鼻咽癌小靶区IMRT更新报道.pdf

鼻咽癌小靶区IMRT更新报道 福建省肿瘤医院林少俊 主要内容 n  鼻咽癌治疗进展 n  小靶区IMRT更新报道 鼻咽癌治疗进展 3 国内鼻咽癌IMRT疗效 4 目前鼻咽癌放疗存在的争议 M.K.M.Kam et al,Oral Oncology,2013 . 5 M.K.M.Kam et al,Oral Oncology,2013 . Atereotactic Boost •  Stanford and Taiwan groups: cyber-knife •  Dose: 7-15Gy/F ， 12 －15Gy/3-5F •  Stanford ：temporal lobe necrosis overall 12% IMRT 11% Reduced Dose: 8Gy/F,12Gy/3F, TL Dmax 55-60Gy No serious neurological complications 7 M.K.M.Kam et al,Oral Oncology,2013 . Atereotactic Boost •  Temporal Lobe Necrosis : •  Kam: 63 cases, GTV 66Gy, Boost 8Gy/4F, TLN 3% •  Lee: 3DCRT, 70Gy/35F, 5 yrs TLN 8.3% Summary: The sequential boost technique may have an advantage in this regard by providing a replanning opportunity to accommodate for setup and volumetic changes uncertainties. 8 M.K.M.Kam et al,Oral Oncology,2013 . Simultaneous integrated Boost in IMRT •  Lauve ( NNPCHNC): GTV 70.8Gy/30F, 2.36Gy/F •  SIB in IMRT in NPC: 64.8-76Gy/27-35F, 2.12-2.4Gy/F 2-5 yrs LC-LRC: 88-96% Problems: small sample size and short follow-up •  Bakst: 70.2Gy/30F, 2.34Gy/F TLN: 12% •  Kwong: 76 Gy/35F, 2.17Gy/F, Hearing impairment 42%, TLN 4%, •  Xiao: 68Gy/30F, 2.36Gy/F, TLN 13.5%, CNP 3.7%, Brainstem injury 1.2% 9 M.K.M.Kam et al,Oral Oncology,2013 . Simultaneous integrated Boost in IMRT Conclusion •  GTV 2.12Gy may be hazardous