IIIa(N2)非小细胞肺癌术后放疗靶区建议PPT课件.ppt

*正常淋巴引流途径A：右肺上尖段和后段。B：右肺中叶和右肺上叶背段。C：右肺下叶基底段。D-G：左肺引流的四条途径。D：通过主动脉弓下淋巴结，然后向近端沿迷走神经引流至斜角肌淋巴结或沿喉返神经引流至纵隔淋巴结。E：沿膈神经引流至斜角肌淋巴结。F：沿主支气管引流至气管旁淋巴结。G：沿主支气管下方引流至隆突下淋巴结。TheorSurg1990;5:19*淋巴结右上右中右下左上左下左肺右肺1L0.0320.0130.0110.2020.0490.1250.0191R0.2340.1570.0660.0500.0580.0540.1522L0.0180.0470.0210.1400.0880.1140.0292R0.2700.1870.1840.0550.0810.0680.2144L0.0180.0470.0210.1500.1220.1360.0294R0.2340.1750.1900.0450.0710.0580.20050.0000.0000.0000.0950.0700.0820.00060.0000.0000.0000.050.0.0500.0500.00070.1530.1530.2900.1660.2460.2060.1998L0.0000.0000.0000.0050.0300.0170.0008R0.0050.0050.0050.0000.0000.0000.0059L0.0000.0000.0000.0050.0050.0050.0009R0.0050.0050.0200.0000.0000.0000.01010L0.0000.0000.0000.1500.1200.1350.00010R0.1370.1050.0870.0120.0310.0220.10911L0.0000.0000.0000.5000.5950.5480.00011R0.4100.4550.5500.0000.0000.0000.472文献资料综合显示各区域淋巴结转移概率CancerRadioth2001:6725-36*各层淋巴结阳性患者百分数StrahlentherOnkol2002;178:199–208*＃5（主肺动脉窗)转移4.2％（3/72)＃6（主动脉弓旁）转移1.4％（1/72）72例右肺癌PET显示第5，6组纵隔淋巴结转移情况**1990，Hata通过纤维支气管镜将99T标记的硫化锑或胶体铼注入各段支气管粘膜下，对无淋巴结转移征象的179例患者作了192次淋巴闪烁照相。用γ照相机每小时做前位和侧位照相，连续6小时，记录淋巴引流的方式。?*cN15pN14cN243pN227cN319pN32cN319pN32****IIIa(N2)非小细胞肺癌

术后放疗靶区建议复旦大学附属肿瘤医院*TNMCLASSIFICATION200220092009IVIVIVIVM1IVIIIBIIIBIIIAIIIAT4IVIIIBIIIAIIIAIIBT3IVIIIBIIIAT2IVIIIBIIIAIIAIAT1M1N3N2N1N0bbbaaaIIAIIBIBIIBIIAIVIVIVIVM1IVIIIBIIIBIIIBIIIBT4IVIIIBIIIAIIIAIIBT3IVIIIBIIIAIIBT2IVIIIBIIIAIIAIAT1M1N3N2N1N0IB*内容IIIa(N2)术后放疗是否需要？IIIa(N2)术后放疗靶区建议*IIIa（N2）NSCLC分类IIIa-1:切除标本中最后病理证实N2转移IIIa-2：术中确认单个N2淋巴结转移IIIa-3：术前分期检查（纵隔镜、穿刺或PET）诊断为单个或多个N2淋巴结转移IIIa-4：术前分期检查大块或固定N2淋巴结转移（CT显示纵隔淋巴结短径>2cm，伴有淋巴结胞膜外侵犯，有多组淋巴结转移和/或组内多个小淋巴结转移灶）*病例1：62岁男性，非小细胞肺癌一般情况好，分期为CT2PN2M0NSCLC适合于行肺叶切除术者*IJROBP2010