鼻腔鼻窦畸胎癌肉瘤的调强放射治疗

1、Treatment of sinonasal teratocarcinosarcoma using IMRT1.Introduction 2.Case 3.Discussion casediscussionintroductionSNTCS sino nasal terato carcino sarcoma casediscussionintroductionHistoryVencent J. HyamsDirector of the Otolaryngic Pathology branch of the Armed Forces Institute of Pathology，1968-198

2、4 Teratoid carcinosarcoma ?Mixed mesodermal tumour ? Malignant teratoma and blastomas ?1984casediscussionintroductionCharacteristicsT1-weighted MR reveals a soft tissue filling the left ethmoid sinus, as uniformly high signal (*), and effusion (white arrowhead) in the left sphenoid sinus. Takasaki,

3、K.,2006Epithelial glandular carcinoma (at right) and osteosarcoma component (at left). (hematoxylin-eosin, original magnification x40). Smith, S. L.,2008Endoscopic examination showing a left sinonasal tumor in the left middle turbinate. M, middle turbinate; S, nasal septum. Su, Y. Y., 2010CBATreatme

4、ntcasediscussionintroduction1.Patients generally present with locally advanced-stage diseasethe highly malignant, aggressive biological behavior the presence of air filled paranasal spaces permits silent growth 2.Distant metastasis of SNTCS is unusual and the most common cause of treatment failure i

5、s local recurrence3.Surgical excision and postoperative radiotherapy has become the most widely accepted therapeutic plan 1.Introduction 2.Case 3.Discussion HPIintroductiondiscussioncase42-year-old man Two weeks history of progressive left nasal obstruction and intermittent nasal bleedingNasal exami

6、nation showed a moderately firm, reddish-purple mass in the left meatusBiopsy of the tumor revealed a heterogeneous admixture of epithelial and mesenchymal elements, suggesting SNTCSTeratocarcinosarcoma Teratocarcinosarcoma consists of two components, epithelial and mesenchymal (hematoxylin-eosin, o

7、riginal magnification 200)cT3N0M0MRIintroductiondiscussioncaseMRI revealed a soft tissue filling the left meatus, maxillary and ethmoid sinus, and effusion in the left maxillary sinusintroductiondiscussioncasepAnterior craniofacial resectionpIMRTGTV included the residual gross disease in the nasal c

8、avity and paranasal sinusCTV-60 includes the GTV with a 510 mm margin, the whole nasal cavity and the involved paranasal sinusCTV-54 a)high-risk local structures (including the whole nasopharynx, lower half of sphenoid sinus, et al)b)lymphatic regions (including ipsilateral lymph node levels IB, II,

9、 III and VA)A 3-mm margin was added to produce PTVsa)PTV-66 was prescribed to 66 Gy with 2.2 Gy/fractionb)PTV-60 was prescribed to 60 Gy with 2.0 Gy/fractionc)PTV-54 was prescribed to 54 Gy with 1.8 Gy/fractionTreatmentFollow-upintroductiondiscussioncase1.Now 3.5 years have passed since the irradiat

10、ion therapy2.No severe dry-eye syndrome, and other severe radiation-induced ocular toxicities happened3.No evidence of recurrence or metastasis1.Introduction 2.Case 3.Discussion Shoulders ?introductioncasediscussionSinonasal tumors1.Frontal Sinus2.Maxillary Sinus3.Ethmoid Sinus4.Spenoid Sinus1234Cha

11、llenge !introductioncasediscussionIMRTintroductioncasediscussion3-beam conventional 2D6-beam conventional 3D conformal7-beam IMRTA dosimetry comparison between (a) a 3-beam conventional 2D treatment, (b) a 6-beam conventional 3D conformal RT treatment, and (c) a 7-beam IMRT treatment. The PTV is rep

12、resented by the solid red line. The 100% and 70% of the prescription dose are shown by the green and red colour-washed areas. A better dose conformity to the PTV can be achieved in the IMRT treatment. Ghent Experienceintroductioncasediscussion2009Madani, I., 2009Dosevolume Constraintsintroductioncas

13、ediscussionMadani, I., 2009Visual Pathway DoseintroductioncasediscussionMadani, I., 2009Acute ToxicityintroductioncasediscussionMadani, I., 2009Studies ReportedintroductioncasediscussionMadani, I., 2009CTV DelineationintroductioncasediscussionImplementation Strategy2001introductioncasediscussionClau

14、s, F.,2001introductioncasediscussion“Compartment-related CTV Definition”1.In those regions where GTV was flanked by intact bone, no margin was added2.In those regions where GTV invaded compartments enclosed by bone, like other paranasal sinuses, or extended up to their ostia, the whole compartment w

15、as included in the CTV contours3.In those regions where GTV invaded radiologically defined spaces known to resist poorly invasion by malignant tumors (e.g., masticator or parapharyngeal spaces), the entire space was added Claus, F.,2001Cervical Lymph NodesDuthoy, W.,2005introductioncasediscussion200

16、5LN RecurrenceDuthoy, W.,2005Ethmoid sinus / Ad : 7% (14/194)Maxillary sinus / SCC: 12% (33/274)introductioncasediscussioncase2006introductioncasediscussionCTV Delineation contCTV Delineation cont “ Indeed, in absence of unambiguous information on the surgical procedure and comprehensive report of t

17、he pathological analysis, a too selective selection and delineation of the CTV may lead to an unacceptable high rate of loco-regional recurrences ”Vincent Gregoire, 2006It will not be inappropriate to be generous in target volume delineationintroductioncasediscussionConclusionintroductioncasediscuss

18、ionmay result in a decrease in ocular toxicity, The appropriate implementation of IMRT for sinonasal tumors, including our SNTCS patient, without compromising local controlThank you for your attention !武汉协和医院HPIintroductiondiscussioncase42-year-old man Two weeks history of progressive left nasal obs

19、truction and intermittent nasal bleedingNasal examination showed a moderately firm, reddish-purple mass in the left meatusBiopsy of the tumor revealed a heterogeneous admixture of epithelial and mesenchymal elements, suggesting SNTCSTeratocarcinosarcoma Teratocarcinosarcoma consists of two component

20、s, epithelial and mesenchymal (hematoxylin-eosin, original magnification 200)introductiondiscussioncasepAnterior craniofacial resectionpIMRTGTV included the residual gross disease in the nasal cavity and paranasal sinusCTV-60 includes the GTV with a 510 mm margin, the whole nasal cavity and the involved paranasal sinusCTV-54 a)high-risk local structures (including the whole nasopharynx, lower half of sphenoid sinus, et al)b)lymphatic regions (i