Dr.Liao心脑血管药理、食管癌放疗.pptVIP

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2017-12-08 发布于浙江
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Dr.Liao心脑血管药理、食管癌放疗.ppt

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Chemo-Radiotherapy - Improvement Strategies: Technology improvements (IMRT, IGRT, Proton) More effective chemotherapeutic agents or conjugates (or radioenhancers) Multimodality therapy Chemotherapy + Radiotherapy + Molecular Targeting Chemotherapy + Radiotherapy + Immunotherapy Chemotherapy + Radiotherapy + Protectors Thoracic Radiation Therapy Thoracic irradiation Esophageal cancer NSCLC SCLC Mesothelioma Major dose limiting toxicities: Pulmonary toxicities Esophageal toxicities Cardiac toxicities Treatment Related Toxicity Grade depends on scoring system (SWOG, RTOG, CTC) Patient factors: smoking, intrinsic sensitivity to intervention, co-morbidity, lung function Tumor factors: GTV, location Treatment factors: Chemotherapy: agents, schedule, intensity Radiation: dose, volume, fractionation, modality TRP and scoring systemsSWOG/CTC TRP and scoring systems-RTOG Tumor location and heart dose Marks et al. Mean heart dose higher for lower lobe tumors No association between mean heart dose and RT-associated dyspnea BUT: no higher incidence of TRP for lower lobe tumors in this dataset (Yu 2003) Heart dose may still be important Concurrent Chemotherapy and TRP Type of chemotherapy Intensity of chemotherapy Different combinations of chemotherapy Concurrent chemotherapy Concurrent chemotherapy Dose-volume parameters Point estimates in DVH space: Volume above threshold dose: V13, V20, V30 V5 Minimum dose to “hottest” % volume:D15, D25, D45 Overall parameters (whole DVH) Mean lung dose (MLD) Effective volume (Veff) MLD and TRP V5 and TRP Correlation of Dosimetric factors Reducing Toxicity Radiation technology 3D CRT vs IMRT Photon vs proton Understanding the biology of Toxicity Cytokine Cytoprotection Molecular target of TRT and development of targeted therapy Intensity Modulated Radiation for Lung Cancer 3D IMRT DVH consideration in thoracic Radiotherapy Dose constraint for lung V20 35% Mean Lung dose 20Gy V5 = 65% Low Dose RT and Lung toxicity Ran