早期非小细胞肺癌SBRT培训班.ppt

山东省肿瘤医院,山东大学附属肿瘤医院,文章内容来源于网络，如果侵权或者不当的地方，请联系我删除或者改正。文章内容仅可参考，不能作为科学依据。谢谢！,The content of this article comes from the Internet.If there is any infringement or improper place,please contact me to delete or correct it.The content of the article can only be referred to,not as a scientific basis.thank you!,山东省肿瘤医院,山东省肿瘤防治研究院,文章内容来源于网络，如果侵权或者不当的地方，请联系我删除或者改正。文章内容仅可参考，不能作为科学依据。谢谢！,The content of this article comes from the Internet.If there is any infringement or improper place,please contact me to delete or correct it.The content of the article can only be referred to,not as a scientific basis.thank you!,山东省肿瘤医院,山东省肿瘤防治研究院,文章内容来源于网络，如果侵权或者不当的地方，请联系我删除或者改正。文章内容仅可参考，不能作为科学依据。谢谢！,The content of this article comes from the Internet.If there is any infringement or improper place,please contact me to delete or correct it.The content of the article can only be referred to,not as a scientific basis.thank you!,山东省肿瘤医院,山东省肿瘤防治研究院,文章内容来源于网络，如果侵权或者不当的地方，请联系我删除或者改正。文章内容仅可参考，不能作为科学依据。谢谢！,The content of 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be referred to,not as a scientific basis.thank you!,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,*,文章内容来源于网络，如果侵权或者不当的地方，请联系我删除或者改正。文章内容仅可参考，不能作为科学依据。谢谢！,The content of this article comes from the Internet.If there is any infringement or improper place,please contact me to delete or correct it.The content of the article can only be referred to,not as a scientific basis.thank you!,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,*,文章内容来源于网络，如果侵权或者不当的地方，请联系我删除或者改正。文章内容仅可参考，不能作为科学依据。谢谢！,The content of this article comes from the Internet.If there is any infringement or improper place,please contact me to delete or correct it.The content of the article can only be referred to,not as a scientific basis.thank you!,*,文章内容来源于网络，如果侵权或者不当的地方，请联系我删除或者改正。文章内容仅可参考，不能作为科学依据。谢谢！,The content of this article comes from the Internet.If there is any infringement or improper place,please contact me to delete or correct it.The content of the article can only be referred to,not as a scientific basis.thank you!,LDCT,：,1.5%,Control,：,0.3%,Stereotactic Body Radiation Therapy(SBRT),Stereotactic Ablative RadioTherapy(SABR),体位固定重复性高，避免治疗间患者运动对治疗精确性的影响,剂量分布高度适形，高剂量区覆盖肿瘤，周围正常组织剂量迅速下降以保护正常组织,个体化测定图像采集、治疗计划和施照时肿瘤的运动并进行针对性的计划制定与实施,通过在线及离线图像引导确保精确施照,最重要的是，在,2,周内通过,3-8,次治疗给予超高生物剂量的照射,不可手术早期,NSCLC,的,SBRT,SABR for Inoperable NSCLC,J Thorac Oncol.2015;10:872882,SBRT vs Proton vs Heavy Ion RT,Grutters et al,Radio Oncol,2009,SBRT is significantly better than 3DCRT in OS and DFS,SBRT is as good as Proton and Heavy Ion.,NSCLC-,病理,T1,，,T2(=100 Gy had better tumor control.,SBRT,剂量思考,肿瘤体积与,SBRT,剂量,期外周型,NSCLC,两种,SBRT,方案疗效比较的长期随访数据（,RTOG0915,，,期研究）,Patient population:,Biopsy-proven NSCLC,medically inoperable,Peripheral,lung tumors(as defined by RTOG 0236,i.e.,2cm from tracheo-bronchial tree),T5cm,N0M0,Objective:,To select the better of the 2 SBRT regimens by comparing them at 1 year(yr.)post SBRT:protocol-specified adverse events;primary tumor control,Int J Radiat Oncol Biol Phys.2015 Nov 15;93(4):757-64.,The true rate of not experiencing a psAE is 83%.,期外周型,NSCLC,34Gy1,次,vs.12Gy4,次（,RTOG0915,，,期研究）,N=39,N=45,结论：,34Gy,组,1,年不良反应发生率和局部控制率满足研究终点要求，建议,III,试验中采用。,期外周型,NSCLC,两种,SBRT,方案疗效比较的长期随访数据（,RTOG0915,，,期研究）,期外周型,NSCLC,两种,SBRT,方案疗效比较的长期随访数据（,RTOG0915,，,期研究）,Arm 1(34Gy1,次,):39,例；,Arm 2(12Gy4,次,):45,例。中位随访,3.8,年。,不良反应：,3,级及以上不良反应发生率较之前结果没有明显变化。,周围型,/,中心型肺癌（,SBRT,）,Central tumors,tumors located 2 cm from the trachea,mainstem bronchus,main bronchi or esophagus,tumors located,3 complications with 3 Fx 20Gy,(,P .004),Decline pulmonary function tests,pneumonias,pleural effusions,apnea,skin reaction,Timmerman,et al.J Clin Oncol,2006;24:4833-4839.,SABR Toxicity of central lung tumor MDACC,2005.2-2011.5,101Pts,T1-2N0M0(n=82);,isolated lung-parenchyma recurrent lesions(n=19),50Gy/4f;or 70Gy/10f,Median Follow-up 30.3m(40.5m for survivor),NO Grade 4 Toxcity,Toxicity%,G1,G2,G3,Chest wall pain,18,13,RP,11,1.9,ASTRO 2014,中心型肺癌,SBRT,剂量,Indiana U/RTOG:60Gy/3f,（,毒性过高,）,MDACC:50Gy/4f,RTOG0813:50-60Gy/5f,VUMC“Risk adapted”:60Gy/3f,5f,or 8f,早期非小细胞肺癌,SBRT,的剂量,早期非小细胞肺癌,SBRT,的剂量不应低于,BE