肺癌个体化放疗指导建议讲义.ppt

Comparative Results of Surgical SBRT Studies for Early Stage NSCLC in USA Rx 5y OS% 5y LF % Stage I Surgery 53-83 4-17 Stage I* RT 15-24 76-85 Stage I SBRT 68-77 10-15 Stage II Surgery 30-50% Stage II* RT 10-20% Stage III RT/CTx 5-15% *medically inoperable SRS/SRT: Stereotactic Radiosurgery/therapy 30-40 treatments (6-8wks) 1-5 treatments (1-2 wks) “Swaths” of radiation Small beam apertures Weekly image guidance Daily image guidance No motion control Strict motion control Small “forgiving” daily dose Large “ablative” daily dose 2-4 beams Many beams or arcs Conventional RT SBRT Styles SBRT VS Conventional RT Elements of SBRT with 6 Hs High dose (ablative dose) per fraction prescription High level body immobilization repositioning High demand on motion control to minimize the PTV High conformal plan to maximize RT dose fall off High precision dose delivery with IGRT Technique High complicated technology to verify the precised RT SBRT Will not be for adjuvant or prophylactic SBRT优势及研究证据SBRT for Early Stage NSCLC 立体定向定义：用多源或多野或多线束在三维空间聚焦于体内某一靶区，使病灶受到持续性高剂量照射，而周围正常组织受到瞬时扫描低剂量照射，其三个必须具备的先决条件分别是： Hypof dose:45-60Gy/3-5fs; BED100; (取决于增殖与乏氧) Daily Verification QA: 3D or 4D/On-line KV or MV IGRT 误差权重：常规分割-2/60Gy=3.3%；立体定向-12/48Gy=25% Organ Motion Control: ABC/Gating/4D-CT/Planning/Delivery 较小手术更能提高局控率：原因在于其靶区外放的范围同样得到合理照射，而手术无法做到(Rutten IJROBP 2006) Compact Dose Deposition OAR Pulmonary Vein Bronchus Esophagus Cord Skin Chestwall Lung So..All of the lung Ca for the trial must be in this peripheral zone! Phase I Dose Response for Local Control Current RTOG SBRT Studies Medical inoperable peripheral: Peripheral lesion: 48Gy in 4fxs Central lesion: Phase I dose escalation: 50Gy in 5fxs Operable peripheral lesion: 54-60Gy in 3Fxs Ablative Dose: BED＞100Gy RTOG 0236: BED 54 Gy in 3 Fx to GTV + 5-10 mm 151Gy Too toxic for central lesion JCOG 0403: 48Gy in 4 Fx to I/C (40 Gy t