头颈部肿瘤放疗.ppt

术后放疗：高危因素 (Lundahl,1998) —————————————————————————————— 分组 单纯手术 术后放疗 —————————————————————————————— 例数 284 95 ?无复发生存率 2年无病生存率 40% 78.2% 5年无病生存率 38% 73.6% 肿瘤相关生存率 2年生存率 60% 69.2% 5年生存率 38% 63.7% 总生存率 2年生存率 42% 60.0% 5年生存率 22% 39.4% —————————————————————————————— 高危因素：LN受累；ECE；血管、淋巴管、软组织或颈静脉受累；周围神经受累 * Detected in a number of tumors found in number of tumors, e.g. * Detected in a number of tumors found in number of tumors, e.g. * Detected in a number of tumors found in number of tumors, e.g. * Detected in a number of tumors found in number of tumors, e.g. * Detected in a number of tumors found in number of tumors, e.g. * Detected in a number of tumors found in number of tumors, e.g. * Detected in a number of tumors found in number of tumors, e.g. * Detected in a number of tumors found in number of tumors, e.g. * Detected in a number of tumors found in number of tumors, e.g. * Detected in a number of tumors found in number of tumors, e.g. Detected in a number of tumors found in number of tumors, e.g. * Detected in a number of tumors found in number of tumors, e.g. * Detected in a number of tumors found in number of tumors, e.g. * Detected in a number of tumors found in number of tumors, e.g. * Detected in a number of tumors found in number of tumors, e.g. 高危因素组推荐术后放疗剂量 (NCCN&EORTC) Radiotherapy dose: 60 Gy Peters, 1993: 63 Gy for ECE+, otherwise 57.6 Gy RTOG 9501: 60 Gy +/- 6 Gy boost (given in 13%) EORTC 22931: 66 Gy to high risk region, 54 Gy to large field Recommendations (NCCN v2.2008): Primary: >= 60 Gy in 2 Gy/fx Involved nodal stations: >= 60 Gy in 2 Gy/fx Uninvolved nodal stations: >= 50 Gy in 2 Gy/fx 靶区剂量制定 根据术后病理危险因素指导术后放疗 ——————————————————————————— 危险性 处理方式 ——————————————————————————— 低危（Stage I/II） 不做放疗 中危（切缘阴性，无ECE） 单纯放疗60Gy 高危 （切缘阳性和/或ECE ） 放疗60-66Gy同期顺铂化疗 ——————————————————————————— 靶区剂量制定 术后IMRT放疗剂量分次 —————————————————————————— 中危因素 高危因素 —————————————————————————— PTV1 60Gy（30f） 66Gy(30-3