髓母細胞瘤的放射治療【醫療資料】

髓母細胞瘤的放射治療髓母細胞瘤的放射治療曹嫣娜1優秀課件概述概述來源：胚胎殘留的未分化的原始髓樣上皮細胞。部位：第四腦室頂上的小腦蚓部。發病率：2.1/10萬/年，占兒童顱內惡性腫瘤的1520%。疾病特點：惡性程度高。生長極其迅速；手術難以完整切除；腫瘤細胞易沿腦脊液播散（1646%）。2優秀課件臨床表現臨床表現顱內壓增高：頭痛、嘔吐、視神經乳頭水腫小腦損害：軀干性共濟失調為主其它：復視、面癱、強迫頭位、頭顱增大、病理反射陽性、嗆咳、小腦危象、蛛網膜下腔出血脊髓轉移灶癥狀：背部或雙下肢痛、進行性加重的截癱或四肢癱3優秀課件分級分級Stage Risk staging system Stage Changs M staging systemLow-risk Localized disease at the time of diagnosis M0 No evidence of gross subarachnoid orGroup Age 3 years hematogenous metastasis Total tumor resection or subtotal with residual tumor 1.5 cm3 High-risk Disseminated disease at the time of diagnosis M1 Microscopic tumor cells found inGroup cerebrospinal fluid Age 3 years M2 Gross nodule seeding seen in the cerebellar or cerebral subarachnoid space or in the third or lateral ventricles Subtotal tumor resection with a residual tumor M3 Gross nodule seeding in the spinal 1.5 cm3 subarachnoid space metastasis M4 Extraneural4優秀課件治療方案標準治療方案(“Philadelphia protocol”)手術放療：術后28天內開始。化療(VCP)：放療中VCR1.5mg/m2/w，共8周；放療后6周開始CCNU75mg/m2 DDP75mg/m2 VCR1.5mg/m2/w3w，每6周一個周期，共8個周期。5優秀課件放療劑量低危組：CSI 23.4Gy/13f+后顱窩加量至 54Gy高危組：CSI 36Gy/20f+后顱窩加量至54Gy6優秀課件放療技術常規分割CSI+Boost to posterior fossa 超分割CSI+Boost to posterior fossa SRT Boost to posterior fossa7優秀課件Craniospinal irradiation(CSI):methods俯臥位，雙手置于體側頭部兩側對穿野照射全腦及上段頸髓單后野照射脊髓各野皮膚間隔1cm每照射10Gy移動一次射野以減少各野間交叉高劑量6MV-X線照射劑量(DT)：23.4Gy36Gy,1.8Gy/f8優秀課件9優秀課件Craniospinal irradiation(CSI):doseradiotherapy alone（5-year EFS）Chemotherapy+（5-year EFS）standard radiotherapy reduced-dose radiotherapy60%7.8%41%8%75%7%69%8%Prospective randomised trial of chemotherapy given before radiotherapy in childhood medulloblastoma:International Society of Paediatric Oncology(SIOP)and the(German)Society of Paediatric Oncology(GPO)SIOP II.Med Pediatr Oncol 25:166-178,1995 10優秀課件23.4GyCSI的療效Risk-adapted craniospinal radiotherapy followed by high-dose chemotherapy and Risk-adapted craniospinal radiotherapy followed by high-dose chemotherapy and stem-cell rescue in children with newly diagnosed medulloblastoma(St Jude stem-cell rescue in children with newly diagnosed medulloblastoma(St Jude Medulloblastoma-96):long-term results from a prospective,multicentre trialMedulloblastoma-96):long-term results from a prospective,multicentre trial http:/oncology.the Vol 7 October 2006Vol 7 October 200611優秀課件23.4GyCSI對智力的影響(POG-8631)Journal of Clinical Oncology,Vol 16,No 5,pp.172328,199812優秀課件CSI:cranial-spinal junction site THE CRANIAL-SPINAL JUNCTION IN MEDULLOBLASTOMA:DOES IT MATTER?Int.J.Radiation Oncology Biol.Phys.,Vol.44,No.1,pp.8184,1999Organ low junction(SD)high junction(SD)Cord 40.3Gy(0.5)38.4Gy(1.3)Thyroid gland 20.3Gy(9.2)26.3Gy(0.6)Mandible 6.2Gy(0.6)10.9Gy(5.1)Larynx 8.3Gy(3.9)27.2Gy(0.4)Pharynx 11.9Gy(5.1)20.3Gy(4.8)Parotid gland 14.9Gy(4.2)14.1Gy(4.2)13優秀課件超分割放療Twice-daily l-Gy fractions were administered separated by 4-6 h.放療劑量和射野同常規分割14優秀課件SRT Boost to posterior fossaPOSTERIOR FOSSA BOOST IN MEDULLOBLASTOMA:AN ANALYSIS OF DOSE TO SURROUNDING STRUCTURES USING 3-DIMENSIONAL(CONFORMAL)RADIOTHERAPY Int.J.Radiation Oncology Biol.Phys.,Vol.46,No.2,pp.281286,2000 15優秀課件放療反應急性反應：骨髓抑制、腦水腫等；遠期副作用：甲低認知障礙其它：聽力減退、骨骼發育障礙、周圍組織損傷繼發第二惡性腫瘤等。16優秀課件甲低 Hypothyroid p值值年齡1 5歲 7/7(100%)10歲 2/10(20%)照射劑量123.4Gy+CT 10/12(83%)3歲、低危者(CSF-)、BED超過50Gy、放療持續時間小于50天提示預后較好；低劑量CSI(23.4Gy)/低劑量CSI+化療/HFRT有助于減輕低?；颊哌h期并發癥但并不能增加治愈率；術后應立即開始放療，一般不推薦放療前化療；根據危險性分級選擇放療劑量和化療方案。34優秀課件謝謝！謝謝！35優秀課件