前列腺癌靶区勾画VIP专享VIP免费

前列腺癌靶区勾画中国医科院肿瘤医院前列腺癌发病率和死亡率国别发病率死亡率美国23万（95.1/10万）3万中国7/10万(城市8.51/10万)2.72/10万GroupMSKCC(T1-T21819)ClevelandClinicFoundation(localizedprostatecancer1682)Cases7-yearbRFSCases8-yearbRFSBrachy73374%EBRT34077%62870%,RP74679%105472%P=0.1P>0.05RadiotherOncol.2004Apr;71(1):29-33.JClinOncol.2002Aug15;20(16):3376-85.对于局限期前列腺癌，根治性前列腺切除与放射治疗疗效相当解剖AnatomyYellow:PeripheralglandBlue:TransitionalzoneRed:CentralglandGreen:Anteriorfibromuscularzone前列腺癌的靶区包括范围前列腺精囊腺盆腔淋巴引流区前列腺及包膜受侵情况CTVinProstateCancerCTV=prostate{(+SV)+LN}ExtracapsularExtensionassociatedwithPSA,GS,andTstagesP=:3/2(PSA)+(Gleasonscore–3)x10Partin’sTablesRoachIII.JUrol150:1923-24,1993WangL,Radiology2004ExtracapsularExtensionMSKCC：RP术后，185/712(26%)中位包膜外扩展距离2mm0.5-12mm平均包膜外扩展距离2.93mmSD±2.3mm勾画前列腺CTV时，幷不必刻意外扩很大边界精囊腺受侵情况SVinvolvementKestinetalIJROBP2002WilliamBeaumont：RP术后，51/344，81SV+中位SV长度3.5cm0.7–8.5cm中位SV侵犯长度1.0cm(7%>1.0Cm1%>2.0Cm）0.2–3.8cmSV+associatedwithPSA,GS,andTstagesLowRiskIntermediateRiskHighRisk1high-risk2high-risk3high-risk1%15%15%32%58%27%KestinetalIJROBP2002SVinvolvementKestinetalIJROBP2002WhentreatingtheSVforprostatecancer,onlytheproximal2.0–2.5cmbeincludedwithintheCTVKestinetalIJROBP2002SVinvasionP=(PSA)+(Gleasonscore–6)x10Partin’sTablesRoachIII.JUrol150:1923-24,1993前列腺癌淋巴引流18patientswithpathologicallyprovenlymphnodemetastases69NodalLocationlymphnodemetastases(N)ParaAortic14Commoniliac13ExtIliac29IntIliac11Perirectal2Total69ShihetalIJROBPNov2005MassachusettsGeneralHospitalProstateCancerNodalSpreadStepwisefrompelvistoabdomenNodalmetastasesmorelikelywith:IncreasingTstageIncreasingPSAIncreasingGSLNM%=2/3(PSA)+(Gs–6)x10Partin’sTablesRoachIII.JUrol150:1923-24,1993ExternaliliaclymphnodesInternaliliaclymphnodesObturatorgroupPerirectalLNPartofthecommoniliacnodesS1-3pre-sacrallymphnodesParaAortic(optional)ProstateCancerpelvicnodalirradiationMSKCC前列腺癌放疗指南结合2009.2NCCN指南ClinicalTargetVolumeRiskGroupLow-RiskIntermediate-RiskHigh-RiskT1–T2aPSA<10ng/mLGS<7T2b–T2cPSA10–20ng/mLGS7T3–T4PSA>20ng/mLGS8–10CTVProstateOnlyProstate+2-2.5CmSVProstate+2-2.5CmSV+Nodalregions(whenriskofinvolvement>15%)RiskstratificationandtreatmentrecommendationLowriskIntermediateriskHighriskT1–T2aPSA<10ng/mLGS<7T2b–T2cPSA10–20ng/mLGS7T3–T4PSA>20ng/mLGS8–103DCRT/IMRT=70Gy3DCRT/IMRT=76Gy3DCRT/IMRT≧76Gy+neoadjuvantandadjuvantADTSimulationCTScan:frombottomofSIjointsto1.5cmbelowthelevelofischialtuberosities.Maximalslicethicknessof5mmPatientset-up:betreatedinthesupineposition.Immobilization:employimmobilizationsystemthatkeepsrandomandsystematicerrorstoacceptablelimitsBladder：sizeshouldnotvarybetweensimulationandtreatments.(e.g.bladdertobeemptied1hpriortosim/treatment,patienttodrink500ccwatersoonthereafter)Rectum:Instructpatientstoevacuatetheirbowelspriortoplanningandtreatment.Contouring:Prostateapex:situatedabovetheurogenitaldiaphragm.5mmabovethebulbospongiosusContourbaseofSVonly,ifnoclinicalSVinvolvement.Rectalwall:from1cmaboveto1cmbelowthePTV.Considercontouringthewholelengthoftherectum.Contourexternalbladderwallfromitsapextothedome.femoralheads:fromtheinferiormargi...