汪延明教授术中放疗.ppt

汪延明教授术中放疗;Intrabeam在乳腺癌保乳术中临床应用;IORT systems术中放疗系统种类;X线与电子线术中放疗剂量分布比较;Intrabeam靶区适形度;Intrabeam: 术中光子刀;Intrabeam: 整机小巧灵活, 使用方便;Intrabeam: X射线源;Intrabeam:诊疗施源器;Intrabeam:美容效果好;Intrabeam靶区剂量分布特征;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;INTRABEAM? is a flexible Platformfor the Comprehensive Cancer Center;(Herskind C et al., Int J Rad Onc Biol Phys 2008;72:1575);等效生物剂量计算;BED与疗效关系;BED与疗效关系;BED与疗效关系;2002 – 2007 n = 154 20 Gy INTRABEAM + 46 – 50 Gy EBRT 2 pt lost to f/u;3年后瘤床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;TARGiT 用做推量照射病人5年复发率为1.73% 常规外照射推量5年复发率为4.3%. TARGiT复发率降低2.5倍;;CONCLUSION;对保乳病人使用低能量X线术中推量照射, 5年数据;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对瘤床做推量益处已经被验证;长久毒性分析:对保乳病人使用低能X线做术中推量照射;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, Samuele Massarut, Wolfgang Eiermann, Mohammed Keshtgar, John Dewar, Uta Kraus-Tiefenbacher, Marc Sütterlin, Laura Esserman, Helle M R Holtveg, Mario Roncadin, Steffi Pigorsch, Marinos Metaxas, Mary Falzon, April Matthews, Tammy Corica, Norman R Williams, Michael Baum 发表在Lancet 2010, 376:91-102;本研究目是确定对乳腺癌病人一次术中照射(补充外照射, 当有风险原因出现时)在降低复发率功效方面是否和常规6周放疗一样 关键在局部控制率和副作用研究.. 这项研究是现在正在进行相关乳腺癌放射诊疗方面最大多中心临床试验. 2010年4月入组结束, 共诊疗2232位病人;时间:; ; ; 肿瘤大小 3.5 cm 非