鼻腔鼻竇畸胎癌肉瘤的調(diào)強(qiáng)放射治療

1、Introduction Case Discussion,case,discussion,introduction,SNTCS,sino nasal terato carcino sarcoma,< 80 cases reported,case,discussion,introduction,History,Vencent J. HyamsDirector of the Otolaryngic Patho

2、logy branch of the Armed Forces Institute of Pathology，1968-1984,Teratoid carcinosarcoma ?Mixed mesodermal tumour ? Malignant teratoma and blastomas ?,1984,,case,discussion,introduction,Characteristics,T1-weighted MR

3、reveals a soft tissue filling the left ethmoid sinus, as uniformly high signal (*), and effusion (white arrowhead) in the left sphenoid sinus. Takasaki, K.,2006,Epithelial glandular carcinoma (at right) and osteosarcoma

4、 component (at left). (hematoxylin-eosin, original magnification x40). Smith, S. L.,2008,Endoscopic examination showing a left sinonasal tumor in the left middle turbinate. M, middle turbinate; S, nasal septum. S

5、u, Y. Y., 2010,Treatment,case,discussion,introduction,Patients generally present with locally advanced-stage diseasethe highly malignant, aggressive biological behavior the presence of air filled paranasal spaces permi

6、ts silent growth Distant metastasis of SNTCS is unusual and the most common cause of treatment failure is local recurrenceSurgical excision and postoperative radiotherapy has become the most widely accepted

7、 therapeutic plan,Introduction Case Discussion,HPI,introduction,discussion,case,42-year-old man Two weeks history of progressive left nasal obstruction and intermittent nasal bleedingNasal examination showed a mod

8、erately firm, reddish-purple mass in the left meatusBiopsy of the tumor revealed a heterogeneous admixture of epithelial and mesenchymal elements, suggesting SNTCS,Teratocarcinosarcoma Teratocarcinosarcoma consists of t

9、wo components, epithelial and mesenchymal (hematoxylin-eosin, original magnification ×200),cT3N0M0,MRI,introduction,discussion,case,MRI revealed a soft tissue filling the left meatus, maxillary and ethmoid sinus, a

10、nd effusion in the left maxillary sinus,introduction,discussion,case,Anterior craniofacial resectionIMRTGTV included the residual gross disease in the nasal cavity and paranasal sinusCTV-60 includes the GTV with a 5~1

11、0 mm margin, the whole nasal cavity and the involved paranasal sinusCTV-54 high-risk local structures (including the whole nasopharynx, lower half of sphenoid sinus, et al)lymphatic regions (including ipsilateral lymp

12、h node levels IB, II, III and VA)A 3-mm margin was added to produce PTVsPTV-66 was prescribed to 66 Gy with 2.2 Gy/fractionPTV-60 was prescribed to 60 Gy with 2.0 Gy/fractionPTV-54 was prescribed to 54 Gy with 1.8 G

13、y/fraction,Treatment,Follow-up,introduction,discussion,case,Now 3.5 years have passed since the irradiation therapyNo severe dry-eye syndrome, and other severe radiation-induced ocular toxicities happenedNo evidence

14、of recurrence or metastasis,Introduction Case Discussion,,,,Shoulders ?,introduction,case,discussion,Sinonasal tumors,Frontal SinusMaxillary SinusEthmoid SinusSpenoid Sinus,1,2,3,4,,,,,Challenge !,introduction,ca

15、se,discussion,IMRT,introduction,case,discussion,3-beam conventional 2D,6-beam conventional 3D conformal,7-beam IMRT,A dosimetry comparison between (a) a 3-beam conventional 2D treatment, (b) a 6-beam conventional 3D conf

16、ormal RT treatment, and (c) a 7-beam IMRT treatment. The PTV is represented by the solid red line. The 100% and 70% of the prescription dose are shown by the green and red colour-washed areas. A better dose conformity to

17、 the PTV can be achieved in the IMRT treatment.,Ghent Experience,introduction,case,discussion,2009,Madani, I., 2009,Dose–volume Constraints,introduction,case,discussion,Madani, I., 2009,Visual Pathway Dose,introduction,c

18、ase,discussion,,,,,,,Madani, I., 2009,Acute Toxicity,introduction,case,discussion,,Madani, I., 2009,,,Studies Reported,introduction,case,discussion,,,,,,,,,,,,,Madani, I., 2009,CTV Delineation,introduction,case,discussio

19、n,Implementation Strategy,2001,introduction,case,discussion,Claus, F.,2001,introduction,case,discussion,“Compartment-related CTV Definition”,In those regions where GTV was flanked by intact bone, no margin was addedIn

20、those regions where GTV invaded compartments enclosed by bone, like other paranasal sinuses, or extended up to their ostia, the whole compartment was included in the CTV contoursIn those regions where GTV invaded radio

21、logically defined spaces known to resist poorly invasion by malignant tumors (e.g., masticator or parapharyngeal spaces), the entire space was added,Claus, F.,2001,Cervical Lymph Nodes,Duthoy, W.,2005,introduction,case,d

22、iscussion,2005,LN Recurrence,Duthoy, W.,2005,introduction,case,discussion,2006,introduction,case,discussion,CTV Delineation cont’,CTV Delineation cont’,“ Indeed, in absence of unambiguous information on the surgical proc

23、edure and comprehensive report of the pathological analysis, a too selective selection and delineation of the CTV may lead to an unacceptable high rate of loco-regional recurrences… ”,Vincent Gregoire, 2006,It will not b

24、e inappropriate to be generous in target volume delineation,introduction,case,discussion,Conclusion,introduction,case,discussion,,may result in a decrease in ocular toxicity,,The appropriate implementation of IMRT for si