鼻腔鼻窦畸胎癌肉瘤的调强放射治疗.ppt

CancerCenter,WuhanUnionHospitalGangPENG,TreatmentofsinonasalteratocarcinosarcomausingIMRT,ChangshaAugust20,2010,IntroductionCaseDiscussion,case,discussion,introduction,SNTCS,sinonasalteratocarcinosarcoma,80casesreported,case,discussion,introduction,History,VencentJ.HyamsDirectoroftheOtolaryngicPathologybranchoftheArmedForcesInstituteofPathology，1968-1984,Teratoidcarcinosarcoma?Mixedmesodermaltumour?Malignantteratomaandblastomas?,1984,case,discussion,introduction,Characteristics,T1-weightedMRrevealsasofttissuefillingtheleftethmoidsinus,asuniformlyhighsignal(*),andeffusion(whitearrowhead)intheleftsphenoidsinus.Takasaki,K.,2006,Epithelialglandularcarcinoma(atright)andosteosarcomacomponent(atleft).(hematoxylin-eosin,originalmagnificationx40).Smith,S.L.,2008,Endoscopicexaminationshowingaleftsinonasaltumorintheleftmiddleturbinate.M,middleturbinate;S,nasalseptum.Su,Y.Y.,2010,Treatment,case,discussion,introduction,Patientsgenerallypresentwithlocallyadvanced-stagediseasethehighlymalignant,aggressivebiologicalbehaviorthepresenceofairfilledparanasalspacespermitssilentgrowthDistantmetastasisofSNTCSisunusualandthemostcommoncauseoftreatmentfailureislocalrecurrenceSurgicalexcisionandpostoperativeradiotherapyhasbecomethemostwidelyacceptedtherapeuticplan,IntroductionCaseDiscussion,HPI,introduction,discussion,case,42-year-oldmanTwoweekshistoryofprogressiveleftnasalobstructionandintermittentnasalbleedingNasalexaminationshowedamoderatelyfirm,reddish-purplemassintheleftmeatusBiopsyofthetumorrevealedaheterogeneousadmixtureofepithelialandmesenchymalelements,suggestingSNTCS,TeratocarcinosarcomaTeratocarcinosarcomaconsistsoftwocomponents,epithelialandmesenchymal(hematoxylin-eosin,originalmagnification200),cT3N0M0,MRI,introduction,discussion,case,MRIrevealedasofttissuefillingtheleftmeatus,maxillaryandethmoidsinus,andeffusionintheleftmaxillarysinus,introduction,discussion,case,AnteriorcraniofacialresectionIMRTGTVincludedtheresidualgrossdiseaseinthenasalcavityandparanasalsinusCTV-60includestheGTVwitha510mmmargin,thewholenasalcavityandtheinvolvedparanasalsinusCTV-54high-risklocalstructures(includingthewholenasopharynx,lowerhalfofsphenoidsinus,etal)lymphaticregions(includingipsilaterallymphnodelevelsIB,II,IIIandVA)A3-mmmarginwasaddedtoproducePTVsPTV-66wasprescribedto66Gywith2.2Gy/fractionPTV-60wasprescribedto60Gywith2.0Gy/fractionPTV-54wasprescribedto54Gywith1.8Gy/fraction,Treatment,Follow-up,introduction,discussion,case,Now3.5yearshavepassedsincetheirradiationtherapyNoseveredry-eyesyndrome,andothersevereradiation-inducedoculartoxicitieshappenedNoevidenceofrecurrenceormetastasis,IntroductionCaseDiscussion,Shoulders?,introduction,case,discussion,Sinonasaltumors,FrontalSinusMaxillarySinusEthmoidSinusSpenoidSinus,1,2,3,4,Challenge!,introduction,case,discussion,IMRT,introduction,case,discussion,3-beamconventional2D,6-beamconventional3Dconformal,7-beamIMRT,Adosimetrycomparisonbetween(a)a3-beamconventional2Dtreatment,(b)a6-beamconventional3DconformalRTtreatment,and(c)a7-beamIMRTtreatment.ThePTVisrepresentedbythesolidredline.The100%and70%oftheprescriptiondoseareshownbythegreenandredcolour-washedareas.AbetterdoseconformitytothePTVcanbeachievedintheIMRTtreatment.,GhentExperience,introduction,case,discussion,2009,Madani,I.,2009,DosevolumeConstraints,introduction,case,discussion,Madani,I.,2009,VisualPathwayDose,introduction,case,discussion,Madani,I.,2009,AcuteToxicity,introduction,case,discussion,Madani,I.,2009,StudiesReported,introduction,case,discussion,Madani,I.,2009,CTVDelineation,introduction,case,discussion,ImplementationStrategy,2001,introduction,case,discussion,Claus,F.,2001,introduction,case,discussion,“Compartment-relatedCTVDefinition”,InthoseregionswhereGTVwasflankedbyintactbone,nomarginwasaddedInthoseregionswhereGTVinvadedcompartmentsenclosedbybone,likeotherparanasalsinuses,orextendeduptotheirostia,thewholecompartmentwasincludedintheCTVcontoursInthoseregionswhereGTVinvadedradiologicallydefinedspacesknowntoresistpoorlyinvasionbymalignanttumors(e.g.,masticatororparapharyngealspaces),theentirespacewasadded,Claus,F.,2001,CervicalLymphNodes,Duthoy,W.,2005,introduction,case,discussion,2005,LNRecurrence,Duthoy,W.,2005,introduction,case,discussion,2006,introduction,case,discussion,CTVDelineationcont,CTVDelineationcont,“Indeed,inabsenceofunambiguousinformationonthesurgicalprocedureandcomprehensivereportofthepathologicalanalysis,atooselectiveselectionanddelineationoftheCTVmayleadtoanunacceptablehighrateofloco-regionalrecurrences”,VincentGregoire,2006,Itwillnotbeinappropriatetobegenerousintargetvolumedelineation,introduct