食管癌个体化放射治疗-选择性淋巴结区照射的价值技巧.ppt

国内食管癌照射范围 ? 局部照射野 传统野 钡片肿瘤部位、病变长度和食管轴向 常规野 钡片所见加CT扫描 根据肿瘤实际范围 ? 三维立体适形照射野(不规则野) ? 精确放疗调强照射野(多子野叠加，同期推量预防和治疗) ? 图像引导生物信息调强(靶区内剂量的不均匀化) 照射野的具体范围与勾画 照射野的具体范围与结果 照射野的具体范围与勾画 低剂量组 肿瘤上下外放5cm、前后左右外放2cm照射 50.4 Gy （颈段癌包锁骨上区，电子线补量 下段包腹腔干淋巴结区） 高剂量组 前程同上达50.4Gy 后程缩野后为肿瘤上下各外放2cm 前后左右外放仍为2cm 总剂量64.8Gy 照射野的具体范围与结果 ? 食管壁内“多源性”病灶 Ｍiller 1/7的病例在主病灶2cm外可见继发病灶 Pradoura 间隔≥5cm多源性癌达16% Reboud 多源性食管病变达35% ? 淋巴结转移 “跳跃式”转移 食管癌生物学特点 淋巴结“跳跃式”转移 放疗靶区 放疗靶区截面图 所有病人中位随访17个月(3-62) 存活者 中位随访41个月(9-62) 放化疗后获CR 62例占59% 其中40例生存 20例复发转移 3年总生存率43% 失败模式 局部失败即原发瘤复发 累及淋巴结复发即原有转移的 远处失败即除原发瘤和区域LNM外 选择淋巴结复发即在 ENI野内的 Radiotherapy and Oncology. 2009,92: 266–269 Elective nodal irradiation (ENI) in definitive chemoradiotherapy (CRT) for squamous cell carcinoma of the thoracic esophagus Elective nodal irradiation (ENI) in definitive chemoradiotherapy (CRT) for squamous cell carcinoma of the thoracic esophagus In CRT for esophageal SCC ENI is effective for preventing regional nodal failure Further evaluation of whether ENI leads to an improved overall survival is needed 结 论 Radiotherapy and Oncology. 2009,92: 266–269 Elective lymph node irradiation late course accelerated hyper-fractionated radiotherapy plus concurrent cisplatin- based chemotherapy for esophageal squamous cell carcinoma: a phase II study Dongqing Wang, Jiali Yang, Jingyu Zhu, Baosheng Li, Limin Zhai， Mingping Sun, Heyi Gong, Tao Zhou, Yumei Wei, Wei Huang, Zhongtang Wang, Hongsheng Li and Zicheng Zhang Department of Radiation Oncology, Shandong Cancer Hospital, Shandong Academy of Medical Sciences, Jinan, China Radiation Oncology 2013, 8:108 Elective lymph node irradiation late course accelerated hyper-fractionated radiotherapy plus concurrent cisplatin based chemothe