前列腺癌靶区勾画教材.ppt

前列腺癌靶区勾画 中国医科院肿瘤医院 前列腺癌发病率和死亡率 对于局限期前列腺癌，根治性前列腺切除与放射治疗疗效相当 解 剖 前列腺癌的靶区包括范围 前列腺 精囊腺 盆腔淋巴引流区 前列腺及包膜受侵情况 CTV in Prostate Cancer Extracapsular Extension associated with PSA , GS, and T stages 勾画前列腺CTV时，幷不必刻意外扩很大边界 精囊腺受侵情况 SV involvement SV+ associated with PSA , GS, and T stages SV involvement When treating the SV for prostate cancer, only the proximal 2.0 –2.5 cm be included within the CTV SV invasion 前列腺癌淋巴引流 18 patients with pathologically proven lymph node metastases 69 Prostate Cancer Nodal Spread Step wise from pelvis to abdomen Nodal metastases more likely with: Increasing T stage Increasing PSA Increasing GS LNM%= 2/3(PSA) + (Gs – 6)x10 Partin’s Tables Prostate Cancer pelvic nodal irradiation External iliac lymph nodes Internal iliac lymph nodes Obturator group Perirectal LN Part of the common iliac nodes S1-3 pre-sacral lymph nodes Para Aortic (optional) MSKCC 前列腺癌放疗指南 Clinical Target Volume Risk stratification and treatment recommendation Simulation CT Scan: from bottom of SI joints to 1.5 cm below the level of ischial tuberosities. Maximal slice thickness of 5 mm Patient set-up: be treated in the supine position. Immobilization: employ immobilization system that keeps random and systematic errors to acceptable limits Bladder：size should not vary between simulation and treatments. (e.g. bladder to be emptied 1 h prior to sim/treatment, patient to drink 500cc water soon thereafter) Rectum: Instruct patients to evacuate their bowels prior to planning and treatment. Contouring: Prostate apex: situated above the urogenital diaphragm. 5mm above the bulbospongiosus Contour base of SV only, if no clinical SV involvement. Rectal wall: from 1 cm above to 1 cm below the PTV. Consider contouring the whole length of the rectum. Contour external bladder wall from its apex to the dome. femoral heads: from the inferior margin of PTV to the superior lip of acetabulum. 靶区勾画规定： CTV = GTV PTV = CTV + 1 cm margin，向后方向仅外放0.5 cm以减少直肠照射。 缩