肺癌个体化放疗指南.pptVIP

主动呼吸控制辅助下的RapidArc快准主动呼吸控制辅助下的RapidArc从技术和剂量学方面证明了RapidArc进行胸部肿瘤、头颈部肿瘤、腹盆部肿瘤的可行性研究成果证明相对于IMRT具有照射时间短机器跳数少、剂量分布优的特点与主动呼吸控制技术的联合应用可在保证靶区精确基础上更好保护危及器官YinYetal.JRadiatRes.2013,54:166-73;YinYetal.MedDosim.2011,36:448-54PARTONESBRTVS.外科EarlyStageNSCLCManagementEBRT(60-66Gyin30fxs/6wks)

BED=72Gy10IMRT(80Gyin40fs/8wks)BED=95Gy10SBRT(48-60Gyin3-5fxs/1wk)BED=168Gy10Dose-DistributionsCurrentStatusofSBRTClinicalUsePanetal;ASurveyofStereotacticBodyRadiotherapyUseintheUnitedStates;Cancer,2011手术与立体放疗比较

SBRTVsSurgery根治性目的较立体放疗容易实现病人在心理上感觉已经完全切除淋巴结可以在术中进行完全清扫可提供完整病理和分子水平分期能更科学指导病人的治疗和预后手术切除主要优点1具有较高的局部和区域的控制率可以治疗不能耐受手术的患者群病人的依从性好容易接受该治疗治疗损伤发生率和死亡率都较低治疗经济且病人可免于住院治疗立体定向主要优点2ComparativeResultsofSurgicalSBRTStudiesforEarlyStageNSCLCinUSA Rx 5yOS% 5yLF % StageI Surgery 53-83 4-17 StageI* RT 15-24 76-85 StageI SBRT 68-77 10-15 StageII Surgery 30-50%StageII* RT 10-20%StageIII RT/CTx 5-15%

*medicallyinoperableSRS/SRT:StereotacticRadiosurgery/therapy30-40treatments(6-8wks)1-5treatments(1-2wks)“Swaths”ofradiationSmallbeamaperturesWeeklyimageguidanceDailyimageguidanceNomotioncontrolStrictmotioncontrolSmall“forgiving”dailydoseLarge“ablative”dailydose2-4beamsManybeamsorarcsConventionalRTSBRTStylesSBRTVSConventionalRTElementsofSBRTwith6HsHighdose(ablativedose)perfractionprescriptionHighlevelbodyimmobilizationrepositioningHighdemandonmotioncontroltominimizethePTVHighconformalplantomaximizeRTdosefalloffHighprecisiondosedeliverywithIGRTTechniqueHighcomplicatedtechnologytoverifytheprecisedRTSBRTWillnotbeforadjuvantorprophylactic SBRT优势及研究证据

SBRTforEarlyStageNSCLC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：Hypofdose:45-60Gy/3-5fs;BED100;(取决于增殖与乏氧)DailyVerificationQA:3Do