喉癌放射治疗课件（可编辑）.docVIP

喉癌放射治疗课件 ver approximately 95 of the dose through opposed lateral wedged fields weighted to the side of the lesion the remaining dose is delivered by an anterior field shifted 05 cm toward the side of the lesion The tumor dose is usually specified at the 95 normalized isodose line 放射治疗技术四单野照射技术 T34声门癌放疗技术 Irradiation of T3 and T4 lesions requires larger portals which include the jugulodigastric and middle jugular lymph nodes The inferior jugular lymph nodes are included in a separate low-neck portal Patients are treated with continuous-course twice-daily radiation therapy at 12 Gy per fraction to total doses of 744 to 768 Gy The portals are reduced after 456 Gy in 38 fractions the reduced portals cover only the primary lesion 影响早期声门癌放疗效果的预后因素 自身因素 KS评分 HB水平 肿瘤因素 病理组织学分级 前联合和双侧声带受侵 肿瘤体积 肿瘤消失剂量 治疗因素 能量 照射野大小 时间剂量因子分次剂量疗程的长短 弥补措施 自身因素 KS评分 Franchin KS 80 89 80 74 SS HB测定 Fein HB 13gdl 95 ≤ 13gdl 66 SS Warde疗前HB测定预测复发 肿瘤因素一 病理分级 多数资料显示对预后无明显影响 少数报道分化差的癌的效果差 Johansen等T1声门癌RT后局部复发率 高分化 15 中分化 22 低分化 48 P 005 肿瘤因素二 前联合和双侧声带受侵 目前有争议 Cellai等报道局部复发率 T1a 11 T1b 24 P 0005 其它如Stevenson Reddy等无明显差异 肿瘤因素三 病变大小 Dickens报道139例T12 病变的大小 ＜5mm 5-15mm ＞15mm 局部复发率 0 4 26 Ruddy 报道114例T1 局限性病变即病变局限于一侧或两侧声带前 13的浅表性病变 广泛性病变较大的外生性和或浸润性病变 已侵及两侧声带的13以上 局部控制率局限性病变组 91