肿瘤综合治疗进展2PPT文档格式.ppt
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Int.JYuetal;
Int.JRadRadOncolOncolBioPhys2009BioPhys2009外科标本最大径外科标本最大径病理标本最大径病理标本最大径实际标本最大径实际标本最大径CT纵隔窗大小纵隔窗大小CT肺窗大小肺窗大小PET-CT大小大小由病理科医生所勾画的肿瘤镜下边界,画线的右边是肿瘤外界肿瘤组织正常肺泡结构正常肺泡结构放大倍数放大倍数4040病理医生勾画好肿瘤边界后的病理医生勾画好肿瘤边界后的HEHE切片切片CT,FDGPET&
PET/CT与病理最大径的比较与病理最大径的比较MeasurementofBiggestTumorDimensionMeasurementofBiggestTumorDimensionCTsize(cm)PETsize(cm)PET/CTsize(cm)Pathologysize(cm)Xaxis(n=4.3)5.511.364.921.205.071.285.201.22Yaxis(n=4.3)5.581.605.141.485.181.505.271.61Zaxis(n=4.3)5.671.395.341.255.401.255.501.37Nosignificantdifference,P0.05;
Yu.EuropJournalofRadiology2008病理体积与病理体积与PET/CT影像体积的比较研究影像体积的比较研究CT&
FDGPET-CTforNSCLCN-StagePathologyResultsCTStagePET-CTStageN-StageNumberN-StageNumberN-StageNumberN049N0N1N229(40%)614N0N1N241(75%)53N148N0N1N21026(55%)12N0N1N2139(80%)8N225N0N1N29313(50%)N0N1N25218(75%)DiagnosticvaluesofDiagnosticvaluesofFLTVSFDGFLTVSFDGforforlymphnodeDetectioninNSCLClymphnodeDetectioninNSCLCpNstagePtNFLTPET/CTFDGPET/CTSensiSpeciAccuPPVNPVSensiSpeciAccuPPVNPVpN0139696010084840100pN11268978793858876806692pN2660978492828073756287PPV:
positivepredictvalue;
NPV:
negativepredictvalueNSCLC原发灶镜下侵袭范围原发灶镜下侵袭范围中华肿瘤杂志中华肿瘤杂志2004年第年第9期期病理类型病理类型XX轴轴YY轴轴ZZ轴轴平均值平均值95%CTV腺癌腺癌1.801.102.862.482.171.582.181.807mm鳞癌鳞癌1.370.971.451.031.141.261.331.095mmP值值0.180.0170.0350.001临床靶区的设定临床靶区的设定取决于病理和靶取决于病理和靶区边界失败频度区边界失败频度患者男性患者男性,73岁岁,PET-CT示示左下肺占位左下肺占位,平均平均SUV=20.3最大最大SUV=30.2术后病理为低分化鳞癌术后病理为低分化鳞癌最大显微镜下浸润范围最大显微镜下浸润范围-Microextension,ME为为6.0mmFDG-PET-SUV用于用于CTV扩充区扩充区前瞻性前瞻性研究研究ProspectiveStudyofCTV-MarginbyPET-SUVSUV&
MTV与肿瘤镜下浸润范围关系与肿瘤镜下浸润范围关系2009ASTROOralPresentation-ChicagoP=0.008P0.00139例例NSCLCME平均值为平均值为4.61mm2.71mm肿瘤最大肿瘤最大SUV的平均值为的平均值为7.242.41肿瘤代谢体积的平均值为肿瘤代谢体积的平均值为40.62cm333.66cm3PhaseIIITrial:
ENIPhaseIIITrial:
ENIvsvsIFI;
Yu,ASCO-2006IFI;
Yu,ASCO-2006STDFSTDFIFIFStageIIINSCLC:
StageIIINSCLC:
ChTChT/RT;
200PtsRandomized/RT;
200PtsRandomizedParameterParameter2YrLF2YrLF1YrOS1YrOS2YrOS2YrOS3YrOS3YrOSENI4959.725.619.2IFRT4167.238.727.3P=0.048RTOG-0617及及NCCN引证引证III期期NSCLC建议累及野照射建议累及野照射关于肿瘤的预防照射关于肿瘤的预防照射ElectiveNodeIrradiation,ENIp如果我们控制那些可见病灶如果我们控制那些可见病灶(GTV)都很困难的话都很困难的话;
p那我们何必要去做没有任何意义的那我们何必要去做没有任何意义的预防性照射呢?
预防性照射呢?
ButAsWeKnowThatButAsWeKnowThat:
AreesophagealcancersAreesophagealcancerslikeinlikeinUSAandinChinaUSAandinChinaHorsesofadifferentcoloranddifferentfunctions?
Horsesofadifferentcoloranddifferentfunctions?
治疗结果治疗结果-TreatmentResultsParametersOverallsurvivalProgressionfreesurvivalFollowtime1yr3yr5yr1yr3yr5yrSurgerygroup88.6%56.2%34.7%73.3%39.7%20.6%RTgroup93.3%61.5%36.9%75.9%43.7%23.1%OverallSurvivalSurgerygroupvsRTgroupOverallSurvivalmonthsProgression-FreeSurvivalinSurgerygroupvsRTgroup为何需要放化疗联合靶向为何需要放化疗联合靶向WhyWhyCetuximab+CCRTCetuximab+CCRTpWereallyneedbetterresultsforCancerspEncouragingresultsinthelabresearchInVitro:
CellCultureInVivo:
AnimalStudypEncouragingresultsintheclinicresearchHeadandneckcancerM-Colo-rectalCancerPreliminarydataforNSCLC西妥昔单抗西妥昔单抗+紫杉醇紫杉醇+顺铂顺铂+同步放疗同步放疗(400/250mg/m2)(45mg/m2)(20mg/m2)(59.4Gy)主要评价:
临床缓解率主要评价:
临床缓解率颈段颈段+胸中上段胸中上段食管鳞癌食管鳞癌(44例例)次要评价:
安全性次要评价:
安全性/生存率生存率其他评价:
其他评价:
K-RAS基因检测基因检测EXCEL-0901ProtocleW2W3评价临床缓解率评价临床缓解率评价临床缓解率评价临床缓解率同步放化疗同步放化疗同步放化疗同步放化疗+cetuximabcetuximabCetuximab(400mg/250mg/m2)W4W5W6W7W1Cisplatin(20mg/m2)3DCRT(1.8GyX33fractions)Paclitaxel(45mg/m2)苯海拉明苯海拉明(50mg)地塞米松地塞米松(5-10mg)试试验验流流程程-FlowChart-FlowChartW8PD153035食管癌食管癌EGFR显像显像XXX,男性男性,64岁岁,胸上段食管鳞癌胸上段食管鳞癌,SUVmax=1.68,T/NT=2.8治疗前和中食管钡餐对比治疗前和中食管钡餐对比治疗前治疗前放疗放疗23.4Gy/13次次