原发性肝癌放疗进展门脉癌栓的放疗课件.ppt

门脉癌栓的诊断 CT中多表现为门静脉管腔增粗，腔内低密度充盈缺损、强化； 间接征象有门静脉管壁强化、侧支循环形成及门静脉海绵样改变。 MRI癌栓在T1WI像呈等信号或低信号，在T2WI像上为高信号， GdDTPA增强后信号强度无明显变化。 PVTT的转归 PVTT自然中位生存率≤3个月。 其转归： (1)肝内广泛转移： (2)肝外转移： (3)继发性门静脉高压： (4)肝功能衰竭： 发生率： 1、高达40-90.2%。 Kaibori M, et al. J Surg Oncol, 2010 2、镜下癌栓： ≤ 2cm, 20%; 2-5cm, 30-60%; ≥ 5cm, 60-90% Llovet JM, et al. Semin Liver Dis, 2005 预后（中位生存期）： 无癌栓， ≥ 87m 镜下癌栓， 38-71m 肉眼癌栓, 8-12m Roayaie S, et al. Gastroenterology, 2009 门静脉癌栓 -- 影响肝癌预后的主要因素 结果 The 1-, 2-, and 3-year pFS for the SG were 32.3, 11.2, and 6.1%, respectively. The 1-, 2-, and 3-year PFS for the RG were 42.2, 24.3, 17.3 %, respectively (p=0.018) . The median and 10.0 months for the SG (p=0.029). OSs were 12.3 months for the RG The 1-, 2-, and 3-year OSs were 51.6, 28.4, and 19.9 %, respectively, for the RG and 40.1, 17.0, and 13.6 %, respectively, for the SG 肝癌合并门静脉癌栓 (PVTT )行3DCRT与外科手术相比有较好的中位生存期、无进展生存率及总生存率。 不同部位癌栓的生存时间比较 n=19 n=45 n=50 中位生存：3 个月 生存率（％） 下腔静脉癌栓 门脉分支癌栓 门脉主干癌栓 B A C Figure 1: CT scan in a 31-year-old man with HCC. A: White arrows show a large tumor, which was surrounded by “satellite” lesions. Portal vein trunk and its branches were involved. B: Two months after the completion of EBRT, the main tumor dramatically disappeared, and the portal vein as directed by black arrows is clearly appeared. C: After combined with TACE, Lipiodol deposits were found in the “satellite” lesions, which could not be treated with EBRT. This case indicates that EBRT is possible to relieve the portal vein occlusion by tumor thrombi, with resultant TACE is safety to this patient. 放疗的技术 推荐采用适形或调强放疗 剂量学优势 3D计划可以获得DVH图 了解靶区和危及器官受照射的剂量和体积 便于总结疗效和治疗的并发症 预后因素 P=0.007 内容提要 肝癌放疗的历史和现状 PHC放疗的疗效 PHC的放射物理和放射生物 PHC放射治疗的