心脑血管药理、食管癌放疗增敏C-ShanghaiWDVolumeeffectsinRTI答案.ppt

* * * ED5-15;肺炎 The volume effect in radiotherapy 放疗中的容积效应 I Wolfgang D?rr Dresden Technische Universit?t Dresden Medizinische Fakult?t Carl Gustav Carus radiation sensitivity放射敏感性 Recovery修复 Redistribution再分布 Repopulation再增殖 Reoxygenation再充氧 radiation effects - 5 Rs of radiotherapy Volume irradiated volume照射容积 6 放射效应-放疗的6个R Volume Lyman model (power law, 4 parameters)Lyman模型（指数定律，4参数） Kutcher-Burman (KB-)model Tissue architecture models Serial architecture/critical element Parallel architecture/critical volume NTCP models NTCP 模型 Growing bone model (Krasin) Tissue architecture 组织结构 parallel organisation 并联组织 功能亚单位的概念 concept of functional subunits (FSUs) ? functional damage, if a critical number of FSU’s is inactivated (threshold volume)阈容积 risk of complication ~ total dose distribution rather than on “hot spots” ? Inactivation of one subunit can lead to loss of organ function (binary response)全或无 risk of complication strongly influenced by “hot spots” serial organisation 串联组织 Volume Lung肺 Liver肝 Kidney肾 spinal Cord脊髓 esopha- gus食道 Intestine小肠 Lung肺 Volume structurally defined subunits: alveoli 结构定义亚单位：肺泡 Endpoints: structure vs. function 研究终点：结构VS功能 Herrmann et al. 1997 __ whole right lung右全肺 ..... ? right lung右半肺 pig lung猪肺 Volume structural changes ~~ volume 结构改变与容积无关 functional changes ~~ volume 功能改变与容积有关 modified from Poulson et al., IJRB 2000 dog lung 狗肺 Volume % severe pneumonitis Dose-volume histogram剂量-容积 柱形图 Mean Lung Dose肺平均剂量 23 Gy V20 44% V30 30% EUD 等效均一剂量 homogenous dose distribution for SF (SF dependence !) Lung肺 Volume Lung放射性肺炎与容积剂量 Volume Mehta et al. IJROBP 63, 2005, 5-24 Lung Volume … the ideal (DVH) metric … has not yet been identified. 尚未发现完美的DVH度量 Vtot = total lung volume (both lungs)两肺容积 Vdose = volume exposed to ? x Gy受大于某剂量照射容积百分比 V25 : Vtot 50% == pneumonitis dose