特殊情况内膜癌的放疗课件

特殊情况内膜瘟的放疗20163特殊情况内膜瘟的放疗1因内科疾病无法手术的内膜癌因内科疾病无法手术的内膜癌2特殊情况内膜癌的放疗课件3特殊情况内膜癌的放疗课件4Systemicreview:Radiationtherapyaloneinmedicalnon-operableendometrialcarcinoma纳入25项研究2694例单纯放疗的患者1976-2013年分期I-Ⅳ治疗方式比例体外+近距离1278(47.4%)单纯近距离放疗1383(513%单纯体外放疗33(12%)EuropeanJournalofCancer65(2016)172-81Systemicreview:Radiationthe5Systemicreview:Radiationtherapyaloneinmedicalnon-operableendometrialcarcinoma治疗效果副反应指标95%CI治疗方式≥3级副反应5年疾病特异78.5%74.5%EBRI+BI生存率DSSBTalone2.8%5年局控率LC799%757%EBRTalone184.1%需外科千预1.6%(range:0-5%)5年总生存率53.2%49.3%OS57.1%EuropeanJournalofCancer65(2016)172-81Systemicreview:Radiationthe6mage-basedthree-dimensionalconformalbrachytherapyformedicallyinoperableendometrialcarcinoma1期内膜癌的精确放疗共38例患者,2007-2013年MRI/CTbasedHDR-BT+EBRTCTV包括宫体、宫颈、阴道1-2cm剂量BT+EBRT平均CTVD90EQD248.6±56724士60Gy平均GTvD90EQD21723±5961380±646GyBrachytherapy13(2014)542-547mage-basedthree-dimensionalc7mage-basedthree-dimensionalconformalbrachytherapyformedicallyinoperableendometrialcarcinomaatientandtreatmentcharacteristicsCharacteristicsAge,median69(53-90)22(579)15中位随访15个月width.medians6cm80m·2年局控率90.6%forinoperability3(792年总生存率944%4(10.5medicalcomorbidities12G316)3(79未发生≥2级远期副反应Cardiaccomorbidities5(13.2Advancedagecaldifficulty)Stroke/riskofdiscontinuinganticoagulationThrombocytopeniaTechniqueEBRT+BT8(474)Image-basedplanningmodality9(500)CTwithpretreatmentMRI3(34.2)CTaloneBrachytherapy13(2014)542-547mage-basedthree-dimensionalc8ConsensusstatementforbrachytherapyforthetreatmentofmedicallyinoperableendometrialcancerAuthoragepatientsTyperadiationPC/UCSoDFS/DSScomplications(%)DID(S)10)1997-20081HDR士EBRT75%73(3yrs)Inciura(20101995-19981HDR±EBRT72%Coon(2008)HDR±EBRT93%008HDR±EBRT71%Nguyen(1998)1989-199710(3years)14.7(3years)Kucera(198)Knocke41997)1981-1992-Ⅱ272Nguyen(1995)1984-19921-127HDR±EBRT1.0(8years)Rotte(1990)I-ⅢHDR000633Sorte(19891977-1986AmericanBrachytherapySociety(ABS)Brachytherapy14(2015)587-599Consensusstatementforbrachy9Consensusstatementforbrachytherapyforthetreatmentofmedicallyinoperableendometrialcancer结构影像勾画定义GTVT2加权可见病灶CTⅤMR/CT全部宫体、宫颈、上1-2cm阴道OARMRI/CT乙状结肠、直肠膀胱、肠管、未累及的下1/3阴AmericanBrachytherapySociety(ABS)Brachytherapy14(2015)587-599Consensusstatementforbrachy10特殊情况内膜癌的放疗课件11特殊情况内膜癌的放疗课件12特殊情况内膜癌的放疗课件13特殊情况内膜癌的放疗课件14特殊情况内膜癌的放疗课件15特殊情况内膜癌的放疗课件16特殊情况内膜癌的放疗课件17特殊情况内膜癌的放疗课件18特殊情况内膜癌的放疗课件19特殊情况内膜癌的放疗课件20特殊情况内膜癌的放疗课件21特殊情况内膜癌的放疗课件22特殊情况内膜癌的放疗课件23特殊情况内膜癌的放疗课件24特殊情况