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1
題名:CLINICAL OUTCOME OF POSTOPERATIVE INTENSITY-MODULATED RADIOTHERAPY FOR ESOPHAGEAL CANCER     (20點)
食道癌術後接受強度調控放射治療的臨床結果
著者:Hui-Ling Yeh(葉慧玲) ;Chung-Ping Hsu(徐中平) ;Jin-Ching Lin(林進清) ;Jian-Sheng Jan(詹建勝) ;Jai-Fu Lin(林佳福) ;Chen-Fa Chang(張振發) ;Ching-Te Wu(吳清德)
出版地區:台灣
出版城市:台北市
學科:醫學綜合
關鍵字:食道癌 ; 強度調控放射治療 ; 手術後放射治療 ; Esophageal cancer ; Intensity-modulated radiotherapy ; Post-operative radiotherapy
刊名:Therapeutic Radiology and Oncology
頁碼:269-278
語言:英語
摘要: 中文摘要PDF ; 英文摘要PDF

目的:評估食道癌術後的接受強度調控放射治療的臨床結果與劑量分析。 方法與材料:一共有30 位stage II – IV 胸段食道癌的病人在接受治癒目的手術之後,接受了術後的放射治療。病人於術後4-6 週接受放射治療,而所有的治療計畫都使用強度調控放射治療的方式。其中有7 位病人同時接受了術後輔助化學治療。放射治療使用6 MV photo beam,以6-7 個射束以不同的照射角度來構成CTV。CTV 包含了整個原胸段食道部位,而當腫瘤位於中段/上段胸部食道時會包含鎖骨上淋巴結,而腫瘤位於下1/3 食道時會包含celiac 淋巴結。在5-6 週的時間,PTV 的劑量會給予50-60 Gy。我們進而評估病人治療的反應與不良反應。 結果:放射治療所引起的急性不良反應相當輕微,而肺部,心臟與脊髓盡量避開於照射範圍;左肺與右肺所接受的平均劑量分別為 13.1 Gy 與 13.3 Gy。左肺與右肺接受超過2000 cGy 的體積(V20)分別為19.7% 與19.8%。心臟所接受的平均劑量為22.4 Gy,且接受超過40 Gy 的體積(V40)只有9.8%。脊髓所接受的最大劑量為36.5 Gy,相對來說是十分低的。平均的 Conformityindex 為0.8,暗示治療計畫與治療標的的高度一致性。平均的homogeneity index 為 0.94,表示治療標的內的劑量均勻度高。在平均追蹤14 個月後,有5 個患者有局部復發,分布於 anatomicsite(1),supraclavicular region(1),subcarina region(3)。兩年的局部復發率為22.4%,而兩年的整體存活率為 45.1%。遠端轉移為兩年內死亡的主要原因。 結論:胸段食道癌術後以強度調控放射治療用6-7 個射束治療可以有很好的腫瘤順形度及劑量均勻度,且可以避開正常的組織。局部控制結果很好,且兩年存活率是可以接受的。然而,早期遠端轉移仍然是個治療上的問題。新的治療方式還需要去研究以期能增進臨床治療結果。
Purpose : To evaluate the clinical outcome and dosimetry analysis of postoperative intensity-modulated radiation therapy (IMRT) for esophageal cancer. Materials and Methods : A total of 30 patients with stage II-IV esophageal cancer were treated with curative surgery followed by postoperative radiotherapy. All postoperative radiotherapy was planned using an intensity-modulated radiotherapy (IMRT) treatment planning system and was administered 4-6 weeks after operation. Seven out of 30 patients received post-radiotherapy adjuvant chemotherapy. Radiation from 6-7 beam angles, which was designed according to specific shape of clinical target volume (CTV), was delivered by a linear accelerator with energy of 6 MV photons. The CTV included the whole esophageal region plus the supraclavicular region for tumors at the upper and middle thoracic portion of the esophagus or celiac region for tumor situated at the lower thoracic portion. A total dose of 50 Gy to 60 Gy was aimed at the PTV over 5 to 6 weeks. Treatment response was evaluated and toxicities were assessed. The organ at risk dose profile was calculated under isocenter dose of 50 Gy. Results : Radiotherapy related acute toxicities were mild. Organs at risk such as lungs, heart, and spinal cord were spared from the prescribed doses. The mean doses for right and left lungs were 13.1 Gy and 13.3 Gy, respectively. The lung volume received doses of 2000 cGy or more (V20) for right and left lung was 19.7% and 19.8%, respectively. The mean dose to heart was 22.4 Gy and only 9.8% of heart tissue received a dosage over 40 Gy (V40). For spinal cord, the maximum dose was 36.5 Gy which is relatively low. An average conformity index (CI) of 0.8 implies high treatment conformity to the target. An average homogeneity index (HI) of 0.94 indicated good dose homogeneity within the target. After a mean follow-up of 14 months, 5 local recurrences were found over anastomotic site in 1 patient, supraclavicular region in 1 patient and subcarina region in 3 patients, the local recurrence rate in 2-year period is 22.4%. The 2-year overall survival rate was 45.1%. Distant metastasis is the most important reason for those who died within 2 year period of follow-up. Conclusion : Postoperative IMRT using 6 to 7 beams has good coverage of the target and high dose homogeneity while decreasing doses to normal tissue. Local control was good with an acceptable 2-year survival rate. However, early distant metastasis remains to be a problem. New approaches are needed to improve the clinical outcome.


    

本卷期目次
Therapeutic Radiology and Oncology
A Case of Abdominal Tumor with Unusual Presentation/ Chi-Fu HungChien-Ru LiuJyh-Der Leu
Evaluation of Cyberknife Treatment Planning for Prostate Cancer using the Conformal Index and the Tumor Control Probability/ Chia-Chun KuoHsiao-Wei YuKuang-Wei HuangChiu-Ping ChenTao-Sang ChungJeng-Fong ChiouJo-Ting Tsai
Clinical Outcome of Postoperative Intensity-Modulated Radiotherapy for Esophageal Cancer/ Hui-Ling YehChung-Ping HsuJin-Ching LinJian-Sheng JanJai-Fu LinChen-Fa ChangChing-Te Wu
放射腫瘤癌患接受西醫、中醫與另類療法的相關性調查分析/ 陳玉萍曾振淦曾雁明洪志宏
Adjuvant Chemoradiation for Surgical Resected Gastric Cancer Patients: CGH Experience/ Su-Zun ShawYung-Chuan SungChing-Shui HuangMin-Yen ShiHan-Ting LiuPei-Chieh YuChing-Jung Wu
型號FWT-70-40(M)劑量計應用於BNCT輻射場的加馬劑量度量/ 許彬杰劉鴻鳴黎雪萍劉朝錦蔡文旗江祥輝
Moderately Differentiated Neuroendocrine Carcinoma of the Larynx: A Case Report and Review of the Literatures/ Tsai-Ying HuangDai-Wei LiuYung-Hsiang HsuHsi-Sheng ChsiaWen-Lin Hsu
鼻咽癌病患經放射治療後生活品質之急性變化/ 許维中丁禮莉陳宇嘉詹淑卿王博民鍾娜娜劉博仁林高德
Adenoid Cystic Carcinoma of the Trachea Treated with Post-operative Chemoradiotherapy and Metronomic Chemotherapy: A Case Report/ Gwo-Che HuangCharng-Jer HuangKou-Hwa ChangYu-Jen Chen
鼻咽癌病患經放射治療後生活品質之急性變化/ 許?中丁禮莉陳宇嘉詹淑卿王博民鍾娜娜劉博仁林高德
CLINICAL OUTCOME OF POSTOPERATIVE INTENSITY-MODULATED RADIOTHERAPY FOR ESOPHAGEAL CANCER/ Hui-Ling YehChung-Ping HsuJin-Ching LinJian-Sheng JanJai-Fu LinChen-Fa ChangChing-Te Wu
ADJUVANT CHEMORADIATION FOR SURGICAL RESECTED GASTRIC CANCER PATIENTS: CGH EXPERIENCE/ Su-Zun ShawYung-Chuan SungChing-Shui HuangMin-Yen ShiHan-Ting LiuPei-Chieh YuChing-Jung Wu
放射腫瘤癌患接受西醫、中醫與另類療法的相關性調查分析/ 陳玉萍曾振淦曾雁明洪志宏
EVALUATION OF CYBERKNIFE TREATMENT PLANNING FOR PROSTATE CANCER USING THE CONFORMAL INDEX AND THE TUMOR CONTROL PROBABILITY/ Chia-Chun KuoHsiao-Wei YuKuang-Wei HuangChiu-Ping ChenTao-Sang ChungJeng-Fong ChiouJo-Ting Tsai
型號FWT-70-40(M)劑量計應用於BNCT輻射場的加馬劑量度量/ 許彬杰劉鴻鳴黎雪萍劉朝錦蔡文旗江祥輝
MODERATELY DIFFERENTIATED NEUROENDOCRINE CARCINOMA OF THE LARYNX: A CASE REPORT AND REVIEW OF THE LITERATURES/ Tsai-Ying HuangDai-Wei LiuYung-Hsiang HsuHsi-Sheng ChsiaWen-Lin Hsu
A CASE OF ABDOMINAL TUMOR WITH UNUSUAL PRESENTATION/ Chi-Fu HungChien-Ru LiuJyh-Der Leu
ADENOID CYSTIC CARCINOMA OF THE TRACHEA TREATED WITH POST-OPERATIVE CHEMORADIOTHERAPY AND METRONOMIC CHEMOTHERAPY: A CASE REPORT/ Gwo-Che HuangCharng-Jer HuangKou-Hwa ChangYu-Jen Chen
 
   
 
   

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