前列腺癌靶区勾画.pptx

前列腺癌靶区勾画,中国医科院肿瘤医院,第一页，共五十三页。,前列腺癌发病率和死亡率,第二页，共五十三页。,Radiother Oncol.2004 Apr;71(1):29-33.,J Clin Oncol.2002 Aug 15;20(16):3376-85.,第三页，共五十三页。,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,第四页，共五十三页。,解 剖,第五页，共五十三页。,Anatomy,Yellow:Peripheral gland Blue:Transitional zoneRed:Central glandGreen:Anterior fibromuscular zone,第六页，共五十三页。,前列腺癌的靶区包括范围,前列腺精囊腺盆腔淋巴引流区,第七页，共五十三页。,前列腺及包膜受侵情况,第八页，共五十三页。,CTV in Prostate Cancer,CTV=prostate(+SV)+LN,第九页，共五十三页。,Extracapsular Extension associated with PSA,GS,and T stages,P=:3/2(PSA)+(Gleason score 3)x10Partins Tables,Roach III.J Urol 150:1923-24,1993,第十页，共五十三页。,Wang L,Radiology 2004,Extracapsular Extension,第十一页，共五十三页。,勾画前列腺CTV时，幷不必刻意外扩很大边界,第十二页，共五十三页。,精囊腺受侵情况,第十三页，共五十三页。,SV involvement,Kestin et al IJROBP 2002,第十四页，共五十三页。,SV+associated with PSA,GS,and T stages,Kestin et al IJROBP 2002,第十五页，共五十三页。,SV involvement,Kestin et al IJROBP 2002,第十六页，共五十三页。,When treating the SV for prostate cancer,only the proximal 2.0 2.5 cm be included within the CTV,Kestin et al IJROBP 2002,第十七页，共五十三页。,SV invasion,P=(PSA)+(Gleason score 6)x10Partins Tables,Roach III.J Urol 150:1923-24,1993,第十八页，共五十三页。,前列腺癌淋巴引流,第十九页，共五十三页。,18 patients with pathologically proven lymph node metastases 69,Shih et al IJROBP Nov 2005,Massachusetts General Hospital,第二十页，共五十三页。,第二十一页，共五十三页。,Prostate Cancer Nodal Spread,Step wise from pelvis to abdomenNodal metastases more likely with:Increasing T stageIncreasing PSAIncreasing GS,第二十二页，共五十三页。,LNM%=2/3(PSA)+(Gs 6)x10Partins Tables,Roach III.J Urol 150:1923-24,1993,第二十三页，共五十三页。,External iliac lymph nodes Internal iliac lymph nodes Obturator groupPerirectal LNPart of the common iliac nodesS1-3 pre-sacral lymph nodes Para Aortic(optional),Prostate Cancer pelvic nodal irradiation,第二十四页，共五十三页。,MSKCC 前列腺癌放疗指南,结合2022.2 NCCN指南,第二十五页，共五十三页。,Clinical Target Volume,第二十六页，共五十三页。,Risk stratification and treatment recommendation,第二十七页，共五十三页。,Simulation,CT Scan:from bottom of SI joints to 1.5 cm below the level of ischial tuberosities.Maximal slice thickness of 5 mmPatient set-up:be treated in the supine position.Immobilization:employ immobilization system that keeps random and systematic errors to acceptable limits,第二十八页，共五十三页。,Bladder：size should not vary between simulation and treatments.(e.g.bladder to be emptied 1 h prior to sim/treatment,patient to drink 500cc water soon thereafter)Rectum:Instruct patients to evacuate their bowels prior to planning and treatment.,第二十九页，共五十三页。,Contouring:,Prostate apex:situated above the urogenital diaphragm.5mm above the bulbospongiosus Contour base of SV only,if no clinical SV involvement.Rectal wall:from 1 cm above to 1 cm below the PTV.Consider contouring the whole length of the rectum.Contour external bladder wall from its apex to the dome.femoral heads:from the inferior margin of PTV to the superior lip of acetabulum.,第三十页，共五十三页。,靶区勾画规定：,CTV=GTVPTV=CTV+1 cm margin，向前方向仅外放0.5 cm以减少直肠照射。,第三十一页，共五十三页。,缩 野,from PTV1 volume to PTV2 volume between 46 and 60 Gy.,第三十二页，共五十三页。,Dose constraints,rectum50 Gy 50%70 Gy 20%the bladder55 Gy 50%70 Gy 30%femoral heads 35 Gy 100%45 Gy 60%60 Gy 30%RTOG:5%50GySmall Bowel:0%52Gy;V505%Large Bowel:0%55Gy;V5010%,第三十三页，共五十三页。,Verification,Isocentre check using AP and lateral films be acquired at least weekly during treatment.,第三十四页，共五十三页。,前列腺和精囊腺的CTV,第三十五页，共五十三页。,第三十六页，共五十三页。,第三十七页，共五十三页。,第三十八页，共五十三页。,第三十九页，共五十三页。,第四十页，共五十三页。,包含盆腔淋巴结预防照射的前列腺癌靶区勾画,第四十一页，共五十三页。,RTOG GU REACH CONSENSUS ON PELVICLYMPH NODE,the pelvic lymph node volumes to be irradiated include:distal common iliac,presacral lymph nodes(S1-S3)external iliac lymph nodes internal iliac lymph nodesobturator lymph nodes,IJROBP,2022,第四十二页，共五十三页。,RTOG GU REACH CONSENSUS ON PELVICLYMPH NODE,CTVs include the vessels(artery and vein)and a 7-mm radial margin carve out bowel,bladder,bone,and muscle.Volumes from the L5/S1 interspace to the superior aspect of the pubic bone.,IJROBP,2022,第四十三页，共五十三页。,L5/S1水平包全髂总骶前淋巴结,IJROBP,2022,1.5 Cm,0.7 Cm,第四十四页，共五十三页。,S1-S3水平包全髂内外和骶前淋巴结Carve out小肠、膀胱、肌肉和骨等,IJROBP,2022,第四十五页，共五十三页。,S3以下包全髂内外淋巴结骶前淋巴结终止于梨状肌出现层面,IJROBP,2022,第四十六页，共五十三页。,髂外淋巴结一直要勾画至股骨头顶端层即腹股沟韧带处髂外A与股A分界处,IJROBP,2022,第四十七页，共五十三页。,闭孔淋巴结要勾画至耻骨联合上缘水平,IJROBP,2022,第四十八页，共五十三页。,我们科勾画情况,第四十九页，共五十三页。,第五十页，共五十三页。,References,RTOG GU RADIATION ONCOLOGY SPECIALISTS REACH CONSENSUS ON PELVIC LYMPH NODE VOLUMES FOR HIGH-RISK PROSTATE CANCER.Int.J.Radiation Oncology Biol.Phys.,2022EAU guidelines on prostate cancerMapping of nodal disease in locally advanced prostate cancer:Rething the clinical target volume for pelvic nodal irradiation based on vascular rather than bony anatomy.MSKCC 临床前列腺癌放疗指南2022年ESTRO前列腺癌靶区勾画2022年SANTRO会议2022.2 NCCN guideline殷主任主编，?肿瘤放射治疗学第四版?李主任：前列腺癌,第五十一页，共五十三页。,谢 谢！,第五十二页，共五十三页。,内容总结,前列腺癌靶区勾画。23万（95.1/10万）。7/10万(城市8.51/10万)。MSKCC：RP术后，185/712(26%)。Para Aortic(optional)。PSA 10 ng/mL。PSA 1020 ng/mL。3DCRT/IMRT=70 Gy。李主任：前列腺癌,第五十三页，共五十三页。,