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应助: 0 (幼儿园)
贵宾: 0.65
金币: 891.9
帖子: 1106
在线: 2.9小时
虫号: 163799
注册: 2006-01-11
性别: GG
专业: 化学工程,海洋环境

[交流] [精品课件] 直肠癌放疗.ppt

????? u?I?~??\
Rectal Ca ???F:?O{
O??H?E?
??????(CEA) ???????DH?
??????????????????????????? ???f??
  ??????????????????(CEA) T???VC)
1.CEA?????????????????????????? ????oV?U
  ??,????С????θ???Ρ?????????? _Fz0???
2.??????????????????????????У? ???? ???0?K
  ????????????????? ?????????CEA  1? ?e??90
  ??????????? 1??]??
3.CEA ????????????????? ??Q??M'??
????????????????? Treatment Development k??O*??
1. ??????????????????(Cornerstone) ???1?
2. ???????????????????????? ???R?v?
3. ???????Ч????????????????? ^???oI??
4. ???????Ч????????????????? ?S??Q??D?
5. ????????????????????? ??d?Z?~
6. ????????(Immunotherapy)??????? ???\?G??
7. ????????(Genetherapy)?????????? .??OJ????x
??????????? Selection of Treatment Policy VG??=??W
1.???????????????? <.k??
(1)?????? (??+??|X:?
(2)????????? ??? 4?h~R
(3)??????? ?(b&M?^`
(4)?????????????????? ?8D????P
(5)??????????????????? ????z_=??
(6)??????? #`?Ww??G?
2.?????????????????? 4t????m
  (1)?????????? 9??#???
  (2)???????? ?G?ngM6??
  (3)???????????? ?|????(
???????????? Surgical Modality & Indications ???06??-?
1. Mile??????(Abdominal Peritonium Resection,APR)??1908??mile?????????????????г??????,???? GHg???b
  ????????????? < 6cm?? +0?,!?s
??1??????????г??????????????? ?????}??
??2????????????????????? 6L?sH=?
2. Dixon????( Lower Anterior Resection, AR)?? ?o>??pnt?
  1939??Dixon????????????????, ???????? <%?=?Q?!
  (1) ???????????????, ???????????????? ???????
  (2) ????????????, ???????????????????? ??=|??mj
???????????????? Purpose of Preoperative RT ?d?(V?s?
1. ??????г? (Unresectable) ??????г? ǔ?Bbj!??;
  (Margional Resectable)?????г??? ?O????U
2. ??????????????Curative???????? .???!8?Mb
  ?????Conservative???????? ???c?k??
3. ?????????????в?????????????? ??$d;?M?m
??????????? Advantage of Preoperative RT ??AZ???
1. ??λ?? ?P??? 2. ????????????????? ?? E??
3. ?????????????????Ч f??{??A??
4. ??????????????????? ?_?????X?
???????????? High-Dose Preoperative RT ????a???
1. ????????? ?o?? xf
(1)?????????????????????г? (B3/C3??? g?Q??6?
(2) Downstaging: ??????С????????????? ??p????}e
2. ?????????????? wS??????
(1)??????40-45Gy??1.8Gy/F??5F/W ????)f?
(2)??????????????????????????? D?c?X????
3. ??????????????3-4??????????? ?n???k??
(1)????3-4?????????????С ??調?
(2)????3-4?????????????? L??C5;?
4. ??? ?? ?<??
(1)????????????????????? ?v.?Q?[?
(2)?????????????????? j?l2I1???
????г??????????? Marginal Resection `If?0??
      ??????г??? (????5-6cm)?? ?=??5ky?]
   ?????????, ???????46Gy??? d?m?y?
   ??Boost 360cGy ??* 4? `
   1. ?????????CR??? 10% ?a#?????
   2. 4?????? 75% ???hF?j?
?TI%?M?`
???????????? Pow-Dose Preoperative RT 2?r???s?F
1.????????? ????(??`?
(1) ??????????????????????? ?q?M>?B?s
(2) ?????С????????????г????? ???wEE??
(3) ????????????????? ;?b?z?Qc
(4) ???????????????? ?qu!;R!*??
2.?????????????? ??! ?j??
  10-20Gy/1-3??????????? ?p????d
3.???????????????????? !??^u>

M
?????????????? ??L Postoperative Radiotherapy ?C,???
for Rectal Cancer q'`???
??????????????? The Purpose of Postoperative RT m??V??6WF
1.???????????? ?h$F?V?
  (1)?????????????????????? ?T???bF
  (2)???????????????????? ??????z%
  (3)???????????????????? ;!???iZ8
  (4)????????? S??^??m?w?
2.????????????? ?????Xt
  (1)??????????? ?t?C'o94?
  (2)????????????????? '.0b??z??
  (3)??B2??T3?????? ?,6?????
  (4)NIH??????????????????? ??????l
??????????Ч Response of Postoperative RT e~x ???S+
1. ???????????????35-50%???? ?SC?   ??10-20% _?i Cd??
2. ???????? 3. ??????????????????, ??????? ?K??R?r
  ???B3????????????? (???????
???????????????(MGH) Postoperative RT & Local Recurrence ???6?z%?
????       ????????    ??????? ???????
   B2          25             0 ?V?C_?
   B3          58             0 *?Tc?Y????
   C1          43             7 ?z?????c
   C2          59             9 ?z?h??
   C3          100          31 L?X?z?I??
??λ????????? Localization & Radiation Dose ??M?Jf??
1.??λ?????? s??Q???k
(1) ?????????????, ????? ???F6?
(2) ??????λ?θ??????????? ????????
2.??λ?????? ??????$L
(1) ????λ, ???????, ???????? ??D??w??
   ?????·????? ?,??n??qS
(2) ??????CT??λ, ????????????????? ?i????
(3) ????????????? ?????e???
(4) ???????????????????????????? t???u?YeC
   ???????AP

A/RL:LL= 65:35??70:30 r?.?`8S??
(5) ???? 30-450 Ш??? ??v?{???
3.????: 1.8Gy/??; 5??/??,???????46-50Gy?? ??q??l???
   ???? Boost ?? 50-55Gy ??@q8??C
-???\r
      ???????????????          ??????????????????????????????? ;?-?e VT??
1. AP-PA Fields?? ????????
(1)??磺?????1.5cm ?9??u u
(2)???: ?? ??AR????:?????? ???r`???
??APR????:?п??·? f????????
(3)???:???????2cm C*T??P?wL?
2. Lateral fields ?????y?
(1)???:??β???????1.5-2cm %??pS?i
(2)???:???????(????????LN) L??w4>?ON?
????????????? Intracavitary RT for Rectal Ca ????Q??
1??????: ????????137Cs??192Ir????? _H"?W$?Y-=
?????????????????Χ???????? ??Y1l>?
2????? 0?f7?l&?
  ??1????????????? ???#z:??
  ??2????λ?? ?!?T|?C?
  ??3??????????????????? ?r???N??$
3????? I???n???
  ??1??????????????????????? j??h?dh?
  ??2???????????????????? M??I?0 ?
??????????з??? Intraoperative RT for Rectal Ca ???42???
1. ????: ???з???????????????????????? ??=H??
  ????????????????д????????????? \m?&???
2. ??? T7???.V?X
  ??1????λ?? ???p??"??
  ??2???????????, ?????Ч????????? ?????pP
  ??3??????????????????????????С {v?f ??I8
  ??4????????????????????? U??k?Nu4??
3. ???? {??罚UL?
  ??1???????????????Ч?????? ???W?dR?
  ??2??????????????????? ?xg??(;;ip
(3) ??????????????? ?P??O???
???嶨?????-?? Stereotactic Radiotherapy-I ??-?? 1???????

Indications) e!???)y
  ??1???????г????Unresectable?? ?s?q??MM?
  ??2?????????????????Inoperable?? E??lcz??_?
2????λ

Localizations) L???????
  ??1????????????????????????? ?| E_?z
  ??2??????λ?????????? Q,Eq ??=??
  ??3??????CT??裬??????????????TPS ?#?|?H?@?
3??????????

Target Delineations) ~?@?#??
  ??1??????????????????40-50Gy??SRT Boost ]?????|?
  ??2?????????????????????????????? ??eO`?i
  ??3??PTV= GTV+15-20mm xZ???Yc???
???嶨?????-II Stereotactic Radiotherapy-II K?PXIN2*B
  4.????????????似?? ??r*,%???
  ??1????5???ǹ???????? ???{'??;??
  ??2??3Gy15-18??/qd??5Gy9-10??/qod ?EI?? & ?
  ??3??????????????λ??????? ????B)]
   ???? ?\.?D???
   ???? ?N?????
   ???????????????? ??????i
   ?????????????????? ?o\??P???b
  ??4??????????????????5-Fu+CF ?????? oF?K!?Y?
6>?Hl?n???
?????????????? ?M-}?fu?
Management of Combined Modalities for Rectal Ca A???????
?????????????????? Postoperative Combined Modalities ?x?^????
1. 1989??NCCTG????, 5-Fu+CF??????????? ??i?^?GQ?
  ??????????????? ??\??D2??J
2. 1990??NCCTG??SWOG???????5-Fu+CF H??L1>?
  ????????????????????????????? ?P&?^i??M
3. 1990?? NIH ??????????????/????????? ?.???
  ??????????? ,?n?pD??
4. 1995??NCCTG??㆔?????????5-Fu+CF??? ?? ?cVW1?
  ?????????????????41%??7???????? ?kB"E?* ?
  46%????60% ??rFE??~
5. ????CF????5-Fu?δ????????????????Ч ??1??wep
????????????????(NCCTG) Treatment Modalities & Failures(%) W.?O????;
   ??????& ?????? ???? ????? ?????? O?@????
   ????λ y??#?Yg???
   ???????    21       19    18       6 ????f?V
   ???????    31       19    28       22 qo=7?
   ??????       3          9       2       4 ?{_lZ???
   ????????    55       46    48       33 ??-????r
???@?P?l
o?W?6??1?
???????????????? Treatment Modalities & Failures {W???_
????????????????????????????? y??1??O
????????????????????????? O?]?9F
?????????? ??V9d?_??
1.????????????????????11% ?Tv?y???
2.??????????????????20% W?????/KI
3.??????????????????24% j?It:??~o?
4 ???????????????27% ?X?~D???
3????{?
??r??r?
????????????????-I Re-radiation for Recurrence o{?V?e?8o
1.????? U??(????i
??1????????η???δ????????跽????? Hh>j}m@?
   ??????? ?Q???u1?
??2??????????嶨????????????????? ??Dм??)\
??3??????ò????????????? 7??)p&??
??4??????? PTV??GTV+1-2cm???? ??x ?MC?
2.????????????? VK??y??z>3
??1??1.2Gy???6С? ??Bid???????30-35Gy 2?s`cn???
??2??1.8-2Gy???????30-35Gy,Boost 40-45Gy R????m(?m
????????????????-II Re-radiation for Recurrence ??#j???
3.????????????????? @?s????H
??1??????????????У? ?S?au?TWd?
????????????? v}??mM ????????к??????? ??)7ˊ?
??????? ????????? ????]?)
??2???????? ?YjP???
??????????? ???????? ?v_??? G6
?????       ??????????? ??Y}???
??С?????????? ???_[?
?????s?
?????????????? Complications & Preventions 6[d???YH?
1. ??????????? 0%??G?x??
??1???????????θ?????? ??#9j](I?
??2????????С??????????????????????? ????` ??
??3????????????? 9???V9Ic??
??4?????????? #???m `Q
2. ???????????? ??Eo?]??
??1??????????    ??2?????Boost ??f??m??
??3???????????? ??4????????? 8??e????G
??5???????????    ??6??????????? ??Fz?G%3?
??7???????????????????????? (?!?;???
??? AE
?????????????????? Radiation-Induced Early Complication ?ey5 ?qΑE
1. ????????????????? ??`???J>?
??1??1%???????????????? [??^???
??2????????????? ???0"漂?
??3???????ɡ???????????? ???d?????
??4????С??????????? $^ ?S??
2. ???????????????????? v?~??N?I
??1???????????? swDruхi?
??2???????????1-2??/?? ??c1???
   ???????????ù??????? ??gNb??
   ???ɡ?????????????? |??$b???
?p??JST?
?????????????????? Radiation-Induced Late Complication %????F J
?????????????????з???????????С???? a}?????{
С???????????С?????? (SBO), SBO???? ???#]???
????????????????й? ??U???Q?
1. ??????????С?????????й?? Ie{?w??j?
  ????????λ??L2??????????30%; ??? ?戢??s(?
  ?????? 21%; 3???4???????????9%; ??????
  ???????????似????????3% d???X_??
2. ??????????? SBO????????15%;δ???? ?????qV ?
  ???????3% ! _ ??Y[Q
3. SBO????????????? 8???? (0-85Mons) ?G?????z#?
U-Zy?{~β3
?????????? Prevention of Complications w???ut1?
1. ???ε?????似?? D?????P
2. ???Boost ?kP6Ζ??a?
3. ?????????? TQ?6??
4. ??????? yo ??u?V
5. ?????????? c.????S
6. ?????????????? 7??????
7. ????????? N?j??W??~W
8. ???????????????? ???????
??a'jGbIC
  ?????????? Chemotherapy for Rectal Ca ??pCQF?F
1. ????????????????????????????????? ???#?=?
??1??T3??? II???B2????? ?+_???^x?
??2??????????????? ??!??k???
??3???????????????????????? ?u???N
??4?????????? ? 6?C?
??5??DNA???????壬SPF??10%????CEA?????? 3lS2?J?H?
2. ????????? (???t??U`
??1?????????: 5-Fu500mg/m2 ??3-5???????????? 3T+????
   5 -Fu 225mg/m2 Protracted iv (Piv) ??????????? Es#?Rk?
??2?????????????: ???????????? ??x??~O?
3. ???????????? ]?????
??1?? 5-Fu/DDP/CF?????? 5-Fu/CF???? ;(o?????8
??2?? 5 -Fu50-750mg/m2 d1-5 ?]???{Z??
   VCR 1mg/ m2 d1-8?5????? ????`m?r
   CCNU 100 1mg/ m2?6????? 0??U?
???????????????? Neoadjuvant or Induction Therapy ???????;?
1.???

Advantage) @$0G???
??1?????????????????? ??_T ??
??2?????????????????? ????f??
??3??????????????????г? cR???f'?fP
??4?????籣???????????? ??U????P
??5????????????????????? 6?????q?
2.???

Disadvantage) U?;@Hi?x
??1??????????????г?????? ?l#bD?Y??
??2?????????????????????? =?A??X2w?
3.????л???2??????,?????? ??M+sS??
??????????????-I Sequencing of Chemotherapy & RT ;:???}??
1.?????????????????Σ???? ??Kuys??
(1) ?????????????? ?H2_?l?
(2) ??????????????????????? 3??K?Z?
(3) ???????????????????6????;?? &????b
????????????????16?????? ???\_?b?
(4) ???????????????????????6?????? gw??On????
2.????????????????Σ????    ?lt;Br?m??M
(1) ???????????????????? $?????
(2) ????????????????????????? GJ1B??C
(3) ???????????????????? '????k
(4) ?????????????а???? >??&d9{?
?T,5?m]T&
??[ ?M??
3.???????Ρ??????(Sandwich): FM???
??1?????????????л???2???? C?? u_???
??2?????1-2??????з??? ??.??5???^
??3?????????????1-2?????4??????? T???j;Ddh
4.??????? (Concurrent Chemoradiation): ]?d Osku/
(1) ????????: p[?t?1?p_
  ?????????? ???=?M$??
??????????? w???[7?}
???????? u{8?5b??
(2) ?????? ???]i??{
????????????????????? \??[4?p
????????????????? ]?DI???
?????????????? 5??2?a[?
  ??????i
??????????? C_?vnH?cQ
??????????о?????

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