肺癌个体化放疗指南选编.ppt

Tailored RT for Lung Cancer; 报告大纲Outline ; 靶区勾画-个体化 ;术后靶区勾画较大差异;IIIA术后放疗靶区的勾画;群体化: 2DRT 3DCRT IMRT 提高靶区的照射剂量和适形指数 降低正常组织及敏感器官的剂量 个体化 :IGRT和ART(4DCT和CBCT) 减少摆位误差和解剖结构影响(分次治疗间) 改善器官运动对剂量学的影响(分次治疗中);;;早期非小细胞肺癌 区域淋巴结设野原则;;;;  照射剂量 -个体化 ;放疗剂量困惑 High or low Dose？;肺癌照射剂量与局控率成正比 Spring et. al Michigan;RTOG 0617:临床设计(74 Vs 60Gy);66.9%;42.4%;Conclusions: 结论;;;SBRT; 射线施照 -个体化;AccuRay CyberKnife;影像引导立体放疗 Image Guidance of SBRT;影像引导在立体放疗地位 Imaging in Radiation Oncology ; 定位机器精度 器官运动影响 病人位置变化 肿瘤位置变化 正常组织变化 靶区勾画错误 摆位导致误差 工作人员问题; CBCT;图像校正方式Image-Guidance;;CBCT;计划CT ; CBCT图像拼接技术;;;主动呼吸控制辅助下的RapidArc;主动呼吸控制辅助下的RapidArc;  ;Early Stage NSCLC Management;Current Status of SBRT Clinical Use;手术切除主要优点;Comparative Results of Surgical SBRT Studies for Early Stage NSCLC in USA;SRS/SRT: Stereotactic Radiosurgery/therapy;30-40 treatments (6-8wks);Elements of SBRT with 6 Hs;SBRT优势及研究证据SBRT for Early Stage NSCLC; Compact Dose Deposition OAR;So..All of the lung Ca for the trial must be in this peripheral zone!;Phase I Dose Response for Local Control;Current RTOG SBRT Studies;Ablative Dose: BED＞100Gy;Optimal SBRT Regimen?;SBRT vs 3DCRT vs Heavy Ion RT ;  肺癌个体化 放疗思考 ;;;;肺癌异质性对放疗的挑战; ;影响个体化放疗差异的因素;;;;; A Multicenter, Randomized, Open-label, Phase II Trial of Erlotinib  vs EP with Concurrent RT in Unresectable Stage III NSCLC with  Activating Mutation of EGFR ; The introduction of radionuclide lung perfusion images into RT of lung ca could significantly decrease RT dose of the functional lung;FLT PET/CT与肿瘤微血管密度相关;;FDG PET-CT放疗前后动态变化预测疗效;FDG PET SUVmax是对早期NSCLC SBRT后局部复发的强预测因子; SUV治疗前=9.2时，预测复发 和转移的灵敏度、特异度和 准确率分别为77 ％、82％ 和79％ SUV治疗后＝4.0时，预测复发 和转移的灵敏度、特异度和 准确率分别为77％、 100％ 和87％ ;肺癌个体化放疗策略制定;分子影像引导个体化放疗 ;;Thanks for Your Kind Attention!