NCCN 肿瘤临床实践指南-（中文版）子宫肿瘤2020V1正式版.pptVIP

NCCN 肿瘤临床实践指南（NCCN 指南）?)子宫肿瘤版本 1.2020—2020 年 3 月 6 日NCCN.orgNCCN 患者指南? NCCN Guidelines Version 1.2020Endometrial CarcinomaNCCN Guidelines IndexTable of Contentsj如果进行了子宫切除术，则考虑对 1-5 处转移病灶进行消融放射治疗（2B 类）。（Palma DA,Olson R,Harrow S,et al.寡转移性癌症患者立体定向放疗与标D准i s姑cussion息治疗的比较 (SABR-COMET)：一项随机、2 期、开放标签试验。Lancet 2019;393:2051-2058.）k手术目标是没有可测量的残留病变。Note: All recommendations are category 2A unless otherwise indicated.Clinical Trials: NCCN believes that the best management of any patient with cancer is in a clinical trial. Participation in clinical trials is especially encouraged.ENDO- NCCN Guidelines Version 1.2020Endometrial CarcinomaNCCN Guidelines IndexTable of ContentsDiscussion复发附加治疗的临床介绍治疗疾病EBRTfEBRTf，ee受限的至阴道±近距离放射治疗f±近距离放射治疗f复发部位之前未接受过放疗orEBRTf，ee盆腔淋巴结局部复发z? 无远处转移放射成像h既往近距离放治±全身治疗g手术探查bb射治疗-疗+ 切除±IORT（IORT为 3 类）既往 RT主动脉旁或至复发部位局部疾病ddEBRTf，ee既往EBRT±全身治疗g髂总淋巴结手术探查+ 切除±IORT（IORT为 3 类）全身治疗g显微镜检查和/或残留疾病±EBRTf，ee全身治疗g±姑息性放疗f上限或近距离放射治腹部/总上限f,cc疗腹膜gNote: All recommendations are category 2A unless otherwise indicated.Clinical Trials: NCCN believes that the best management of any patient with cancer is in a clinical trial. Participation in clinical trials is especially encouraged.ENDO-10 NCCN Guidelines Version 1.2020Endometrial CarcinomaNCCN Guidelines IndexTable of ContentsDiscussion分子分析原理图 1：子宫内膜癌的病理学和遗传学f,g极点测序极点热点突变No 极点热点突变DNA MMR 蛋白免疫组子宫内膜样癌h极点化表达式丢失表达保留p53 免疫组化正常/野生型模式异常/突变模式子宫内膜样癌h MSI-H子宫内膜样癌h 拷贝数-低浆液性癌 子宫内膜样癌i高拷贝数f经 Murali R,Delair DF,Bean SM,et al 许可复制。组织学评价和分子/基因组分析在子宫内膜癌治疗中的作用演变。J Nat ComprōNetw 2018;16:201-209.g子宫内膜癌综合基因组-病理分类的诊断算法（蓝色代表组织类型；红色代表 TCGA 基因组类别）。h也可能适用于透明细胞癌。Note: All recommendations are category 2A unless otherwise indicated.Clinical Trials: NCCN believes that the best management of any patient with cancer is in a clinical trial. Participation in clinical trials is especially encouraged.ContinuedENDO-A NCCN Guidelines Version 1.2020Endometrial CarcinomaNCCN Guidelines IndexTable of ContentsDiscussioni该算法不能区分以下组织类型TP53-突变的高拷贝数肿瘤（即，高级别子宫内膜样癌、浆液性癌和透明细胞