妇癌治疗.pptVIP

婦癌治療 陳怡仁 醫師 袁九重 教授 台北榮民總醫院 婦產部 國立陽明大學師 Cervical cancer Introduction Prevention Diagnosis (Proteomic, DNA microarray) Radiotherapy Surgery Chemotherapy Novel Approaches: Immunotherapy (vaccine) Gene therapy,Target therapy Reference Te Linde’s, Operative Gynecology 8th edition. John A. Rock. Lippinocott Williams Wilkins, Philadelphia, USA1999 子宮頸癌, 初版. 吳香達, 茂昌圖書公司, 台北市, 2002. Clinical Gynecologic Oncology 6th edition. Disaia PJ and Creasman WT. Mosby, Inc. St. Louis. 2002. Cervical Cancer Mortality 發生率:16.14/十萬 (4592 cases in 1996;1732 cases in 2000) 1982,癌症死亡率12.9% 十大死因首位 2000,癌症死亡率23.2% 十大死因首位 婦女癌症死亡的第三或第四位, 女性生殖器官第一或第二位. Pap Smear George Nicholas Papnicolaou (1943) Sensitivity:30-87% Pap smear : in European and USA,15-20 years old, in Taiwan 30 years old (1995). 篩檢率: Taiwan 31%, European 50-90%. Natural History of Cervix Cancer Other Screen Method ThinPrep Pap: sensitivity80% PapSure: improve sensitivity in premenopausal women. HPV Improved Early Detection of Cervical Intraepithelial Lesions in Premenopausal Women by Combination of Pap Smear and Speculoscopy (PapSure Examination) (Twu et al. 2003) Results Results in the premenopausal group Stage Clinical staging 1961 (International Federation of Gynecology and Obstetrics, FIGO): stage 0-IV 1976:Ia,Ib, IIa, IIb….. 1994:Ia1, Ia2, Ib1, Ib2 American joint commission on cancer: TNM system Radiotherpay 侖琴（Rentgen）於1895年發現Ｘ光。 居禮（Curie）夫婦在1898年提煉出鐳。 鐳囊被應用於子宮頸癌的治療，至今也已一百餘年了。 Teletherapy 早期Ｘ光機之能量低，以淺Ｘ光（superficial x-ray）言，僅能達到數公分，而且最大劑量是在皮膚表面。故此容易造成皮膚反應及骨骼（尤其是股骨頸）之壞死。 以往常用旋轉（rotational）治療技術，以分散正常組織劑量，減少副作用。但是腫瘤劑量仍嫌不足。 至1950 年代，鈷六十（Cobalt-60）設備，及1960年代，高能直線加速器之Ｘ光問世，其深度劑量比，大為改善。 今日以直線加速器（linear accelerator）配合模擬定位機 Brachytherapy Randon-222 (24 hr) Cesium-137 Iridium-192: 1970 (10 min) Pre-loading (1930, realized the danger of RT) Manual after loading (1960) Remote after loading (recently, machine) Combination of teletherapy and brachytherapy 3D conformal radiotherapy Just Do It ! Surgery Surgery H