【文档说明】食管癌个体化放射治疗选择性淋巴结区照射的价值课件.ppt，共(60)页，6.256 MB，由小橙橙上传

转载请保留链接：https://www.ichengzhen.cn/view-241540.html

以下为本文档部分文字说明：

食管癌个体化放射治疗选择性淋巴结区照射的价值国内食管癌照射范围☁局部照射野传统野钡片肿瘤部位、病变长度和食管轴向常规野钡片所见加CT扫描根据肿瘤实际范围☁三维立体适形照射野(不规则野)☁精确放疗调强照射野

(多子野叠加，同期推量预防和治疗)☁图像引导生物信息调强(靶区内剂量的不均匀化)2照射野的具体范围与勾画RTOG85-01(鳞癌占82%)放化组锁骨上区到食管胃结合部（下1/3段食管癌不照射锁骨上区)30Gy/15F后缩野到原肿瘤上下各外放

5cm再加20Gy/10F总剂量50Gy单放组原肿瘤上下各外放5cm达50Gy/25F（胸上、中段食管癌照射锁骨上区)缩野至病变上下各外放5cm再加14Gy/7F总剂量64Gy3生存或单放组放化疗结合组首次失败随机62例随机61例（90年前)非随机69例(90后)1年生存(%)34%(21/62

)52%(32/61)62%(43/69)3年生存(%)030%(18/61)18%(26/69)5年生存(%)026%(14/61)14%(10/69)中位生存12.2个月14.1个月16.7个月疾病未控率(%)37%(

23/62)25%(15/61)28%(19/69)局部区域失败(%)16%(10/62)13%(8/61)20%(14/69)单纯远转移(%)15%(6/62)8%(5/61)16%(11/69)局部+区域+远转(%)15%(9/62)8%(5/61)10%(7/69)照射野的具体范围

与结果RTOG85-01长期结果4低剂量组肿瘤上下外放5cm、前后左右外放2cm照射50.4Gy（颈段癌包锁骨上区，电子线补量下段包腹腔干淋巴结区）高剂量组前程同上达50.4Gy后程缩野后为肿瘤上下各外放2cm前后左右外放仍为2cm总剂量64.8Gy照射野的具体范围与勾画RTOG9

4-05（二维放疗）5照射野的具体范围与结果218例可供分析，高、低剂量组各109例，鳞癌占87%和84%中位随访16.4个月，生存者中位随访29.5个月治疗相关死亡高剂量组和低组分别为10%(11例)和2%11例死亡者中，7例发生在≤50.

4Gy过程中3例在高剂量加量中1例在结束64.8Gy后9个月瘘形成RTOG94-05长期结果高剂量组109例低剂量组109例中位生存期13.0个月18.1个月2年生存率39%40%局部区域失败+未控50%55%远转移9%16%全部无差别6☁食管壁内“多源性”病灶Ｍille

r1/7的病例在主病灶2cm外可见继发病灶Pradoura间隔≥5cm多源性癌达16%Reboud多源性食管病变达35%☁淋巴结转移“跳跃式”转移关于食管癌多原发的研究食管癌的生物学特点：“跳跃性”752例食管癌术后亚临床病灶分布亚临床病灶单

纯近端单纯远端上下两端均有总发生率(%)多中心起源7例3例5例15/52(28.9)重度不典型增生11例11例6例28/52(53.9)食管壁内浸润12例10例19例41/52(78.9)CTV纵向外放标准探讨史鸿云祝淑钗翟福山《中华放射肿瘤学杂志》2006;15(4):280-2848多中

心起源、壁内浸润和跳跃性转移均可发生在距主瘤部位较远的食管壁上CTV纵向外放标准探讨这也是胸外科医生要保证手术边界的安全性必须要切除较长的正常食管组织的主要原因马国伟，中华肿瘤杂志，2003，25(5):472～474史鸿云，中华放射肿瘤学杂志，2006，15(4)：280～284Nishi

makiT,WorldJSurg,1996,20(1):32～37LamKY,ClincPathol,1996,49(2):124～1299食管癌生物学特点淋巴结“跳跃式”转移10Detailsofrecurrencesites

afterelectivenodalirradiation(ENI)using3D-conformalradiotherapy(3D-CRT)combinedwithchemotherapyforthoracicesophagealsquamouscellcar

cinoma–AretrospectiveanalysisHideomiYamashita,KaeOkuma,ReikoWakui,ShinoKobayashi-Shibata,KuniOhtomo,KeiichiNakagawaDepartmentofRa

diology,UniversityofTokyoHospital,Hongo,Bunkyo-ku,Tokyo,JapanRadiotherapyandOncology.2011，98：255–26011Deta

ilsofrecurrencesitesafterelectivenodalirradiation(ENI)using3D-conformalradiotherapy(3D-CRT)combinedwithchemot

herapyforthoracicesophagealsquamouscellcarcinoma–Aretrospectiveanalysis(Japan)2000.6-2009.7126例鳞癌中位年龄67岁全部3DCRT疗前均PET病

变部位胸上/胸中/胸下29/53/44例中位长度7.0cm临床分期T1/T2/T3/T428/18/54/26例N0/N150/76M0/M1a/M1b91/5/30Ⅰ/Ⅱ/Ⅲ/Ⅳ22/31/38/35(metastaticsitesofM1bwerelowercervica

l,supra-clavicularorceliacLNs)化疗方案allpatientsreceivedchemotherapyconcurrentlytwocycles5-fluorouracil800mg/m2/day,days

1–4&days29–32nedaplatin80mg/m2,day1&day29同期后再2twocyclessamedosechemotherapyRadiotherapyandOncology.2011，98：255–26012Definitionregional

LNbyAJCCismediastinalandperigastricLNexcludingceliacLN.DefinitionofM1aregioniscervicalLNsintheupperth

oracic,noneinthemiddlethoracic,andceliacLNsinthelowerthoracicesophagus13Detailsofrecurrencesitesafterelectivenodalirradiation(ENI)using3D-co

nformalradiotherapy(3D-CRT)combinedwithchemotherapyforthoracicesophagealsquamouscellcarcinoma–Aretrospectiveanalysis(Japan)GTVin

cludedprimarytumorandLN1cminshortaxisbyCTorPETCTVwasdefinedasthewholethoracicesophagus(fromthesupracl

avicularfossaetotheesophagogastricjunction)includingGTVplus5mmmarginCTVcompriseduptoM1aLNsandregiona

lLNsincludingpositiveLNsPTVaddingmargins5–10mmtotherespectiveCTVsMeanlungD≤20GyV20<20%.Spinalcorddose<45GyAll

patientsENIandweretreated50–50.4Gy/1.8–2Gy/5–5.6W14结果治疗失败40例单纯局部复发20例单纯远转12例局部+远转8例选择性淋巴引流区0例局部失败部位上段

失败34%(10/29)中段9%(5/53)下段11%(5/44)P=0.0073(medianperiodlocalrecurrence6.9months)AfterCRTCR69%(87/126)localresidualtumor31%(39/126)失

败类型16%(20/126)localrecurrence47%(59/126)localrecurrenceand/orresidualtumor15%(19/126)distantfailure38%(48/126)remaineddiseasefreeDetailsofre

currencesitesafterelectivenodalirradiation(ENI)using3D-conformalradiotherapy(3D-CRT)combinedwithchemotherapyforthoracicesophagealsquamousce

llcarcinoma–Aretrospectiveanalysis(Japan)15Detailsofrecurrencesitesafterelectivenodalirradiation(ENI)using3D-

conformalradiotherapy(3D-CRT)combinedwithchemotherapyforthoracicesophagealsquamouscellcarcinoma–Aretrospectiveanalysis(Japan)16结果MTS1年2年3年总生存

28.5±6.9M56%43%无病生存9.0±1.1M46%38%33%Detailsofrecurrencesitesafterelectivenodalirradiation(ENI)using3D-conformalradiotherapy(3D

-CRT)combinedwithchemotherapyforthoracicesophagealsquamouscellcarcinoma–Aretrospectiveanalysis(Japan)RTOG85-0ENIINT0123no-ENIPvalueloca

l/regionalfailureand/orresidualtumor46%55%<0.05MST(months)14.118.1>0.052-yearsurvival36%40%>0.0517Detailsofrecurrencesitesafterel

ectivenodalirradiation(ENI)using3D-conformalradiotherapy(3D-CRT)combinedwithchemotherapyforthoracicesopha

gealsquamouscellcarcinoma–Aretrospectiveanalysis(Japan)18largeradiationfieldsusedinthisstudywasthefundamentaladhere

ncetothefirstradiationfieldusedinRTOG85-01andtheresultsofmostsurgicalseriesinJapanhaveindicatedasurvivalbenefitofprophylactic3-fi

eldLNdissectionforSqCCinthethoracicesophagusDetailsofrecurrencesitesafterelectivenodalirradiation(ENI)using3D-conformalradiotherapy(3D-CRT)com

binedwithchemotherapyforthoracicesophagealsquamouscellcarcinoma–Aretrospectiveanalysis(Japan)ConclussionT

hisstudysuggestthatENIwaseffectiveforpreventingregionalnodalfailureinCRTforesophagealSqCCmorelocalrecur

rencesweredetectedintheupperthaninthemiddleandlowerthoraciccarcinomas19RetrospectiveAnalysisofOutcomeDifferencesinPreop

erativeConcurrentChemoradiationWithorWithoutElectiveNodalIrradiationforEsophagealSquamousCellCarcinomaFeng-MingHsu,M.D.Jan

g-MingLee,M.D.,Ph.D,Pei-MingHuang,M.D.Chia-ChiLin,M.D.,Ph.D.Chih-HungHsu,M.D.,Ph.D.Yu-ChiehTsai,M.D.Yung-ChieLee,M.D.,Ph.D.JasonChia-Hs

ienCheng,M.D.,Ph.DDepartmentofOncology,DepartmentofSurgery，NationalTaiwanUniversityHospital,NationalTaiwa

nUniversityCollegeofMedicine,Taipei,TaiwanInt.J.Radiat.Oncol.Biol.Physi.2011,81(4):593–59920RetrospectiveAnalysisofOutcomeDi

fferencesinPreoperativeConcurrentChemoradiationWithorWithoutElectiveNodalIrradiationforEsophagealSquamousCellCarcinoma(Taiwan)回顾分析118例鳞癌1997年AJCC分期Ⅱ和

Ⅲ术前同期放化疗放疗剂量中位值36Gy后行根治性切除ENI73例62%（锁骨上预防54例和腹腔引流区预防19例）IFI45例38%56例57%接受同期化疗（紫杉醇+顺铂，2周期）随访远处淋巴结转移包括(M1a和M1b)中位随访期38个月材料21Retros

pectiveAnalysisofOutcomeDifferencesinPreoperativeConcurrentChemoradiationWithorWithoutElectiveNodalIrradiationforEsophagealSquamousC

ellCarcinoma(Taiwan)ENI组73例IFI组45例P值围手术期死亡率0.48≥3级心肺毒副反应0.44M1a3年复发率3%11%0.05孤立远LNM(M1a+M1b)10%14%0.293年总生存率45%5

2%0.313年无进展生存率45%43%0.89病理淋巴结转移系总生存的独立影响因素HR=1.78P=0.045结果结论ENI降低了M1a复发率但未改善生存，淋巴结转移系影响因素22RadiotherapyandOncology.2009,92

:266–269Electivenodalirradiation(ENI)indefinitivechemoradiotherapy(CRT)forsquamouscellcarcinomaofthethoracicesophagusMasakatsuOnozawaa,KeijiNihe

ia,SatoshiIshikurac,KeikoMinashib,TomonoriYanob,ManabuMutob,AtsushiOhtsub,TakashiOginoa.1999.2—2001.4102例可分析的鳞癌接受根治性放化同期化疗方案DDP40mg/m2d1,

d85-Fu400mg/m2/dd1-5,d8-12每5周重复,疗中用2周期疗后剂量DDP80mg/m2d1,5-Fu800mg/m2/dd1-5,每4周重复放疗方案CT诊断LNM为长径≥1cm范围胸上段包括锁骨上,胸下段包括

腹腔在ENI野内前后两野对穿40Gy/20F/4W休息2周后给予后程放疗斜野或多野20Gy/10F/2WCTV包括原发瘤和转移淋巴结,上下外放3cmPTV包括原发瘤和转移淋巴结和区域淋巴结,放1~1.5cm2324所有病人中位随

访17个月(3-62)存活者中位随访41个月(9-62)放化疗后获CR62例占59%其中40例生存20例复发转移3年总生存率43%失败模式局部失败即原发瘤复发累及淋巴结复发即原有转移的远处失败即除原发瘤和区域LNM外选择淋巴结复发即在ENI野内的Radiotherapyan

dOncology.2009,92:266–269Electivenodalirradiation(ENI)indefinitivechemoradiotherapy(CRT)forsquamouscellcarcinomaoftheth

oracicesophagus25Electivenodalirradiation(ENI)indefinitivechemoradiotherapy(CRT)forsquamouscellcarcinomaofthet

horacicesophagusInCRTforesophagealSCCENIiseffectiveforpreventingregionalnodalfailureFurtherevaluationofwhetherENIleadstoanimprovedoverallsur

vivalisneeded结论RadiotherapyandOncology.2009,92:266–26926Electivelymphnodeirradiationlatecourseacceleratedhyper-fra

ctionatedradiotherapyplusconcurrentcisplatin-basedchemotherapyforesophagealsquamouscellcarcinoma:aphaseIIs

tudyDongqingWang,JialiYang,JingyuZhu,BaoshengLi,LiminZhai，MingpingSun,HeyiGong,TaoZhou,YumeiWei,WeiHuang,ZhongtangWang,HongshengLiandZichengZhang

DepartmentofRadiationOncology,ShandongCancerHospital,ShandongAcademyofMedicalSciences,Jinan,ChinaRadiationOncology2013,8:10827Electivel

ymphnodeirradiationlatecourseacceleratedhyper-fractionatedradiotherapyplusconcurrentcisplatinbasedchemotherapyforesophagealsquamouscellc

arcinoma:aphaseIIstudy2004.1-2011.1168例AJCC分期Ⅱ--Ⅳa食管鳞癌回顾性分析中位年龄63岁(40-75)KPS≥80颈段/胸上/胸中/胸下8/24/27/9Ⅱ/Ⅲ/Ⅳa分期为

14/32/22比例为20.6%、47.1%、32.3%2周期以DDP基础同期化疗DDP+5-Fu20例占29.4%DDP+Capecitabine12例占17.5%DDP+pemetrexed32例占47.1%临床材料28Electivelymphnodeirradiati

onlatecourseacceleratedhyper-fractionatedradiotherapyplusconcurrentcisplatinbasedchemotherapyforesophagealsquamouscellcarcinoma:apha

seIIstudy放疗方案GTVp+GTVnGTVp上下各外放5cm,轴向外放1cm前程PTV1GTVn上下和轴向均外放0.8cm高危淋巴引流区HRLNR均匀外放0.8cm处方剂量40Gy/20F/4WG

TVp上下各外放3cm,轴向外放1cm后程PTV2GTVn上下和轴向均外放0.8cm不再照射高危淋巴引流区HRLNR19.6Gy/14F/1.4W1.4Gy/F2F/d间隔>6h前后两程总剂量59.6Gy/34F/5.4W29Electivelymphn

odeirradiationlatecourseacceleratedhyper-fractionatedradiotherapyplusconcurrentcisplatinbasedchemotherapyforesophagealsquamouscellcarc

inoma:aphaseIIstudy30Electivelymphnodeirradiationlatecourseacceleratedhyper-fractionatedradiotherapyplusconcurren

tcisplatinbasedchemotherapyforesophagealsquamouscellcarcinoma:aphaseIIstudy31Electivelymphnodeirradiationlatecou

rseacceleratedhyper-fractionatedradiotherapyplusconcurrentcisplatinbasedchemotherapyforesophagealsquamouscellcarcinoma:aphaseIIstudy32El

ectivelymphnodeirradiationlatecourseacceleratedhyper-fractionatedradiotherapyplusconcurrentcisplatinbasedchemotherapyforesophagealsquamouscellc

arcinoma:aphaseIIstudy33Electivelymphnodeirradiationlatecourseacceleratedhyper-fractionatedradiotherapyplusconcur

rentcisplatinbasedchemotherapyforesophagealsquamouscellcarcinoma:aphaseIIstudy中位随访18.5个月中位生存34.4个月1年3年5

年P值总生存率75.5%46.5%22.7%Ⅱ期和Ⅲ期总生存率78.6%49.4%39.9%0.671Ⅳa期总生存率68.3%41.0%15.4%治疗结果首次失败局部复发20.6%局部+区域失败者29.4%(20/68)区域失败17.6%远处转移19.1%≥3级急性食管炎和白细胞下降26.4%

(18/68)和32.4%(22/68)≥3级晚期损伤：食管狭窄1例，肺纤维化1例，5例死于晚期并发症(消化道出血3例，瘘2例)34临床资料12005.1---2010.12食管癌患者219例接受放疗男144例,

女75例,中位年龄67岁(40～89岁)2根据是否采用淋巴引流区放疗分为预防野组114例，累及野组105例3临床分期采用2009年中国非手术治疗食管专家小组提出的《非手术治疗食管癌临床分期标准》入组条件1病理或细胞学证实的食管

癌患者2进流食或半流食,卡氏评分≥70分3不合并严重内科疾病4无食管出血、穿孔等征象5可行根治性放射治疗初治患者6CT检查未发现远处转移者食管鳞癌根治性放化疗淋巴引流区预防照射的比较研究35食管鳞癌根治性放化疗淋巴引流区预防照射的比较研究Upperthoracic

esophagusMiddlethoracicesophagusLowerthoracicesophagus36食管鳞癌根治性放化疗淋巴引流区预防照射的比较研究➢GTV为增厚食管壁及阳性淋巴结➢CTV为GTV轴向外扩0.5cm,上下外扩1.5～2.0cm➢PTV为CTV各方向外扩

0.5～1.0cm➢CTV1为淋巴引流区预防照射胸上段：锁骨上淋巴引流区、食管旁、2区、4区、5区、7区及部分8区即隆突下3.5-4.0cm胸中段：食管旁、2区、4区、5区、7区、8区及9区纵隔淋巴结并包括贲门旁淋巴结或/和胃左区胸下段：食管旁、4区、5区、7区、

8区及9区纵隔淋巴结贲门旁淋巴结和胃左淋巴引流区或/和腹主动脉旁➢PTV1在CTV1基础上各外放0.5～1.0cm37食管鳞癌根治性放化疗淋巴引流区预防照射的比较研究处方剂量累及野组：95%PTV60Gy～66Gy预防野组：前程95%PTV146Gy～52Gy后程缩野至PTV5

6Gy～66Gy➢随访方式包括门诊复查、电话随访等➢采用SPSS11.5进行统计分析。➢计数资料采用χ2检验或精确概率法。➢Kaplan-Meier统计生存率、局控率、无远处转移率,Log-rank检验➢多因素分析采用Cox回归模型➢P＜0.05判定为有统计学意义38食管

鳞癌根治性放化疗淋巴引流区预防照射的比较研究中位值（月）1-year3-year5-year局控率2866.94%46.44%40.47%生存率2370.78%35.64%20.74%无远转生存率--79.93%66.20%55.04%随访截至2012年1

2月31日，中位时间23个月(2～82.3)随访率为96.35％39食管鳞癌根治性放化疗淋巴引流区预防照射的比较研究临床资料累及野组预防野组统计值P值姓别(例)男6678χ2=0.750.39女3936年龄(岁)平均值68.77±9.9163.05±8.70t

=4.550.00中位值6963原发部位(例)颈段38χ2=12.990.01胸上段2245胸中段5042胸下段3019T分期(例)T1+22351χ2=12.70.00T32015T46248N分期(例)N06762χ2=2.

000.16N1+23852TNM分期(例)Ⅰ1730χ2=3.340.19Ⅱ2624Ⅲ6260是否化疗(例)是3846χ2=0.400.53否676840靶区例数中位值1年3年5年χ2值P值局控率IFI1052062.9739.0627.26.220.01ENI114-

-70.5153.3451.67生存率IFI1051967.6224.915.005.040.03ENI1142573.7145.0626.00无远转率IFI105--76.4460.8160.810.050.83

ENI114--83.0069.5152.29食管鳞癌根治性放化疗淋巴引流区预防照射的比较研究41变量因素组别例数中位值局控率χ2值P值1年3年5年年龄（岁）＜65IFI351857.3428.9119.276.820.01ENI62--69.3158.03

54.81≥65IFI702465.7944.4731.131.410.24ENI523572.0047.4347.43病变部位颈+胸上段IFI252366.7843.8526.310.290.59ENI53336

7.3647.7243.38中段下段IFI802061.7137.7133.007.170.01ENI61--73.5059.1159.11T分期T1+2IFI234778.2650.4025.203.700.06ENI51

--85.9468.9165.53T3IFI202477.8238.43--0.050.83ENI152870.5236.6236.62T4IFI621351.6434.8934.891.020.31EN

I481853.7342.4342.43影响两组局控率的各因素的分层分析42变量因素组别例数中位值局控率χ2值P值1年3年5年N分期TNM分期N0IFI672469.4941.2818.355.940.01ENI62--76.4758.2655.3

4N1+2IFI381351.4535.0835.081.930.16ENI523563.1051.0047.36ⅠIFI174776.4750.53--3.760.05ENI30--86.770.5165.12ⅡIFI262579.2141.3033.

010.570.30ENI24--78.1253.4353.43ⅢIFI621351.6439.9139.913.150.19ENI602358.9244.7244.72GTV体积(cm3)＜30IFI212666.6732.1432.14

3.190.07ENI52--76.6358.6255.3730～60IFI442466.1240.3921.541.470.23ENI38--67.0650.8450.84＞60IFI401353.1033.9933.990.

830.36IFI243561.4950.137.58化疗无IFI672065.4340.7317.463.940.04ENI68--69.9153.6153.61有IFI381858.7836.5636.5

62.470.12IFI463871.2653.1548.72续表影响两组局控率的各因素的分层分析432023/4/72023/4/7年龄<65岁胸中下段N0期未化疗变量因素组别例数中位值生存率χ2值P值1年3年5年年龄（岁）＜65IFI351660.0024.7518.563.390.07

ENI623777.4251.3524.74≥65IFI702071.4324.4612.041.410.22ENI522376.9237.8823.14病变部位颈+胸上段IFI251772.0030.0024.000.330.57ENI533077.3648.599.82中

下段IFI8020.466.2523.0211.164.020.04ENI612570.4942.3230.20T分期T1+2IFI233491.3049.6021.260.630.43ENI514684.3152.843.82T3IFI202

075.0133.82--0.020.88ENI152966.7038.129.52T4IFI621456.5012.3212.321.570.21ENI481764.6233.3311.52影响两组生存率的各因素的分层分析45变量因素组别例数中位值生存率χ2值P值1

年3年5年N分期N0IFI672474.6329.7212.396.130.01ENI624080.6557.7829.72N1+2IFI381655.2616.7116.711.150.28ENI521865.3830.1322.25TNM分期ⅠIFI173988.

2451.4714.303.130.08ENI30--86.7073.2150.84ⅡIFI262380.8035.6222.340.710.40ENI243679.2148.1328.44ⅢIFI62145

6.5212.4312.431.130.29ENI501565.0030.0011.22GTV体积(cm3)＜30IFI211880.9530.2320.163.400.07ENI525282.6956.9439.3730～60IFI442170.4534.

2916.530.040.84ENI382381.5844.7418.08＞60IFI401857.5011.0811.080.000.95ENI241458.3318.759.38化疗无IFI671970.1517.7

811.432.860.10ENI682370.5939.3728.10有IFI382165.7935.8421.501.150.28ENI463878.2653.320.26影响两组生存率的各因素的分层分析续表46变量累及野组预防野组χ2值P值肺平均1212.66±371.801449.

12±328.824.990.00V553.66±18.5765.95±18.034.970.00V1040.75±14.5149.96±14.124.70.00V2021.69±7.2826.94±6.205.730.00V3011.97±4.9714.60±4.484.130

.00心脏平均2039.92±1439.862209.68±1337.990.900.37V2538.30±28.4041.44±27.360.830.41V3035.04±26.4037.06±25.700.570.57V4025.

39±22.0425.16±22.830.070.94V4519.41±18.6518.19±18.850.480.63V5013.15±12.9312.46±14.230.370.71脊髓最大4244.47±505.434353.62±234.002.020.0

5两组正常组织受照剂量的比较47级别n1级2级3级χ2值P值n%n%n%累及野组1054744.80%2523.80%21.90%4.470.22预防野组1145850.90%3328.90%32.60%级别n1级2级χ2值P值n%n%累及野组10576.70%98

.60%2.080.35预防野组1141412.30%87.00%食管鳞癌根治性放化疗淋巴引流区预防照射的比较研究两组急性放射性肺炎比较两组急性放射性食管炎比较48胸中下段N0期食管鳞癌根治性放化疗淋巴引流区预

防照射的比较研究结论1早期及胸中下段食管癌患者采用ENI方案有生存获益2淋巴引流区预防照射并未明显增加急性正常组织损伤49食管癌根治放疗靶区勾画建议GTV-T食管壁厚度≥0.5cm或不含气管腔直径≥1.0cm参考食管造影和食

管镜、PET-CT勾画GTV-TCTV-TGTV-T沿食管纵轴上下外放1.5~2.0cm轴向外放0.5~1.0cm为CTV-T再根据解剖部位和淋巴引流区域适当修改调整PTV-TCTV上下外扩1.0cm，轴向外扩0.5cm为PTV-T(结合本单位的摆

位误差)原发肿瘤病灶局部勾画50GTV-N根据淋巴结大小，结合其形态、密度、部位等单个淋巴结肿大短径≥1.0cm同一部位多个淋巴结肿大短径≥0.5cm特殊部位如食管旁、气管食管旁沟淋巴结等短径≥0.5cmCTV-NGTV-N均匀外扩0.5cmPTV-NCTV-N均匀外扩

0.5cm食管癌根治放疗靶区勾画建议纵隔淋巴结勾画51☁CTV１需预防照射的淋巴结引流区颈段胸上段锁骨上、食管旁、2区、4区、5区、7区、8区胸中段食管旁、2区、4区、5区、7区、８区和贲门胸下段食管旁、4区、5区、7区、８区、胃左贲门周围☁PTV１在CTV1基础上各外放0.5

～0.８cm食管癌根治放疗靶区勾画建议淋巴结引流区的勾画处方剂量95%PTV体积接受60～64Gy/30~32次/6～6.4周或95%PTV1体积接受50Gy/25次/5周再95%PTV体积接受10～14Gy/5～7次52放疗靶区53放疗靶区截面图

545556处方剂量及危及器官剂量限制（常规分割）要求95%PTV体积接受100%以上的处方剂量脊髓Dmax<45Gy心脏Dmean≤30GyV25-30≤50%V40≤30%双肺V5≤60~65%V10≤50～40%V20≤25～30%V30≤15～18%，MLD≤15Gy若不能全部满足，首先要

满足脊髓以及双肺V5和V20食管癌根治放疗靶区勾画建议5758谢谢58谢谢！59谢谢大家！结语