最新台湾董氏针灸穴位图(下)幻灯片课件

M0 No evidence of gross subarachn hematogenous metastasis
M1 Microscopic tumor cells found i cerebrospinal fluid
Age ≤3 years
Subtotal tumor resection with a residual tumor ≥1.5 cm3
Craniospinal irradiation (CSI):dose
radiotherapy alone Chemotherapy+
（5-year EFS）
（5-year EFS）
standard radiotherapy
60% ± 7.8%
75% ± 7%
reduced-dose radiotherapy
Society of Paediatric Oncology (GPO)—SIOP II. Med Pediatr Oncol 25:166-178, 1995
23.4GyCSI的疗效
Fra Baidu bibliotek
Risk-adapted craniospinal radiotherapy followed by high-dose chemotherapy
41% ± 8%
69% ± 8%
Prospective randomised trial of chemotherapy given before radiotherapy in childhood medulloblastoma: International Society of Paediatric Oncology (SIOP) and the (German)
http://oncology.the lancet.com Vol 7 October
2006
23.4GyCSI对智力的影响(POG-8631)
Journal of Clinical Oncology, Vol 16, No 5, pp. 1723–28, 199
CSI:cranial-spinal junction site
high junction(SD
38.4Gy (1.3) 26.3Gy (0.6) 10.9Gy (5.1) 27.2Gy (0.4) 20.3Gy (4.8) 14.1Gy (4.2)
THE CRANIAL-SPINAL JUNCTION IN MEDULLOBLASTOMA: DOES IT MATTER?
治疗方案
• 标准治疗方案(“Philadelphia protocol”)
• 手术 • 放疗：术后28天内开始。 • 化疗(VCP)：放疗中VCR1.5mg/m2/w，共8周；
放疗后6周开始CCNU75mg/m2 DDP75mg/m2 VCR1.5mg/m2/w×3w， 每6周一个周期，共8个周期。
Low-risk Localized disease at the time of diagnosis Group Age >3 years
Total tumor resection or subtotal with residual tumor <1.5 cm3 High-risk Disseminated disease at the time of diagnosis Group
临床表现
• 颅内压增高：头痛、呕吐、视神经乳头水肿 • 小脑损害：躯干性共济失调为主 • 其它：复视、面瘫、强迫头位、头颅增大、病
理反射阳性、呛咳、小脑危象、蛛网膜下腔出 血
• 脊髓转移灶症状：背部或双下肢痛、进行性加 重的截瘫或四肢瘫
分级
Stage Risk staging system
Stage Chang's M staging system
Craniospinal irradiation (CSI):methods
• 俯卧位，双手置于体侧 • 头部两侧对穿野照射全脑及上段颈髓 • 单后野照射脊髓 • 各野皮肤间隔1cm • 每照射10Gy移动一次射野以减少各野间交叉
高剂量 • 6MV-X线照射 • 剂量(DT)：23.4Gy~36Gy, 1.8Gy/f
台湾董氏针灸穴位图(下)
髓母细胞瘤的放射治疗
曹嫣娜
概述
• 来源：胚胎残留的未分化的原始髓样上皮细胞。 • 部位：第四脑室顶上的小脑蚓部。 • 发病率：2.1/10万/年，占儿童颅内恶性肿瘤的
15~20%。 • 疾病特点：恶性程度高。
①生长极其迅速； ②手术难以完整切除； ③肿瘤细胞易沿脑脊液播散（16~46%）。
M2 Gross nodule seeding seen in t
cerebellar or cerebral subarach space or in the third or lateral ventricles M3 Gross nodule seeding in the sp subarachnoid space metastasis M4 Extraneural
and stem-cell rescue in children with newly diagnosed medulloblastoma (St
Jude Medulloblastoma-96): long-term results from a prospective, multicentre
trial
放疗剂量
• 低危组：CSI 23.4Gy/13f+后颅窝加量至 54Gy
• 高危组：CSI 36Gy/20f+后颅窝加量至54Gy
放疗技术
• 常规分割CSI+ Boost to posterior fossa • 超分割CSI+ Boost to posterior fossa • SRT Boost to posterior fossa
Organ
Cord Thyroid gland Mandible Larynx Pharynx Parotid gland
low junction(SD)
40.3Gy (0.5) 20.3Gy (9.2) 6.2Gy (0.6) 8.3Gy (3.9) 11.9Gy (5.1) 14.9Gy (4.2)