特殊情况内膜癌的放疗__培训课件.pptx

特殊情况内膜癌的放疗2016-11-13因内科疾病无法手术的内膜癌高龄患者比率不断增加，65岁以上患者达18.2%尽管手术技术（阴式手术、腔镜手术等）、麻醉和围手术期管理水平不断提高约3-9%患者因内科合并症或高龄无法完成手术体外放疗±近距离治疗±内分泌治疗的模式可有明显获益Medically inoperable stage I adenocarcinoma of the endometrium treated with radiotherapy loneI期内膜癌的5年无进展生存率G1 94%G2 92%G3 78% IJROBP 1987;13:483-8Systemic review: Radiation therapy alone in medical non-operable endometrial carcinoma纳入25项研究2694例单纯放疗的患者1976-2013年分期I-IV治疗方式比例体外+近距离1278(47.4%)单纯近距离放疗1383 (51.3%)单纯体外放疗33 (1.2%)European Journal of Cancer 65 (2016) 172-81Systemic review: Radiation therapy alone in medical non-operable endometrial carcinoma副反应治疗效果指标95%CI5年疾病特异生存率DSS78.5% 74.5%-82.5%5年局控率LC79.9%75.7%-84.1%5年总生存率OS53.2% 49.3%-57.1%治疗方式≥3级副反应EBRT+BT3.7%BT alone2.8%EBRT alone1.2% 需外科干预1.6% (range: 0-5%)European Journal of Cancer 65 (2016) 172-81Image-based three-dimensional conformal brachytherapy for medically inoperable endometrial carcinomaI期内膜癌的精确放疗共38例患者，2007-2013年MRI/CT based HDR-BT±EBRTCTV包括宫体、宫颈、阴道1-2cm剂量BT aloneBT+EBRT平均CTV D90 EQD248.6 ±5.672.4±6.0 Gy, 平均GTVD90 EQD2172.3±59.6 138.0±64.6 Gy.Brachytherapy 13 (2014) 542-547Image-based three-dimensional conformal brachytherapy for medically inoperable endometrial carcinoma中位随访15个月2年局控率 90.6%2年总生存率 94.4% 未发生≥2级远期副反应Brachytherapy 13 (2014) 542-547Consensus statement for brachytherapy for the treatment of medically inoperable endometrial cancerAmerican Brachytherapy Society（ABS）,Brachytherapy 14 (2015) 587-599Consensus statement for brachytherapy for the treatment of medically inoperable endometrial cancer结构影像勾画定义GTVT2加权MRI可见病灶CTVMRI/CT全部宫体、宫颈、上1-2cm阴道OARMRI/CT乙状结肠、直肠、膀胱、肠管、未累及的下1/3阴道American Brachytherapy Society（ABS）,Brachytherapy 14 (2015) 587-599Consensus statement for brachytherapy for the treatment of medically inoperable endometrial cancer建议 I期 内膜癌：限量American Brachytherapy Society（ABS）,Brachytherapy 14 (2015) 587-599单纯近距离放疗可用于I期无淋巴结转移且MRI未深肌层受侵的患者。无法行MRI的情况下，建议体外联合腔内放疗。CTV D90 近距离治疗≥48Gy 联合放疗≥65GyGTV ≥80Gy乙状结肠&直肠D2cc70-75Gy膀胱D2cc80-100Gy肠管D2cc65GyConsensus stateme