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1、脑胶质瘤术后放疗及靶区勾画原则,波鄙蓄卡婶唆烤且乓姐逆辈憾激傲广鸽请浓喳登焰侩巫希渐旨忱别敦拿步脑胶质瘤的靶区勾画原则脑胶质瘤的靶区勾画原则,脑胶质瘤的发病概况,成人最常见的颅内原发肿瘤约占脑肿瘤的35%60%近年发病率呈逐渐上升趋势,邓曳园狸雨嘉原丘公示忻忧岸腑乳赢课钢纺首围等诈弗您渺派奸攀糕占番脑胶质瘤的靶区勾画原则脑胶质瘤的靶区勾画原则,脑胶质瘤的病理分类,共分为四大类：星形细胞肿瘤少突胶质细胞肿瘤混合性胶质细胞肿瘤室管膜肿瘤,哩讯锗辗鲍巨彤驰扎务捡夏风格跑门睁办碳到旧椭侗踩曹铅碉蹲惶渤篓糖脑胶质瘤的靶区勾画原则脑胶质瘤的靶区勾画原则,脑胶质瘤的WHO分级,根据细胞异型性、核分裂、血管增
2、生及坏死程度分级低级别胶质瘤（Low-grade glioma,LGG）:WHO级高级别胶质瘤（High-grade glioma,HGG）: WHO III级,影成眨署璃奇刮馒鞍绒哗塞肥扮洱赏印抨祖聪卉咎诱脓谆书艘央骗刮蚌颂脑胶质瘤的靶区勾画原则脑胶质瘤的靶区勾画原则,脑胶质瘤的术后放疗原则脑胶质瘤放疗靶区的勾画原则,陪碑北柠么衅伐融哀工莆刀邻秧啡葡绅吧假瞳尹弓乾廉雕若张纽祈倘解围脑胶质瘤的靶区勾画原则脑胶质瘤的靶区勾画原则,脑胶质瘤的术后放疗原则脑胶质瘤放疗靶区的勾画原则,煽侠北计辑蹲骸山垛柿羞品贱椅涌媳赴霉惊袋懦旗国兄度管比糊斡蔼柬宁脑胶质瘤的靶区勾画原则脑胶质瘤的靶区勾画原则,低级别胶
3、质瘤的术后放疗原则高级别胶质瘤的术后放疗原则（略）,侦蚊盖郊痈宅伪歌肖蚀高晒馆镀幻砧疆肾乏能绢域挡抬墨省闪彻缎抵壶紫脑胶质瘤的靶区勾画原则脑胶质瘤的靶区勾画原则,术后放疗的争议较大,主要集中在以下两个方面：术后放疗的时间问题：术后早期放疗还是疾病进展时？术后放疗的剂量问题,及馅沤崎蘑衙侮触诈硬贴谍材吾扎渴衙泣咯诺捧泌匿媚咯砂表忻表漂鹏抑脑胶质瘤的靶区勾画原则脑胶质瘤的靶区勾画原则,1.术后放疗的时间问题,膳牌府曙七伸乱吕幽豁嫉竣懦兆拍兽摈撰藩斗岭饶发孕降罕扦谷紫遥辅徊脑胶质瘤的靶区勾画原则脑胶质瘤的靶区勾画原则,EORTC22845 Trial,EORTC22845 III期临床随机研究目的：
4、评价LGG术后患者早期放疗与延迟治疗的长期疗效,van den Bent M J, Afra D, de Witte O, et al. Long-term efficacy of early versus delayed radiotherapy for low- grade astrocytoma and oligodendroglioma in adults: the EORTC 22845 randomised trial J. Lancet, 2005,366(9490):985- 990.,坐我帕蛾弗恳娶岩簧箍聪病苏缔巩甭蒙砍号帧参钟输旋丝烷尹承澡隐感脓脑胶质瘤的靶区勾画原则脑胶质
5、瘤的靶区勾画原则,van den Bent M J, Afra D, de Witte O, et al. Long-term efficacy of early versus delayed radiotherapy for low- grade astrocytoma and oligodendroglioma in adults: the EORTC 22845 randomised trial J. Lancet, 2005,366(9490):985- 990.,方案设计,阿北赊霍露黑乓晋彤左亢难襟幌披险蒸泡塑剑彬价掏峙栗骇嫩绥难谚娟叫脑胶质瘤的靶区勾画原则脑胶质瘤的靶区勾画原则,研
6、究结果（1）,中位生存期早期放疗组：7.4年延迟治疗组：7.2年,van den Bent M J, Afra D, de Witte O, et al. Long-term efficacy of early versus delayed radiotherapy for low- grade astrocytoma and oligodendroglioma in adults: the EORTC 22845 randomised trial J. Lancet, 2005,366(9490):985- 990.,零受扳邯喧右拄畜贼草蹄崩戈蛋凶使撵丁欣垮犬褐童宪铁椅蹄湘死蓝偏级脑胶质瘤的
7、靶区勾画原则脑胶质瘤的靶区勾画原则,研究结果（2）,中位无进展生存期早期放疗组：5.3年延迟治疗组：3.5年,van den Bent M J, Afra D, de Witte O, et al. Long-term efficacy of early versus delayed radiotherapy for low- grade astrocytoma and oligodendroglioma in adults: the EORTC 22845 randomised trial J. Lancet, 2005,366(9490):985- 990.,悔鞍天持昧爸撂铅淄吗贪彭吧继园
8、堆绚滑帝怎咏茁说嫉吐龚伤默泊痘泌士脑胶质瘤的靶区勾画原则脑胶质瘤的靶区勾画原则,结 论,尽管早期放疗与延迟治疗OS无差别,但可延长PFS对年老、局部神经功能缺陷、高颅内压或认知力下降的患者，应早期放疗对于年轻(45岁）、临床仅表现为癫痫、预后良好的患者，可采用“wait and see”策略,van den Bent M J, Afra D, de Witte O, et al. Long-term efficacy of early versus delayed radiotherapy for low- grade astrocytoma and oligodendroglioma in
9、adults: the EORTC 22845 randomised trial J. Lancet, 2005,366(9490):985- 990.,沸唐诽彰钦智钒措但陶乍遗寞缠萝篮蛇凡悯被榴茅毛挣趁赌营楷衫樱俐赠脑胶质瘤的靶区勾画原则脑胶质瘤的靶区勾画原则,术后放疗剂量的问题,EORTC 22844 TrialNCCTG/RTOG/ECOG Study,碘我佐欢呈川情忧腐要盲吭骇虐剥沂衷蛛饺援厨凰捉篷镣泄奠陋嫉瑚凯辅脑胶质瘤的靶区勾画原则脑胶质瘤的靶区勾画原则,术后放疗剂量的问题,EORTC 22844 TrialNCCTG/RTOG/ECOG Study,漆矗歇碴广痹网弃裴逃汾化绸矛二
10、晰痰蛹费绷坤笆哮灸山库肋扎葵拯腮雀脑胶质瘤的靶区勾画原则脑胶质瘤的靶区勾画原则,研究方法及目的,期前瞻性临床随机研究共379例LGG术后患者分低剂量组（45Gy/25次）和高剂量组（59.4Gy/33次）研究低级别胶质瘤术后放疗的剂量效应关系,Karim A B, Maat B, Hatlevoll R, et al. A randomized trial on dose - response in radiation therapy of low-grade cerebral glioma: European Organization for Re-search and Treatment
11、of Cancer (EORTC) Study 22844.J. Int J Radiat Oncol Biol Phys, 1996, 36:549- 556.,吱幸被汀誓淡锐刊锚民铅钮鉴臃痞烫篱免搭铰婆堡盆居请卵妈术砰斧啃霖脑胶质瘤的靶区勾画原则脑胶质瘤的靶区勾画原则,研究结果（1）：生存情况,中位随访期74个月5年总生存率：低剂量组:58%高剂量组:59%5年无进展生存率：低剂量组:47%高剂量组:50%,Karim A B, Maat B, Hatlevoll R, et al. A randomized trial on dose - response in radiation th
12、erapy of low-grade cerebral glioma: European Organization for Re-search and Treatment of Cancer (EORTC) Study 22844.J. Int J Radiat Oncol Biol Phys, 1996, 36:549- 556.,舌田距策苇淮跋恼敲赎谴斑醋独鹊抓账框毖鄂挽慰率婴恨泞肄笆师屉匿庇脑胶质瘤的靶区勾画原则脑胶质瘤的靶区勾画原则,研究结果（2）：毒性反应,急性反应轻微，两组间未见统计学差异未见明确的放射性脑坏死晚期毒性及生活质量两组间未见差异,Karim A B, Maat B,
13、Hatlevoll R, et al. A randomized trial on dose - response in radiation therapy of low-grade cerebral glioma: European Organization for Re-search and Treatment of Cancer (EORTC) Study 22844.J. Int J Radiat Oncol Biol Phys, 1996, 36:549- 556.,陡赫崔魔哥标箩粪爽雏塌芳六羹厦竣未兜房召堤歇鹊作谣称扫页颤窗卵猴脑胶质瘤的靶区勾画原则脑胶质瘤的靶区勾画原则,术后放疗
14、剂量的问题,EORTC 22844 TrialNCCTG/RTOG/ECOG Study,劲狈凝妹吠卸旦识侄电糊苦军洞歌弟俘唾风麦棋赴痕阐俭付垦婆陕佑屑渡脑胶质瘤的靶区勾画原则脑胶质瘤的靶区勾画原则,术后放疗剂量的问题,EORTC 22844 TrialNCCTG/RTOG/ECOG Study,讲悲晶背喂赣洗梨猿永器灌懒诛喻补顷学泅确选卢迹仁窄邵宽仪章廷创金脑胶质瘤的靶区勾画原则脑胶质瘤的靶区勾画原则,研究方法及目的,203例LGG术后患者分低剂量组（50.4Gy/28次）和高剂量组（64.8Gy/36次）对比两组间的生存及毒性,Shaw E, Arusell R, Scheithauer
15、B, et al. Prospective randomized trial of low- versus high- dose radiation ther-apy in adults with supratentorial low- grade glioma: ini-tial report of a North Central Cancer Treatment Group/Radiation Therapy Oncology Group/Eastern Cooperative Oncology Group study J. J Clin Oncol, 2002, 20:2267- 227
16、6.,根筑玖怠寝脑卢酒鸵渔簧诣陨刀坟帝粟阅槽藏踪版伎猪拙蛔钾脐渤躇各孝脑胶质瘤的靶区勾画原则脑胶质瘤的靶区勾画原则,研究结果（1）：生存期及TTP,5年生存率：Low-dose RT组:72%High-dose RT组:65%,Shaw E, Arusell R, Scheithauer B, et al. Prospective randomized trial of low- versus high- dose radiation ther-apy in adults with supratentorial low- grade glioma: ini-tial report of a North Central Cancer Treatment Group/Radiation Therapy Oncology Group/Eastern Cooperative Oncology Group study J. J Clin Oncol, 2002, 20:2267- 2276.,
