柵精確計(jì)算重要結(jié)構(gòu)受量2009昆明會(huì)議鼻咽癌殘存推量照射3monthsafterFSRTBeforeFSRT4yearsafterFSRTMRI55yearsold,male,parapharyngealresidualdiseaseonemonthafterexternalbeamradiotherapyof70Gy，F(xiàn)SRT:8Gyx3f，onceaweek，25cc2009昆明會(huì)議鼻咽癌殘存推量照射小結(jié)

FSRT治療鼻咽癌放療后殘存病變安全有效明確適應(yīng)癥禁忌癥治療方案規(guī)范化個(gè)體化降低并發(fā)癥T3患者獲得與早期相似的控制率與生存率殘存患者獲得與無(wú)殘存相似的控制率與生存率得到一致認(rèn)同成為常規(guī)治療2009昆明會(huì)議鼻咽癌殘存推量照射結(jié)論分次立體定向放射外科治療鼻咽癌放療后鼻咽殘存腫瘤有肯定臨床價(jià)值；選擇合適病例能獲滿意療效;劑量分割方式有個(gè)體化特點(diǎn);晚期組織損傷應(yīng)引起高度重視2009昆明會(huì)議鼻咽癌殘存推量照射forlocalpersistentNPCorboostintheliteratureAuthorNo.

ModalitiesRegimenofSRS/FSRTResults2-yLC100%

MajorcomplicationsnoAhnetal.(2000)

19(B)

FSRT4-yrLC89%4-yrOS75%Mucosalnecrosis1(5.3%)Xiaoetal.(2001)32(P)

FSRT14-24/2-43-yOS70.37%FNH2(6%)Leetal.(2003)45(B)

SRS7-153-yLC100%3-yOS75%CNI4(8.9%)TLN3(6.7%)Chuaetal.(2003)7(P)SRS11-141-yLC100%noWuetal.(2007)34(P)

FSRT18/33-yLC89.4%3-yDSS80.7%TLN3(8.8%)

Presentstudy

111(P)

FSRT

12-26/2-75-yLC92.1%5-yOS83.7%CNI6(5.4%)Mucosalnecrosis1(0.9%)

*Abbreviations:P=persistentlesions,B=boost,LC=localcontrol,OS=overallsurvival,DSS=diseasefreesurvival,FNH=fetalnasopharyngealhemorrhage,CNI=cranialnerveinjury,TLN=temporallobenecrosis.ClinicaloutcomesofSRS/FSRTChangetal.(1999)23(P)

SRS7-168-40/4-20

2009昆明會(huì)議鼻咽癌殘存推量照射發(fā)表文章與交流美國(guó)放射腫瘤學(xué)雜志

XiaoJP,XuGZ,MiaoYJ.etal.Fractionatedstereotacticradiosurgeryfor50patientswithrecurrentorresidualnasopharyngealcarcinoma.Int.J.RadiatOncolBiol.Phys.2001:51,164-170.中華放射腫瘤學(xué)雜志

肖建平,徐國(guó)鎮(zhèn),高黎,等.鼻咽癌初程放射治療后殘存的分次X刀治療初探

2005年3月第14卷第2期,77-80.國(guó)際會(huì)議

“FRACTIONATEDRADIOSURGERYFOR98PATIENTSWITHRESIDUALLESIONAFTERFIRSTCOURSEOFRADIATIONTHERAPYFORNASOPHARYNGEALCARCINOMA”

The4thS.TakahashiMemorialInternationalWorkshopon3DimensionalconformalRadiotherapy.

December10-12,2004NagoyaJapan.FractionatedStereotacticRadiotherapyin111PatientswithResidualLesionafterFirstCourseofRadiationTherapyforNasopharyngealCarcinoma2008年九月波士頓召開(kāi)的美國(guó)腫瘤放射治療50周年年會(huì)交流

2009昆明會(huì)議鼻咽癌殘存推量照射臨床資料DoseofEB