汪延明教授 术中放疗2012.3.10.ppt

济南军区总医院放射治疗科主任 放射肿瘤学博士后，主任医师，硕士生导师 济南军区肿瘤研究所副所长 全军肿瘤放射治疗专业委员会秘书长 山东省老年肿瘤专业委员会主任委员 山东省医学会肿瘤放疗分会副主任委员 Intrabeam在乳腺癌保乳术中的临床应用 济南军区总医院放疗科 汪 延 明 2012.03.10 济南 X线与电子线术中放疗剂量分布比较 Intrabeam的靶区适形度 Intrabeam:治疗施源器 Intrabeam:美容效果好 Intrabeam靶区剂量分布特性 Summary of Radiobiological Research Depth dose curve is specific for X-Ray spectrum and applicators RBE depends upon radiation characteristics:Depth dose curve and dose rate RBE is multiplier of 1.1 – 2 for physical dose and varies with distance from applicator Summary of Radiobiological Research 等效生物剂量计算 BED与疗效的关系 BED与疗效的关系 BED与疗效的关系 3年后瘤床的3级纤维化为6%，皮肤反应轻微 结 论 使用Intrabeam对乳腺癌保乳术中推量（20Gy）照射+全乳外照射，复发率低，放疗反应轻微 TARGETED INTRAOPERATIVE RADIOTHERAPY (TARGIT) YIELDS VERY LOW RECURRENCE RATES WHEN GIVEN AS A BOOST JAYANT S. Int. J. Radiation Oncology Biol. Phys., Vol. 66, No. 5, pp. 1335–1338, 2006 301例患者，302个病灶 1/3患者﹤51岁，57%病灶为1~2cm，21%病灶﹥2cm，29%肿瘤为3级，29%患者有淋巴结转移 术中20Gy瘤床照射，术后全乳照射但不再做瘤床推量 结果： 1.治疗有很好的耐受性 2.随访时间为3~80个月 3.复发率1.3%（淋巴结阳性率29%）/ EORTC 推量试验：4.3%（淋巴结阳性率8.1%） CONCLUSION Targeted intraoperative radiotherapy combined with EBRT results in a low local recurrence rate. This could be attributed to both accurate targeting and timeliness of the treatment. These data support the need for a randomized trial to test whether the TARGIT boost is superior to conventional external boost, especially in high-risk women. TARGIT Boost with INTRABEAM? is a single Fraction Boost given at the Time of Surgery or shortly after Standard Protocol But the External Boost misses the Target! The Tumor Bed changes over Time! The Benefit of a Dose Escalation to the Tumor Bed is well documented对瘤床做推量的益处已经被验证 济南军区总医院肿瘤放疗中心大楼 Targeted intraoperative radiotherapy versus whole breast radiotherapy for breast cancer (TARGiT-A trial): an international, prospective, randomised, non-inferiority phase 3 trial Jayant S Vaidya, David J Joseph, Jeffrey S Tobias, Max Bulsara, Frederik Wenz, Christobel Saunders, Michael Alvarado, Henrik L Flyger, Sam