头颈肿瘤的术后放疗胡超苏.ppt

* * * * RTOG 9501addresses a particularly important question, relevant to a large group of patients, as estimates from patterns of care studies suggest that approximately one third of all head and neck cancer patients receive surgery and radiation as their principal treatment. There are also potentially significant implications for medical oncology practice, since these are patients in whom the medical oncologist has not historically not been involved in treatment. The study logically builds on prior work within the RTOG regarding both the efficacy of the concurrent cisplatin-radiation regimen used, and the determination of poor risk selection criteria. The quoted study by Bauchaud et al. published in 1991 with a final report in 1996, which compared postoperative radiation alone versus radiation with the addition of weekly cisplatin in patients with extracaspsular spread of tumor in lymph nodes, is noteworthy in that it demonstrated a significant improvement in overall survival at 5 years of (36% vs. 13% at five years, p.01), with no increase in late complications. 术后放疗的指征 绝对指征： 淋巴结包膜外受侵，切缘镜下残存（R1） 超过1 个分区的淋巴结受累，淋巴结转移的绝对数≥2 个 转移的淋巴结直径超3 cm 周围神经受侵，临床分期（III/IVA、IVB），脉管内癌栓 根据影响局部控制和长期生存的因素，对术后病理检查的结果进行危险性分析 生物学预测指标暂仍不能作为术后放疗的依据 术后放疗的时机 术后2～4 周，最迟不超过6周 手术区域内纤维疤痕的形成造成放射敏感性降低 残存的肿瘤细胞出现加速再增殖，肿瘤负荷增加 理由 术后放疗的时机 总的治疗时间对术后放疗的影响 Ang KK, et al. Int J Radiat Oncol Biol Phys ,2001 ,51 :571－578. 术后放疗的时机 单因素分析显示： 总的治疗时间≤150天 vs ＞150天（口腔、口咽、下咽 及喉部肿瘤）对局部控制率的影响有明显差别，P＝0.015。 Muriela VP, et al. Radiotherapy and Oncology,60(2001),137-145. 术后放疗的时机 高危因素、非常规分割放疗（前3周常规分割，后两周改为每天2次，间隔4－6小时，分次剂量不变）：≤6周与＞6周手术间隔的疗效比较，没差异 Ang KK, et al. Int J Radiat Oncol Biol Phys ,2001 ,51 :571－578. 术后放疗的时机 高危因素、常规分割放疗： ≤6周与＞6周手术间隔的疗效比较，有差异 Ang KK, et al. Int J Radiat Oncol Biol Phys ,2001 ,51 :571－578. 术后放疗的时机 手术与放疗时间间隔≤50天 vs ＞50天（口腔、口咽、下咽及喉部肿瘤）的局部控制率，有差异。 Muriel