2015 子宫内膜癌串讲3-赵迎超.ppt

* * * * * * 武汉协和医院肿瘤中心 赵迎超 Quality categories Study design Ascertainment of outcome High Prospective Follow-up for at least 5 years Moderate Prospective Follow-up for 1 and b5 years Low Retrospective Short follow-up of b1 year 子宫内膜癌的靶区勾画 3 近距离照射技术：对肿瘤延伸到阴道者，则阴道的全长应用柱状、Delclos施源器或行组织间植入治疗。临床上不能手术而选择单用放疗者，腔内植入放疗时阴道表面剂量为60Gy，且外照射剂量给予20-30Gy时，中线予以铅挡块以保护膀胱和直肠，然后将盆腔野推量至45-50Gy；对于子宫内膜癌术后需要补充内照射的患者，则予以阴道近距离放疗4?6Gy x 2?3次。 Given the retrospective nature and treatment heterogeneity of our study, we are unable to make definitive therapy recommendations. However, since the majority of our patients received external beam radiation (45 Gy in 25 fractions) followed by intracavitary HDR brachytherapy (total dose to point A of 75 Gy), tolerated treatment well, and had a good outcome, we consider this a reasonable management approach for these compromised patients. the CTV for BT included the GTV, entire uterus, cervix, and upper 1-2 cm of the vagina (Fig. 1). Although the GTV was identified, the prescription dose was still delivered to the CTV. Thirty-eight patients were treated from 2007 to 2013, 20 receiving BT alone with a median dose of 37.5 Gy in five to six fractions. For combined therapy, median external beam and BT doses were 45 and 25 Gy in four to five fractions. With 15-month median followup, the 2-year actuarial local control and overall survival were 90.6% and 94.4%. No Grade 2e5 late toxicities were observed. Mean CTV D90 EQD2 for BT alone and combined therapy was 48.6 and 72.4 Gy, whereas mean GTV D90 EQD2 was 172.3 and 138.0 Gy. Image-based BT is feasible for medically inoperable early stage endometrial cancer with excellent early results. Despite low CTV doses, high doses delivered to GTV with BT likely accounts for high local control. Endometrial cancer guidelines for image-based planning are needed to define target volumes based on risk with differential dose delivery. 武汉协和医院肿瘤中心 赵迎超 Quality categories Study design Ascertainment of outcome High Pro