腫瘤綜合治療進展2照射靶區(qū)與邊界的研究

Individual&Adaptive我們所需要的是病人的個體化的靶區(qū)或邊界-

patient-specificmargins

而不是群體化的病人的靶區(qū)或邊界-populationspecificmargins靶區(qū)或邊界應當要包括物理靶區(qū)或邊界生物靶區(qū)或邊界

影像/手術/病理體積與GTV勾畫

Yuetal;Int.JRadOncolBioPhys2009外科標本最大徑病理標本最大徑

實際標本最大徑

CT縱隔窗大小

CT肺窗大小

PET-CT大小由病理科醫(yī)生所勾畫的腫瘤鏡下邊界，畫線的右邊是腫瘤外界腫瘤組織正常肺泡結構放大倍數(shù)40病理醫(yī)生勾畫好腫瘤邊界后的HE切片CT,FDGPET&PET/CT與病理最大徑的比較

MeasurementofBiggestTumorDimension

CTsize(cm)PETsize(cm)PET/CTsize(cm)Pathologysize(cm)Xaxis(n=4.3)5.51±1.364.92±1.205.07±1.285.20±1.22Yaxis(n=4.3)5.58±1.605.14±1.48

5.18±1.505.27±1.61Zaxis(n=4.3)5.67±1.395.34±1.255.40±1.255.50±1.37Nosignificantdifference,P>0.05;Yu.EuropJournalofRadiology2008病理體積與PET/CT影像體積的比較研究CT&FDGPET-CTforNSCLCN-Stage

PathologyResultsCTStagePET-CTStageN-StageNumberN-StageNumberN-StageNumberN049N0N1N229(40%)614N0N1N241(75%)53N148N0N1N21026(55%)12N0N1N2139(80%)8N225N0N1N29313(50%)N0N1N25218(75%)DiagnosticvaluesofFLTVSFDGforlymphnodeDetectioninNSCLC

pNstagePtNFLTPET/CTFDGPET/CTSensiSpeciAccuPPVNPVSensiSpeciAccuPPVNPVpN013—96960100—84840100pN11268978793858876806692pN2660978492828073756287PPV：positivepredictvalue；NPV：negativepredictvalueNSCLC原發(fā)灶鏡下侵襲范圍

中華腫瘤雜志2004年第9期病理類型X軸Y軸Z軸平均值95%CTV

腺癌

1.80±1.102.86±2.482.17±1.582.18±1.807mm

鱗癌

1.37±0.971.45±1.031.14±1.261.33±1.095mm

P值

0.180.0170.0350.001臨床靶區(qū)的設定取決于病理和靶區(qū)邊界失敗頻度患者男性,73歲,PET-CT示左下肺占位,平均SUV=20.3最大SUV=30.2術后病理為低分化鱗癌最大顯微鏡下浸潤范圍-Microextension,ME為6.0mmFDG-PET-SUV用于CTV擴充區(qū)前瞻性研究

ProspectiveStudyofCTV-MarginbyPET-SUV

SUV&MTV與腫瘤鏡下浸潤范圍關系

2009ASTROOralPresentation-Chicago

P=0.008P<0.00139例NSCLCME平均值為4.61mm±2.71mm腫瘤最大SUV的平均值為7.24±2.41腫瘤代謝體積的平均值為40.62cm3±33.66cm3PhaseIIITrial:ENIvsIFI;Yu,ASCO-2006STDFIFStageIIINSCLC:ChT/RT;200PtsRandomizedParameter2YrLF1YrOS2YrOS3YrOSENI4959.725.619.2IFRT4167.238.727.3P=0.048RTOG-0617及NCCN引證III期NSCLC建議累及野照射

關于腫瘤的預防照射

ElectiveNodeIrradiation,ENI如果我們控制那些可見病灶(GTV)都很困難的話;那我們何必要去做沒有任何意義的預防性照射呢？ButAsWeKnowThat:AreesophagealcancerslikeinUSAandinChinaHorsesofadifferentcoloranddifferentfunctions?

治療結果-TreatmentResultsParameters

OverallsurvivalProgressionfreesurvivalFollowtime1yr3yr5yr1yr3yr5yrSurgerygroup88.6%56.2%34.7%73.3%39.7%20.6%RTgroup93.3%61.5%36.9%75.9%43.7%23.1%OverallSurvival

SurgerygroupvsRTgroupOverallSurvivalmonthsProgression-FreeSurvivalin

SurgerygroupvsRTgroup為何需要放化療聯(lián)合靶向

WhyCetuximab+CCRTWereallyneedbetterresultsforCancersEncouragingresultsinthelabresearchInVitro:CellCultureInVivo:AnimalStudyEncouragingresultsintheclinicresearchHeadandneckcancerM-Colo-rectalCancerPreliminarydataforNSCLC

西妥昔單抗+紫杉醇+順鉑+同步放療

(

400/250mg/m2)(45mg/m2)(20mg/m2)(

59.4Gy)主要評價：臨床緩解率頸段+胸中上段

食管鱗癌（44例）次要評價：安全性/生存率

其他評價：K-RAS基因檢測EXCEL-0901ProtocleW2W3評價臨床緩解率同步放化療

+cetuximabCetuximab(400mg/250mg/m2)W4W5W6W7W1

Cisplatin(20mg/m2)3DCRT(1.8GyX33fractions)Paclitaxel(45mg/m2)苯海拉明

(