腮腺癌精准放疗靶区勾画
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• None of the high-risk node-negative patients who received ENI developed regional failure. T stage, N stage, grade, and presence of perineural invasion and facial paralysis correlated significantly with DFS.
腮腺癌精准放疗靶区勾画
四川省肿瘤医院 电子科技大学医学院附属肿瘤医院 冯梅
CRTOG
1
背景
• 涎腺肿瘤发病率为1-3/10万，占头颈部肿瘤5-6%
• 大涎腺包括腮腺，下颌下腺和舌下腺
• 腮腺肿瘤发病率最高，良性肿瘤绝大多数，恶性肿瘤不足20%
CRTOG
2
病理类型
• 涎腺肿瘤绝大多数来自于腺上皮，少数来源于中胚叶。 • 病理类型：粘液表皮样癌、腺样囊性癌、腺泡细胞癌、腺癌、
CRTOG
10
• 4068恶性唾液腺肿瘤，来自于National Cancer Database • 67.1%行术后放疗，32.9%未接受术后放疗 • 中位随访49.1月 • 5年OS提高（56% vs 50.6%） • 多因素分析提示，放疗和性别是可能的独立预后因素
CRTOG
Hale Waihona Puke Baidu
11
• METHODS: 96 patients treated with gross total resection and IORT for primary or recurrent cancer of the parotid gland. IORT was administered as a single fraction of 15 or 20 Gy with 4-6-MeV electrons.
分值 2 3 4 5 6
淋巴结转移率 4% 12% 25% 33% 38%
CRTOG
Terhaard CHJ, Lubsen H, Rasch CRN et al (2005) The role of radiotherapy in the treatment of malignant salivary gland tumors. Int J Radiat Oncol Biol Phys 61:103–111
• RESULTS: 1 patient experienced local recurrence, 19 developed regional recurrence, and 12 distant recurrence. The recurrence-free survival rate at 5 years was 65.2%. The 5-year OS after surgery and IORT was 56.2%. Complications developed in 26 patients.
6
AJCC 7th
分期
CRTOG
7
治疗原则
• 手术：主要的治疗手段
• 放疗：术后，不可手术、复发 回顾性研究（高危因素） 缺乏RCT研究
• 化疗: 没有证据
CRTOG
8
治疗原则
• 高危因素：高级别，pT3- 4，近切缘/切缘阳性，深叶受侵， 淋巴结阳性（≥2枚），神经周围受浸润等
• 中子和离子治疗可能取得更好的LC • 近距离治疗或术中放疗可用于复发肿瘤
癌在多形性腺瘤中、鳞状细胞癌等 • 病理类型复杂，生物学行为不同，临床表现和预后也各异。
CRTOG
3
解剖基础
• 腮腺位于下颌升支和咬肌的外侧 • 面神经将腮腺分为深叶和浅叶 • 腮腺通过Stensen导管引流到上颌第二磨牙，再到达口腔 • 腮腺淋巴引流到腮腺内和腮腺外淋巴结，接着到患侧I, II,
CRTOG
9
• 186 primary parotid carcinoma treated with surgery and postoperative radiotherapy, ENI was applied to high-risk, node-negative disease.
• 5-year LRC, DFS, CSS, and OS were 89%, 83%, 80%, and 68%. More LRF were reported in patients with squamous cell and high-grade mucoepidermoid carcinoma (21% and 19%), and more DM in patients with adenoid cystic and adenocarcinoma (20% and 19%).
和III区淋巴引流区
CRTOG
4
淋巴结转移规律
• 淋巴结转移风险低于头颈部鳞癌 • 淋巴结转移的发生率随着病理类型、肿瘤部位的不同而变化 • 腺样囊性癌和腺泡细胞癌的颈淋巴结转移率低，腺样囊性癌
约5–8% • 鳞癌、腺癌、涎腺导管癌易发生淋巴结转移
CRTOG
5
腮腺癌淋巴结转移规律
根据T分期和病理类型进行分值计算： 1、T1=1；T2=2；T3-4=3； 2、腺样囊性癌/腺泡样癌=1；粘液表皮样癌=2；鳞癌/未分化癌=3。
• The 5-year cumulative incidence of grade ≥2 late toxicity was 8%. QOL scores deteriorate, returned to baseline scores within 6 months.
• The role of adjuvant systemic or targeted therapy in patients at high risk of DM should be investigated in prospective trials.
• CONCLUSIONS: IORT results in effective local disease control at acceptable levels of toxicity and should be considered for patients with primary or recurrent cancer of the parotid gland.
腮腺癌精准放疗靶区勾画
四川省肿瘤医院 电子科技大学医学院附属肿瘤医院 冯梅
CRTOG
1
背景
• 涎腺肿瘤发病率为1-3/10万，占头颈部肿瘤5-6%
• 大涎腺包括腮腺，下颌下腺和舌下腺
• 腮腺肿瘤发病率最高，良性肿瘤绝大多数，恶性肿瘤不足20%
CRTOG
2
病理类型
• 涎腺肿瘤绝大多数来自于腺上皮，少数来源于中胚叶。 • 病理类型：粘液表皮样癌、腺样囊性癌、腺泡细胞癌、腺癌、
CRTOG
10
• 4068恶性唾液腺肿瘤，来自于National Cancer Database • 67.1%行术后放疗，32.9%未接受术后放疗 • 中位随访49.1月 • 5年OS提高（56% vs 50.6%） • 多因素分析提示，放疗和性别是可能的独立预后因素
CRTOG
Hale Waihona Puke Baidu
11
• METHODS: 96 patients treated with gross total resection and IORT for primary or recurrent cancer of the parotid gland. IORT was administered as a single fraction of 15 or 20 Gy with 4-6-MeV electrons.
分值 2 3 4 5 6
淋巴结转移率 4% 12% 25% 33% 38%
CRTOG
Terhaard CHJ, Lubsen H, Rasch CRN et al (2005) The role of radiotherapy in the treatment of malignant salivary gland tumors. Int J Radiat Oncol Biol Phys 61:103–111
• RESULTS: 1 patient experienced local recurrence, 19 developed regional recurrence, and 12 distant recurrence. The recurrence-free survival rate at 5 years was 65.2%. The 5-year OS after surgery and IORT was 56.2%. Complications developed in 26 patients.
6
AJCC 7th
分期
CRTOG
7
治疗原则
• 手术：主要的治疗手段
• 放疗：术后，不可手术、复发 回顾性研究（高危因素） 缺乏RCT研究
• 化疗: 没有证据
CRTOG
8
治疗原则
• 高危因素：高级别，pT3- 4，近切缘/切缘阳性，深叶受侵， 淋巴结阳性（≥2枚），神经周围受浸润等
• 中子和离子治疗可能取得更好的LC • 近距离治疗或术中放疗可用于复发肿瘤
癌在多形性腺瘤中、鳞状细胞癌等 • 病理类型复杂，生物学行为不同，临床表现和预后也各异。
CRTOG
3
解剖基础
• 腮腺位于下颌升支和咬肌的外侧 • 面神经将腮腺分为深叶和浅叶 • 腮腺通过Stensen导管引流到上颌第二磨牙，再到达口腔 • 腮腺淋巴引流到腮腺内和腮腺外淋巴结，接着到患侧I, II,
CRTOG
9
• 186 primary parotid carcinoma treated with surgery and postoperative radiotherapy, ENI was applied to high-risk, node-negative disease.
• 5-year LRC, DFS, CSS, and OS were 89%, 83%, 80%, and 68%. More LRF were reported in patients with squamous cell and high-grade mucoepidermoid carcinoma (21% and 19%), and more DM in patients with adenoid cystic and adenocarcinoma (20% and 19%).
和III区淋巴引流区
CRTOG
4
淋巴结转移规律
• 淋巴结转移风险低于头颈部鳞癌 • 淋巴结转移的发生率随着病理类型、肿瘤部位的不同而变化 • 腺样囊性癌和腺泡细胞癌的颈淋巴结转移率低，腺样囊性癌
约5–8% • 鳞癌、腺癌、涎腺导管癌易发生淋巴结转移
CRTOG
5
腮腺癌淋巴结转移规律
根据T分期和病理类型进行分值计算： 1、T1=1；T2=2；T3-4=3； 2、腺样囊性癌/腺泡样癌=1；粘液表皮样癌=2；鳞癌/未分化癌=3。
• The 5-year cumulative incidence of grade ≥2 late toxicity was 8%. QOL scores deteriorate, returned to baseline scores within 6 months.
• The role of adjuvant systemic or targeted therapy in patients at high risk of DM should be investigated in prospective trials.
• CONCLUSIONS: IORT results in effective local disease control at acceptable levels of toxicity and should be considered for patients with primary or recurrent cancer of the parotid gland.