[临床医学]4-食管癌放射治疗.ppt

* The rationales for this design: There were already a lots of reports shown that the accelerated hyperfraction increased the survival for head and neck cancers. In terms of accelerating proliferation the esophagus was very similar to head and neck tissue, with a very closed Tpot value. The accelerating proliferation of the esophageal carcinoma generally presented at 3-5 postradiative weeks. Therefore accelerated hyperfraction should also start at this term. This procedure might have the advantage that makes the presence of acute radioactive adverse effect by AHF after the radiotherapy, so as not to let this side effect interrupt the treatment. * * Let me first thank the chairman for her very kind remarks, and thank professor Okawa very much for inviting me to this symposium. Ok, Let’s begin. * * * * * * * * * * * * * * * * * * * * * * * * * * * 参考P493 * 参考P493 * 参考P493 * Let me first thank the chairman for her very kind remarks, and thank professor Okawa very much for inviting me to this symposium. Ok, Let’s begin. DNa：横膈淋巴结 PENi：食管旁淋巴结(低位) RANt：胸动脉后淋巴结 JVNi：椎间淋巴结 DNa： 横膈淋巴结 DNlat:横膈淋巴结(侧) PENi：食管旁淋巴结(低位) RANt：胸动脉后淋巴结 JVNi：椎间淋巴结 CN：腹腔干淋巴结 RPNsr：右腹主动脉旁淋巴结 LGNc：胃左淋巴结 SplNs：脾淋巴结 LPNsr：左腹主动脉旁淋巴结 RNAs：腹主动脉后淋巴结(上) LGNlc：胃左淋巴结(小弯) HNha：肝动脉淋巴结 SplNh：脾淋巴结(脾门) SplNs：脾淋巴结(胰上) CN：腹腔干淋巴结 LPNsr：左腹主动脉旁淋巴结(上组) RANsr：腹主动脉后淋巴结(上组) RPNsr：右腹主动脉旁淋巴结(上组) 吴阶平基金课题 日本 美国 GTV 影像学资料所见肿瘤范围（包括原发灶和转移淋巴结） CTV原发灶 （上下外扩） 3cm 2-4cm 5cm CTV原发灶 （横向外扩） 0.5-0.8cm 0.5cm 2cm CTVnD （淋巴引流区） 上段：锁骨上淋巴引流区、食管旁、2区、4区、5区、7区 中段：食管旁、2区、4区、5区、7区的淋巴引流区。 下段：食管旁、4区、5区、7区和胃左、贲门周围的淋巴引流区） 只包括有肿大淋巴结转移的区域，其它区不预防照射 由于上下放的范围较大，客观上包的范围很广 PTV外放 0.5-0.7cm 0.5cm（四周）/1cm（上下） 0.5-0.8cm 靶区勾画 ⑴ 治疗剂量： 原发灶总剂量60～70Gy，低于60Gy或高于70Gy生存率都 会受到影响。淋巴引流区域的预防照射剂量一般为50Gy； (2) 正常组织控制剂量： 脊髓剂量：平均剂量9～ 21Gy和0体积剂量＜45Gy 肺剂量：双肺V20 ＜28 %,同时化放疗者双肺V20 ＜27% 心脏剂量： V40＜40% ⑶ 照射方式 常规分割照射：2Gy/次，5次/周, 总剂量60～70Gy； 分段照射：分为两段，中间