（精品课件）早期非小细胞肺癌SBRT-培训班.ppt

危及器官 * 三、实际病例介绍 * 计划设计 按照推荐，使用3D-CRT技术。设定大于10个非共面射野,其中3个非共面野 由于靶区位置较偏，适当调整ISO位置，以防止机架碰撞（尤其是存在非共射野） * AccuRay CyberKnife Orthogonal kV imaging, couch Elekta Varian IGRT?Tools for SBRT MV and kV radiographs, kV Cone Beam CT Tomotherapy Helical scan, low MV imaging source; detectors optimized for low-dose imaging Conventional CT acquired with patient on treatment real-time tracking MV Cone Beam CT Uses treatment beam; modified EPID reduces imaging dose ? Gantry-mounted kV source, 2 EPIDs ? kV and MV planar imaging; kV fluoroscopy ? kVCBCT HiArt Siemens ExacTrac CT-in-Room Novalis * 治疗前位置校正 CBCT手动按肿瘤配准 * KV正侧位2D图像验证 * 立体定向治疗 SBRT 精确射线施照 Hitting the Target 精确靶区勾画 Finding the Target 立体定向放疗瓶颈 Break Bottlenecks of SBRT To give higher dose to the tumors To avoid surrounding critical organs Organ Motion Control IGRT and Verification Definition of GTVp/n; CTVp/n PTV Margin * 谢 谢！ * * RTOG 0236, reported in 2010 This was a phase II trial in which treatment consisted of 54 Gy in 3 fractions delivered over8-14 days However, the rate of ≥ grade 3 protocol-specified toxicityin the trial was 16.3% (although without grade 5 toxicity) and an additional 6 patientsexperienced non-protocol specified high grade toxicity, related to complications of the skinor the ribs, giving an overall toxicity rate of approximately 25%.  * * * SABR Toxicity of central lung tumor MDACC 2005.2-2011.5 101Pts, T1-2N0M0(n=82); isolated lung-parenchyma recurrent lesions (n=19) 50Gy/4f; or 70Gy/10f Median Follow-up 30.3m(40.5m for survivor) NO Grade 4 Toxcity Toxicity % G1 G2 G3 Chest wall pain 18 13 RP 11 1.9 ASTRO 2014  * 中心型肺癌SBRT剂量 Indiana U/RTOG: 60Gy/3f （毒性过高） MDACC: 50Gy/4f RTOG0813: 50-60Gy/5f VUMC “Risk adapted”: 60Gy/3f,5f, or 8f * 早期非小细胞肺癌SBRT的剂量 早期非小细胞肺癌SBRT的剂量不应低于BED 100Gy 小于3厘米肿瘤，中高剂量的（BED 100-150Gy）应该足够 大于3厘米肿瘤，具体剂量有待进一步确定 中央型肿瘤要充分考虑正常组织损伤 * 可手术早期NSCLC的SBRT探索 * SBRT for Operable Stage I NSCLC J Thorac Oncol. 2015;10: 872–882 * SBRT Versus Surgery Matched Studies