放疗增敏剂ppt课件
放疗培训课件ppt
放疗过程中涉及患者隐私的信息应严格保密，防止泄露和滥用。
遵守法律法规
放疗工作应遵守相关法律法规，确保合法合规地开展治疗活动。
06
放疗的未来发展与研究方向
Chapter
新技术与新设备的研究与应用
人工智能与放疗的结合
利用人工智能技术进行放疗计划设计 、剂量计算、图像配准等方面的研究 ，提高放疗的精准度和效率。
放疗技术
放疗技术包括常规放疗、立体定向放疗、调强放疗等。不同的技术适用于不同 的肿瘤类型和分期。放疗前需要进行详细的计划和评估，确保治疗的安全和有 效性。
02
放疗设备与技术
Chapter
放疗设备介绍
01
02
03
放疗设备种类
包括直线加速器、伽马刀 、射波刀等，每种设备有 其独特的工作原理和应用 范围。
功能性疾病
放疗还可以用于治疗某些功能 性疾病，如疼痛综合征、痉挛
等。
禁忌症
严重心肺疾病
放疗可能会加重心肺疾病患者的 病情，因此患有严重心肺疾病的
患者应慎用放疗。
恶病质
恶病质患者身体状况较差，放疗 可能会进一步削弱其身体机能，
因此应慎用。
孕妇
孕妇在放疗期间可能会对胎儿造 成影响，因此应避免接受放疗。
04
放疗的适应症与禁忌症
Chapter
适应症
恶性肿瘤
放疗是治疗恶性肿瘤的重要手 段之一，适用于多种实体肿瘤 ，如肺癌、乳腺癌、结直肠癌
、宫颈癌等。
良性肿瘤
对于一些特殊类型的良性肿瘤 ，放疗也可能作为治疗选择， 如垂体腺瘤、血管瘤等。
感染和炎症
放疗可以用于治疗某些感染和 炎症，如深部真菌感染、炎症 性肠病等。
心脑血管药理、食管癌放疗增敏
Best of 51th ASTRO in 2009 Lung Cancer SessionJinming Yu MD. PhD; Shandong Cancer Hospital & Institute Shanghai, December 4, 2009Plataue for ChT & RT I n the Treatment of NSCLC ☐ASCO-2007: LA-NSCLC Data –From 1965 to 2004,15000 pts out of 64 centers–Sur+Cht 5y survival= 4%;RT+ChT 5y survival= 2.2% ☐Global of Lung Ca: WCLC-2009 –13% in 1975 Vs 15% in 2007 for 5yr survival–No significant survival increase over 30yrsNeed Better Understand BalanceRisks ?Benefits?Gold Standard☐Survival☐Quality☐CostUSA Japan Europe China Canada Korea Poster# 67 17 18 12 8 1 Oral # 21 3 1 1 2 0Discussion Total #89620221132121Accepted Abstracts of ASTRO for Lung Cancer-WorldwideThe total accepted number of abstracts in lung Cancer is 173Hospital NameTotalOralShandong Cancer Hospital 6 1 Air Force General Hospital 2 0 Fudan Cancer Hospital 2 0 Hebei Cancer Hospital 1 0 Tongji Hospital1Accepted Abstracts of ASTRO For Lung Cancer in ChinaThe total accepted number of China in lung Cancer is 12Presentation Outline ❒SBRT for early staged NSCLC AdvantagesChallenges & Pitfalls❒Treatments and outcomes❒Accurate target delineation Anatomic imaging guidedBiological imaging guidedPart One SBRT for Early Staged NSCLC(1)SBRT for Medically Inoperable Early Stage NSCLC Pts: Analysis of RTOG 0236R. D. Timmerman, J. Bradley, G. Videtic, H. Choy et alPurpose:The RTOG 0236 protocol was a phase II trial utilizing SBRT with ablative prescription dose to treat early staged and medically inoperable NSCLC ptsMaterial & Methods☐All pts with biopsy proven peripheral/unoperable T1-T2NoMo☐The prescription dose was 18-20Gy/f, 3 fxs, total dose of 54-60 Gy and the treatment was delivered in 1.5-2 wks☐The primary endpoint was 2 yr local control. The 2nd endpoint was OS, DFS, RT toxicity, & patterns of failure☐Local failure was defined as enlargement of at least 20% on CT and either biopsy confirming Cancer or PET higher uptakePreliminary Results☐Total of 59 pts in the study and of 55 evaluable pts, 44 had T1and 11 had T2 tumors. Median age was 72 years☐Grade 3 and 4 adverse events were reported in 13 (24%) & 2pts(4%), respectively, most common complications waspulmonary. No treatment related deaths were found☐Median follow-up of 24.8 mons, 3 pts (5%) have local failure, giving estimated2 yr local control of93.7%. Only 2 pts have regional failure while 11 pts (20%) experienced distant failure☐2yr DFS & OS were 66.6% and 72.0%,respectivelyConclusions☐SBRT using total dose of 54-60Gy in 3 fxs associated with very high local tumor control and moderate RT related morbidity in pts of medically inoperable early stage NSCLC peripheral lesions☐Despite clinical stage, local & regional failure was low but the significant distant mets was found☐This data showed: 2-yr DFS & OS are encouraging(2) SBRT Results of Promising Local Control In Pts With RecurrentOr 2nd Lung Ca After Definitive Conventional Thoracic RT Purpose:Recurrent or secondary lung Ca is common amongpts who have previously undergone definitive thoracic RT.To analyze tumor local control, patterns of failure, survival &toxicity after SBRT in such ptsP. Kelly, P. A. Balter, N. C. Z. Liao, R. Komaki, J Y. ChangMaterial & Methods☐Retrospectively identified 42 pts who were treated with SBRT to thethorax after prior RT to the chest. All pts had undergone definitivethoracic RT for primary lung Ca 88% or esophageal Ca 12%☐Recurrent, mets, or secondary lung Ca was histologically confirmedand staged with PET/CT. No pt had evidence of nodal mets but 4 had evidence of distant mets.☐All pts underwent 4DCT-based planning & daily in room CT guided,The most common prescribed doses were 40Gy(n=6) or 50Gy(n=33) to the PTV (the motion envelope of the GTV plus an 8mm margin for CTV plus a 3mm margin for daily targeting uncertainties), at 10 to 12.5 Gy/fraction delivered in 4 consecutive daysPreliminary Results☐The median period between treatment interval was 21.1 mons☐Median follow up time of 11.8 mons from SBRT,in-field local control rate was 95% and 1 yr overall survival rate was 86%☐The most common failure after SBRT was intrathoracic relapse outside the SBRT field(52%). Relapse occurred most often in the previouslyirradiated site, particularly when the interval to SBRT was < 6 mons ☐After SBRT, 40% of pts experienced worse shortness of breath vsbefore SBRT; 14% required supplemental oxygen; 16% experienced chest wall pain & 7% had grade 3 esophagitis. No grade 4 or 5 toxicityConclusionsSBRT provides a excellent local control & with acceptable toxicities for pts with recurrent or secondary lung cancer who were previously treated with definitive conventional thoracic RT(3) Outcomes Comparison: SBRT orWedge Resection for Stage I NSCLCI.S. Grills, V. Mangona, R. Welsh, G. Chmielewski, E. McInerney S. Martin, L. L. Kestin William Beaumont Hospital, Royal Oak, MI Purpose:Local failure after wedge resection (W) for early stage NSCLC is higher than after lobectomy,but borderline operable pts often undergo W aloneThat such pts might be equally good candidates for lung SBRT and also compares SBRT to WMaterial & Methods☐124 pts of Stage I (T1-2N0M0) NSCLC were treated with W (n=69) or image-guided SBRT (n=58) from 2/03-2/09☐SBRT pts were treated on a Phase II trial. All pts were ineligible for lobectomy; 95% undergoing SBRT were medically inoperable☐All pts were staged using CT, PET-CT, pulmonary function testing, and chemistries. SBRT pts had bone scan and brain MRI☐SBRT was prescribed as 48Gy(T1)- 60Gy(T2) in 4-5fxs to the edge of target. Adjuvant ChT given to 16% of SBRT & 10% of W pts☐No significant differences existed in T-stage or size for SBRT vs WPreliminary Results☐Median follow-up=2.5 yrs. No significant differences were identified in30mons in regional recurrence(RR) (4% SBRT vs 18% W), locoregional recurrence(LRR)(9% v 27%W), DM(19% SBRT v 21% W), or freedom from any failure (FFF) (77% v 65%W) between groups (p>0.16 for all)☐SBRT reduced the risk of local recurrence (LR), (4% vs 20% W, p=0.07) Overall survival (OS) was higher with W (87% v 72% , p=0.01), but cause-specific survival (CSS) was identical (93% W vs 94% SBRT)Conclusions for Part One☐SBRT is good treatment options for Stage-I NSCLC pts SBRT better than W/SLobectomy VS SBRT?☐SBRT was associated with the followingsIdentical survival, especially in CSSReduced LR, RR and LRR☐Pay more attentions to pts with heavy smoking & poor pulmonary function before RT for fetal lung damages我们真正需要有一个Phase III的临床研究来回答这个问题T 1N 0M 0临床与病理N 分期-山东资料周围型T 1N 0M 0(30例) 准确率22/25(88%)中心型T 1N 0M 0(38例)准确率30/38(79%)病理N0 N1 N2 T1 22 3 1 T231病理N0 N1 N2 T13044T2 0 0 0T 2N 0M 0临床与病理N 分期-山东资料中心型T 2N 0M 0(30例)–准确率22/27(81%)病理 N0 N1 N2 T1 1 1 0 T2 22 4 0 T330 0 病理N0N1N2T12 1 0 T2288T3 1 0 0周围型T2N0M0(40例)准确率28/37(80%)SBRT技术的不足点SBRT for Early Stage NSCLC ❑对原发灶缺乏准确的分期–容易导致靶区勾画的错误❑对淋巴结缺乏准确的分期–导致淋巴结的低分期问题❑不能正确指导治疗的问题–影响化疗及其放疗的选择❑不能正确判断患者的预后初步的结论是SBRT for Stage-I NSCLC ❒用于不能耐受手术的Stage-I患者( V ) ❒用于那些拒绝手术的Stage-I患者( V ) ❒用于能够切除的周围型T1N o患者( V) ❒用于3-5个或以下的肺转移病灶者( V) ❒用于能够切除的T2N o周围型患者( ? ) ❒用于能够切除的T2N o中心型患者( ? )杜绝治疗错误? CFRT=1/33 Vs SBRT=1/3-5Part Two Treatments & Outcomes(1) Survival Impacts of PCIfor Limited Stage SCLCM. E. Giuliani, A. Hope, A. Sun, D. Payne, N. Leighl, A. Bezjak Purpose:The objectives were to assess the impact of PCI on OS & brain failure free survival (FFS) in pts with limited stage SCLC. To assess the value of PCI & the factors impacting PCI utilization 主要是要回答PCI能否给SCLC治疗后达到CR的患者提高生存的问题Material & Methods☐From 1997 to 2007, 796 pts were treated at PMH for SCLC. Of these,227 pts (28.5%)had limited stage of disease treated radically☐OS and brain FFS were estimated which comparedthe pts treated with or without PCIPreliminary Results☐Of the 227 pts treated radically for LS-SCLC, 56% received PCI ☐The median follow-up time was 16.7 mons☐Brain FFS at 12, 24, 36 and 60 mons was 77%, 41%, 41% & 41% respectively for pts who did not receive PCI; & 95%, 77%, 75% and 69%, respectively for pts who did (p<0.001)☐Overall survival at 12, 24, 36 and 60 mons was 74%, 35%, 27% and 13% for pts who did not receive PCI;and 94%, 56%, 46%, 33% for pts who did (p<0.002)Conclusions☐PCI significantly improves overall survival &brain FFS in pts with LS-SCLC☐All pts with LS-SCLC who got CR should be considered for PCI(2) A Phase III Study of PCI VS Observationin Pts with LA-NSCLC; RTOG 0214QOL and Neurecognitive AnalysisB Movsas, H Choy; et alPurpose: To study the effects of PCI for the pts with NSCLC on neurocognitive function & QOL;To evaluate the benefits for OS and DFSBackground❑CNS failure rates are high for pts with LA-NSCLC❑Prior randomized studies showed that PCI can decrease risk of brain mets☐The effect to survival is contraversial?RTOG 0214: SchemaNo CNS metastases By Brain MRI or CT No tumorprogressionafter curativetherapy forStage ⅢA/BNSCLC S T R A T I FY Stage: 1. cStage-IIIa 2. cStage-IIIB Histology: 1. Squa-C-Ca 2. Non-SCCa Treatment: 1.Surgery or2.No Surgery R A N D O M I Z E PCI 30Gy at 2Gy/Fx OBSERVATIONTo accrual was 356 pts of the targeted 1058Preliminary Results❑1 yr OS was 75.6% VS 76.9% (p=0.86); and 1 yr DFS 56.4% VS 51.2%,(p=0.11) for PCI VS Observa respectively,with no significant differences❑The incidence of CNS mets at 1 yr was 7.7% VS 18% respectively☐There were no significant differences in global cognitive function or QOL following PCI, but there was a significant decline in memoryConclusion & Suggestion❑PCI significantly decreases the risk of CNS failure for pts with stage-III NSCLC; but no significantdifferences in OS or DFS❑There was no significant difference in cognitive function or QOL following PCI❑There was a significant declines in pt’s memory ❑We should limit PCI to very high risk pts only –Non-squamous NSCLC pts have 27% risk❑Use BBB-penetrating ChT agents such as TMZ(3) Patterns of First Failure In A Phase II Study of Accelerated High Dose Thoracic RT(TRT) With Concurrent ChT for LS-SCLCRTOG 0239 StudyR. U. Komaki, R. Paulus, G. Videtic, J. Bradley, B. Glisson, H.Choy Purpose:Total dose (45Gy) was low in an AcceleratedFractionation (AXHFX) trial (INT0096) which showed high local recurrence both in AXHFX (40%) and Daily FX (60%) arms.RTOG 0239 was a phase II trial to improve local-regionalcontrol and survival of LS-SCLC pts treated by higher dose ofAXHFX TRT with concurrent boost and EP X 4 Cycles主要回答>45Gy加速分割能否提高SCLC患者局部-区域控制与生存率Material & Methods☐TRT was given to large field to 28.8Gy/16Fx/once daily. followed by BID with large field in AM, boost in PM, then off-cord boost BID for last 5 days, all at 1.8Gy/FX, 5 days/wk. Total dose was61.2Gy 34 Fs/5 wks. Concurrent ChT was started with RT with EP Protocle ☐The patterns of first failures were studyed: local-regional failure(LRF), distant metastatic failure (DMF) and survivalsPreliminary Results☐Accrual 72 pts & the median follow-up is 19.0 mons for all pts☐41% of pts achieved a CR at 2 mons post-treatment, & another 39% had a PR☐The 2-yr survival rate was 36.6%☐Disease progression was present in 51 pts (72%). DM only was the leading site of first failure seen in 31 pts (61%). LRF only was seen in 14 pts (27%). Mixed LRF & DMF were seen in 6 pts (12%) ☐Liver & bone were the most common with 27% of pts & followedby brain mets (24%). Other DMF were 14% in the lung, 3% in the supraclavicular fossa and 3% in pleuralConclusions☐This accelerated higher dose TRT with concurrent boost and EP for LS-SCLC demonstrated a good loco-regional control☐Distant mets is higher. More efficacious systemic treatment as well as better staging workup suchas PET/CT is required to improve distant failures(4)Addition Of Erlotinib To Pre & Post-op ChT/RT And As Maintenance For Resectable Mediastinoscopy-defined Stage III NSCLC: Phase II TrialG. M. Videtic, T. Rice, M. Shapiro, C. Reddy, T. MekhailPurpose:To report on phase II trial results, testing theaddition of E to pre & post-op ChT/RT for potentiallyresectable stage III NSCLCMaterial & Methods☐Eligible pts had stage IIIA & B NSCLC as determined by mediastinoscopy and PET. They were judged surgicallyresectable. Pre & post-op ChTRT consisted of wkly PC & concurrent hyperfractionated RT(30Gy/1.5Gy BID,>6hrs) with daily oral E (150mg) for 28 days☐Following restage, non-progressors underwent resection.4 to 6 wks following surgery, ChTRT with E was re-administered, followed by 2 yrs of maintenance of EPreliminary Results☐Total 25 pts & median follow-up was 30.3 mons.64% were female.16% were never smokers. 92% had stage IIIA disease, 64% had adeno☐There were no pre & post-op esophageal & respiratory toxicities abovegrade 2; 8 pts (32%) had pneumonectomy. Downstage to N0-1 was seenin 50% pts.Surgery was the only significant factor accounting for change in pulmonary function (p <0.0001)☐Median duration of maintenance E was 6.9 mons. Median, 3 yr overall & relapse-free survival were: 41.4mons, 58.8% & 43.6%, respectively☐For downstaged pts, median 3yr overall and relapse-free survivals were 70% and 59.5%respectivelyConclusions☐Addition of E to pre & post-op ChTRT produced minimal toxicity & resulted in notable Down-staging☐Resulting in improved survival for this study and the further testing of this regimen is warrantedPart ThreeTarget Delineation for NSCLC(1) Use Of SUV-max & Metabolic Tumor Volume To Predict Microscopic Extensions For CTV Delineation Of NSCLC X. Meng, X. D. Sun, G. R. Yang, D. B. Mu, X. G. Zhao, J. M. YuPurpose:To investigate correlation both the SUVmax and Metabolic Target Volume(MTV) with the maximal Microscopic Extensions (MicExt) for primary tumor of NSCLC主要研究是回答 SUVmax & MTV 能否帮助我们个体化确定NSCLC的CTVMaterial & Methods☐38 NSCLC pts in stage I-IIIA had integrated FDG PET/CT scans before therapy☐SUVmax and MTV were calculated & all ptsunderwent thoracotomy within 5 days after FDG PET/CT study☐The tumor was transected postoperatively tointerpret correctly the limit of the MicExt. Wemeasure the maximum linear distance from the tumor margin to the farthest extent of the tumorSUV & MTV 与肿瘤镜下浸润范围关系 2009 ASTRO Oral Presentation-Chicago P=0.008 P<0.001 39例NSCLC ME 平均值为4.61mm ±2.71mm肿瘤最大SUV 的平均值为7.24±2.41肿瘤代谢体积的平均值为40.62cm 3±33.66cm 3Preliminary Results☐MicExt for all pts had a significant correlation with SUVmax (P=0.008) and a stronger correlation with MTV (P<0.001)☐SUVmax and MTV differed significantly across histologic subtypes. SCC had lower SUVmax and MTV compared with ADC (P=0.004 and P=0.001, respectively). Tumors with better differentiation had lowerSUVmax (P<0.001) and also had lower MTV (P<0.001)☐MicExt was also differed with tumor pathology. SCC were found tohave lower MicExt than ADC(P=0.002). The results obtained for FDG uptake, Well differentiatated tumors had lower MicExt (P<0.001)Conclusions☐This study demonstrated a clear relationship between SUVmax and MTV with MicExt in primary tumor of NSCLC, suggesting that high SUVmax and MTV have more microscopicextension and would therefore require more margin expansion from GTV to CTV☐These prospective results would probe intoallowing the CTV to be optimally adapted to individual situations in vivo(2) Local & Distant Failure Rate and Patterns of Recurrence in Stage-II & N1 Surgically resected NSCLC J. Varlotto, L. M Davis, E. Schaefer, M. DeCamp Purpose:This investigation will examine the failure pattern & factors associated with local & distant recurrence of surgically resected NSCLC with N1 nodal involvement主要是回答Stage II-N1病人主要失败方式及确定治疗手段Material & Methods☐This study included 457 pts treated who didn’t receive adjuvant or neoadjuvant RT, Who had at least 3 mons follow-up☐Of these, 51 pts(11.0%) had Stage II-N1 disease.They compared these to 224 Stage IA and 140 IB pts fromthe same series. Local and distant recurrence as well as survival were calculated and compared。
放疗护理PPT课件
9 饮食调整
9.1 饮食品种丰富，搭配合理，保证高蛋白、高 热量、高维生素，低脂肪饮食。 不要盲目忌口。
9.2 以清淡无刺激消化食物为主，禁烟酒，忌过 冷、过硬、过热食物、忌油腻、辛辣食品。
9.3 根据放疗反应进行饮食调整。少食多餐，保 证足够营养和水分摄入。
二、放疗期间护理
1.照射野皮肤的保护 1.1 充分暴露照射野皮肤，避免机械性刺激，穿
柔软宽松、吸收性强的纯棉内衣 1.2 可用温水软毛巾温和的清洗，禁用碱性肥皂
搓洗，不可用酒精、碘酒药膏以及对皮肤有刺激 性的药物，禁用冰袋及暖具。 1.3 剃毛发宜用电动剃须刀，以防损伤皮肤造成 感染。 1.4 保持照射野皮肤的清洁干燥，特别是多汗区 如腋窝、腹股沟、外阴等处。 1.5 防止暴晒及风吹雨淋。
7 全身反应
7.1 患者出现疲劳、虚弱、食欲下降、恶心、呕 吐、睡眠障碍等，在对症处理同时，注意营养饮 食，增加食欲，提供安静休养环境，给予精神鼓 励。
7.2 机体免疫力下降可引起病毒感染
如：带状疱疹，处理以抗病毒，神经营养，增 强免疫力药物为主，保持皮肤清洁，加强营养改 善全身状况。
8 心理护理 8.1 加强护患之间沟通 8.2 有针对性做好阶段性健康指导 8.3 组织小课，召开工休座谈会，介绍成功病例
正常组织分成早反应组织和晚反应组织，更新快 的组织在放疗中是早反应组织，而更新慢的组织
属于晚反疗前护理
1.心理准备 健康指导：介绍有关知识，大至的治疗程序，可
能出现的不良反应及需要配合的事项，消除焦虑 情绪和恐惧心理。 2.身体准备 摘除金属物质、口腔预处理、评估全身状况。
口困难。 4.5 脑瘤患者放疗期间，观察有无颅内压增高症
肺癌的放疗进展ppt课件
Variables
Duration 1-Yr 2-Yr 3-Yr Progression Local Distant
Survival,%
Radiotherapy Radiotherapy and Weekly Cisplatin
46
54Biblioteka 1326216
54
44
46
36
Radiotherapy and Daily Cisplatin
随机分组：诱导组(chemoradiation) vinblastine 5mg/m2 weekly×5wk cisplatin 100 mg/m2 wk 1 and 5
RT 60Gy/6w 对照组(radiation alone)：RT 60Gy/6w 结果：median survival :CR:13.6mo;RT:9.7mo 5 yr survival benefit :CR:19%;RT:7%.
inhibitors, 乏氧细胞毒药物，生物调理剂 等
同步放化疗针对人群
普通情况差，治疗前体重减轻>5%的患 者无益
一个基于RTOG实验的二次分析显示：70 岁以上的普通情况良好的患者生存受害 低于70岁以下者
RTOG 94-10：？
诱导化疗+同步
优点：添加肿瘤细胞暴露时机，最大限 制减少微转移；减少原发灶，使放射野 减少；评价药物敏感性
提示ChT对远处微转移有益
诱导ChT+同步放化疗
French CEBI trial [Le Chevalier T, J Natl Cancer Inst 1991;83:417-423]
Resectable NSCLC
同步放化疗
添加局控的实际根底：直接细胞杀伤； 放射增敏
t心脑血管药理、食管癌放疗增敏zhaoyou
上海国际肝癌肝炎会议
5届大会主席
1986
1991
复旦大学肝癌研究所
在国际上占一席之地
40
35
30
25
20
影响因子积分
15
10
5
0
80 84 88 92 96 2000
表达科技方面
－ 是一门“艺术” － 不是单纯技巧 － 是科技的表达 － 是思维的表达 － 是素养的表达 － 是技巧的表达
J Natl Cancer Inst 13.8
J Clin Oncol
10.9
Cancer Res
8.6
Adv Cancer Res 7.9
Clin Cancer Res 6.5
Int J Cancer
4.4
Cancer
4.0
Br J Cancer
3.9
Eur J Cancer
3.7
Cancer Gene Ther 3.7
3y-82.4%, n=117 3y-69.4%, n=116
精益求精
每张幻灯片、照片都反复修改
扫描
数码手拍
数码架拍 数码架拍暗光
再论表达的艺术科技方面
－ 学风：表达的灵魂 － 创新：表达的核心 － 重点：表达的关键 － 逻辑：表达的技巧 － 对比：表达的方法 － 素养：表达的基础
小肝癌研究获国家一等奖－亦源于创新
Cancer Biol Ther 3.0
Int J Oncol
2.9
J Ca Res Clin Oncol 2.2cer Drug
2.0
Cancer Metast Rev 2.0
Oncol Res
1.8
放疗基本ppt课件
放射治疗有两种照射方式：一种是远距离放疗（外照射），
即将放射源与病人身体保持一定距离进行照射，射线从病
人体表穿透进人体内一定深度，达到治疗肿瘤的目的；另
一种是近距离放疗（内照射），即将放射源密封置于肿瘤
内或肿瘤表面，如放入人体的天然腔内或组织内（如舌、
鼻、咽、食管、气管和子宫体等部位）进行照射，即采用
脊髓压迫症 脊髓压迫症发展迅速，一旦截瘫很难恢复正
常。原发性或转移性肿瘤是脊髓压迫症的常见原因，肺癌、
乳腺癌、前列腺癌、多发性骨髓瘤和，淋巴瘤最易转移至
脊椎，导致脊髓压迫。95%以上的脊椎转移瘤均在髓外，
对不能手术的髓外肿瘤应尽快采取放射治疗，同时也应使
用大剂量皮质类固醇，促使水肿消退，防止放疗水肿发生。
定义：减少总的照射次数，增加每次照射的剂量。较常用 的是每周照射3次，隔日照射，每次靶区剂量为3.0～ 5.0Gy。
(2)生物学基础:
根据早、晚反应组织的曲线即α/β比，晚反应组织的 损伤主要与每次分割的剂量有关，所以，超分割照射能 减轻晚反应组织如脊髓、脑、肺、肾等正常组织的损伤， 使其耐受量可增加15～25%。
早反应组织损伤基本不变或略有增加，肿瘤病灶的控制 率可增加10%。
每天2次分割照射，间. 隔时间至少4小时以上，以利正28 常 组织细胞完成亚致死性损伤的修复。
（2）生物学基础：缩短放疗总时间，以减少在放疗期间 肿瘤细胞的增殖，其结果可加重早期反应，晚期反应也可 加重或稍有改变。
（3）临床应用：多用于肿瘤倍增时间短，病程发展快， 而可一在般症情状况缓又解较 后好 改的 为病 常人 规. 。 分如 割果 照病 射人 。在治疗中反应较重29 ，
4、大剂量分割
放疗基本规范 （1）
放疗基本知识介绍ppt课件
• 亚临床病灶 • 至一般临床检查发放不能发现的，肉眼也看不到，而 且显微镜下也是阴性的病灶，肿瘤病灶常常位于肿瘤 主体的周围或者远隔部位，有时是多发病灶。 • 举例： 局部：乳腺癌根治术后行胸壁及淋巴引流区照射可以减 低局部复发 远处：骨肉瘤术后全肺预防照射，可以明显降低肺转移 率，小细胞肺癌脑预防性照射可以降低脑转移的发生 总结：亚临床病灶无法测量，一般按临床规律进行，具 有一定的盲目性，所以亚临床病灶的研究是肿瘤研究 的一个重要问题
照射肿瘤的剂量取决正常组织的耐受量和肿瘤控 制剂量的平衡
常用的分割方案
• • • • 常规分割： 1.8-2Gy 一天1次，1周5次 超分割： 1.1-1.2Gy 一天2次，1周10次 加速超分割：1.2-1.5Gy 一天2次，1周10次 大分割：2.5Gy以上 1天1次，1周5次
放射治疗技术介绍
外照射靶区剂量分布的规定
• 内靶区（internal target volume，ITV ）GTV和CTV都 是根据肿瘤的分布特点及形态在CT/MR/DSA/PET等静 态影像上确定的，没有考虑到器官的运动，但在患者 的坐标系中，CTV的位置是不断变化的，由于呼吸或 者器官运动或照射中CTV体积和形态的变化所引起的 CTV外边界运动的范围，成为内边界（internal margin ，IM），IM的范围称为ITV。 • 计划靶区（planning target volume, PTV ）在布置照射 野时，不仅要考虑靶区和照射野间的相对空间关系， 以及照射中由于呼吸及器官的运动引起的临床靶区位 置的变化、疗程中肿瘤的缩小等，还要考虑每天治疗 摆位过程中患者体位的重复性和对剂量分布的影响。 所以提出了PTV的概念，所以PTV应该包括：CTV本身 ，照射中器官的运动，由于日常摆位、治疗中靶位置 和靶体积的变化等因素引起的扩大照射野的组织范围 ，以确保CTV得到规定的治疗剂量。
肿瘤放疗基础课件(附PPT)
肿瘤放疗案例分析和数据统计
真实案例分析
分享一个真实放疗案例的详细 分析，包括治疗计划和结果。
数据统计
提供有关肿瘤放疗效果和生存 率的统计数据。
患者故事
讲述一个成功放疗的患者的真 实故事和感受。
肿瘤放疗基础课件（附 PPT）
这份基础课件将为您介绍肿瘤放疗的关键概念和技术，以及对未来的展望。 我们将深入探讨放疗的原理、常见技术、副作用、风险和案例分析。希望让 您对这个领域有更全放疗是什么？
解释了肿瘤放疗的定义和它在治疗肿瘤中的作用。
2 放疗的历史
简要介绍肿瘤放疗的历史背景和发展。
肿瘤放疗的基本原理
辐射破坏肿瘤细胞
详细描述了辐射是如何破坏 肿瘤细胞，达到治疗目的。
选择性杀伤
讨论了放疗是如何实现对肿 瘤细胞的选择性杀伤，最大 程度保护健康组织。
剂量计算与调整
解释了如何计算放疗的剂量， 以及根据患者情况进行调整。
肿瘤放疗的常用技术
外照射放疗
介绍了最常用的外照射放疗技 术，如IMRT和VMAT。
近距离放疗
立体定向放疗
说明近距离放疗的原理和应用， 以及种类如LDR和HDR。
简要介绍立体定向放疗在肿瘤 治疗中的独特地位和技术。
肿瘤放疗的副作用和管理
1
常见副作用
列出常见副作用，如疲劳、皮肤反应
副作用管理
2
和消化道不适。
介绍如何有效管理和减轻放疗的副作
用，提高患者的生活质量。
3
心理支持
探讨肿瘤放疗期间患者心理健康的重 要性和支持服务的提供。
肿瘤放疗的进展和前景展望
新技术新方法
讨论最新的放疗技术和方 法，如免疫放疗和粒子疗 法，以及它们对未来的影 响。
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放疗增用5-Fu
放疗增敏剂
放疗与顺铂（一）
顺 铂：放疗增敏作用，增加自由基形 成，抑制损伤修复 联用顺序：先用顺铂，再放疗
放疗增敏剂
放疗增敏剂
放疗增敏剂
放疗增敏剂
• 放疗增敏剂是肿瘤放射治疗的一个重要研究课题， 它能提高肿瘤细 胞对放疗的敏感性，提高放射 线对肿瘤细胞的杀伤率，增强放 疗疗效。
• 理想的放射增敏剂应能显著增加肿瘤细胞的放疗 疗 效，而对正常组织没有或很小有毒副反应。
• 使用最大可能的照射剂量或改变照射方法，有时 仍达不到根治目的。原因是多方面的，其中主要 是由于实体肿瘤中普遍存在10%～50%的乏氧细胞 。 这些乏氧细胞对射线的抗拒作用比有氧细胞强 2.5～3倍 ，由此限制了肿瘤放疗效果，而成为肿 瘤容易复发的重要根源。
放疗增敏剂
放射治疗增敏机理：
1、增加辐射的原发性损伤 2、抑制损伤修复 3、细胞周期同步化
放疗增敏剂
放射增敏剂的种类：
• 1、乏氧细胞增敏剂 • 2、巯基抑制剂 • 3、类氧化合物 • 4、阻断细胞。
放疗增敏剂
• 甘氨双唑钠（Sodium Glyci-didazole，商品名:希 美纳，CMNa）
放疗与顺铂（二）
放疗+PF同步化疗：先用顺铂， 再放疗， 再用5-Fu
放疗增敏剂
放疗增敏剂
（一）放射增敏剂应具备的特点：
• 1、不易与其他物质起反应，性质稳定； • 2、有效剂量没有毒性或毒性很低，副作用小； • 3、有较长的生物半衰期，在体内能保持其药物活
性，足以渗入整个肿瘤； • 4、对不同周期的细胞均应有效； • 5、对常规分次照射必须有效，较低的药物剂量即
可有放射治疗增敏的效果。
放疗增敏剂
放疗与希美纳（一）
放射治疗：直接或间接损伤细胞DNA 希美纳：放疗增敏剂，将射线对乏氧 肿瘤 细胞DNA的顺伤固定，增强乏氧
细胞敏感性
放疗增敏剂
放疗与希美纳（二）
联用顺序：800mg/m2溶于生理盐水 100ml，30min内滴完，qod，每周三次
给药后1h内行放疗
放疗增敏剂
放疗与5-Fu（一）