恶性胶质瘤靶区勾2016 课件.pptVIP

大脑镰（5 mm）（ 海绵窦/视交叉（ 0 mm） 图1.左额叶胶质母细胞瘤（依次在CT / CE T1/FLAIR层面上勾画），GTV（紫色）：术腔，CTV（蓝色）：GTV + 2厘米并在解剖屏障处修改；大脑镰（5 mm）（CT层面10–40，T1层面2-13）、海绵窦/视交叉（0 mm）（CT层面40–41，T1层面 13-14，FLAIR层面 13–14）、骨（0 mm）（所有层面和系列）。PTV（红色）：CTV+ 3mm。危及器官：脑干（浅绿色）、视交叉（天蓝色）、左视神经（灰绿色），右侧视神经（黄色），左眼（粉红色），右眼（红），左晶体（蓝），右晶体（暗橙色），右侧海马（橙色），左耳蜗（棕色） 阿尔茨海默症防治相关知识埃及的金字塔有建造方法动画艾司洛尔在神经外科重症中的应用二级二班防溺水等安全教育 2016ESTRO-ACROP指南：恶性胶质瘤靶区勾画 蔡文杰 福建医科大学附属泉州第一医院 放疗科 2016-03 Radiotherapy has been the mainstay of treatment for glioma since the 1980’s when it was established that postoperative treatment improves survival 全脑　3ＤＣＲＴ　ＩＭＲＴ　ＶＭＡＴ The experience with individual case review of the EORTC/NCIC trial showed that more rigorous de?nition of volumes, OARs and techniques is required This guideline article aims to provide an overview of existing delineation strategies, their therapeutic value to date and recurrence pattern analyses The ultimate aim is to de?ne the optimal　strategy for target delineation in GBM. 背景资料 Laperriere N, Zuraw L, Cairncross G. Radiotherapy for newly diagnosed malignant glioma in adults: a systematic review. Radiother Oncol 2002;64:259–73. Imaging techniques影像学技术 Target delineation should be performed using contrast　enhanced T1 + T2/FLAIR sequences Caution should however be　advocated when using the latter for planning purposes 慎重采用T2/FLAIR！ T2/FLAIR 信号受肿瘤容积效应与术后水肿影响明显 完全采用T2/FLAIR勾画CTV而未缩野推量，常导致脑受量超过正常组织受量限制 功能影像（ill-de?ned） perfusion-and diffusion-weighted MRI, with or without spectroscopy（ prospective trials and not in routine ） PET imaging (MET or FET)---- may be useful in　the context of re-irradiation because of the extensive post-therapeutic imaging changes which might be differentiated more　accurately by PET. This role has not been fully validated FETPET imaging Patient case showing peripheral contrast agent enhancement around the resection cavity in the postoperative MRI with additionalFET-PET/CT metabolically active parafalcial tumor residues Modification of the MRI-based clinical tar