The temple neck cancer projects a treatment technical of make progress

The temple neck cancer is the our country familiar women's malignant tumor.To the temple neck cancer in earlier period carry on a surgical operation treatment have already acquired better curative effect, still take putting to treat as to the patient in partial later period main treatment means, put to treat with synchronous the chemotherapy is to cure a partial later period a temple neck cancer of standard treatment method.The temple neck cancer put to treat a technique to have obvious progress in recent years, main performance at:(1)The outside irradiation led to go into a proper form to adjust strong put to treat a technique, make tumor Ba the amount of of the physical volume the proper form degree be better, the surroundings normally organizes to get very protect.(2)Inside project light upon beginning applied with 3 D image for the basal 3 D cure plan to design and make the treatment be getting more accurate.(3)At temple neck the image diagnosis of the cancer up promote much applied MRI can betterly explicit Ba physical volume scope, and apply MRI can nicely judge to prepare after.On 200547th ASTRO meeting in the United Stateses, the above-mentioned topics all include a report way.



About 3 in the last years each ASTRO meeting adjusts concerning the temple neck cancer and other gynecology tumors strong put to treat of report way, the main contents is an application to adjust strong put to treat a technique can clearly reduce to endanger organ such as be subjected to of rectum, urine bladder and small intestines and part marrow project light upon physical volume, decrease complications.Put the chemotherapy synchronous project to the partial later period temple neck cancer adoption, the blood toxicity is one of the factor of main consideration, L.K.Mell etc. from Chicago to basin chamber bone the physical volume accept of quantity and blood toxicity respond quantitative analysis, result manifestation, accept big at the 20 Gy basin chamber bone the physical volume be obvious impact factor which predicts a blood toxicity and be basin the chamber bone V20 more than 75%, II class above of the blood toxicity respond to will obviously increase.Further analytical manifestation, basin chamber lower part cent bone disgrace bone, hucklebone, Kuan Jiu, near carry a bone and L5 and Mao bone is more obvious impact factor.The author put forward and pass excellent turn the IMRT plan make these bone of the amount of lower, can reduce descend of WBC.For open the exhibition temple neck cancer to adjust strong put to treat, this be the good suggestion.



J.D.Kochanski etc. which comes from Chicago uses the tumor control as endpoint and reported a way an application to adjust first strong put to treat the technique treatment temple neck the result of the cancer, from 2000-2004 years 62 temple neck cancer patient application adjust strong put to treat, 42 don't surgical operation, 18 after operation put to treat.The application basin chamber IMRT adds to put to treat inside chamber and parts of patients synchronously follow a platinum chemotherapy.The DFS for 3 years attains 72.7% and 12 patients relapse.Don't the surgical operation patient's 3 years DFS is 67.8%, surgical operation set the patient's DFS is 78.9%.The application IMRT article of the gynecology tumor doesn't have the exaltation which speaks of quantity to the tumor irradiation and reflect of to the improvement of amount of proper form degree, is BE pass to normal organization low doses project light upon physical volume of increment to carry out the Ba physical volume better and proper form degree.Therefore, the author thinks to still need more long-playing close with visit, then can see the real value that an IMRT amount of learn advantage.



The applied IMRT by all means needs to consider that the emanation treatment moderates organ sport problem that the time in cent cures a period, K.A.Raj etc. of the medical center of the Duke university reported normal sport scope of temple neck, they carry on continuous MRI image a check to 1029-83-year-old non- temple neck cancer patients, discover 70% patients within 20 minutes temple neck position would along with the Chong Ying of the urine bladder degree variety, mainly is to move above backward, fore the rear be the upward biggest and can move a 7.6 mms, biggest move a 9.2 mms in the head and tail direction, hint to need to consider the variety of the urine bladder Chong Ying and temple neck position while carrying on the temple neck cancer IMRT to the PTV design.



Cure for good of temple neck cancer sex puts to treat and have to add to use to project light upon inside chamber.Put the application for treat inside chamber in the IIIb the period the patient of many factor the analysis is the most important treatment factor.Try outside the irradiation after put treat or χ knife and у knife treatment replace inside close quarter chamber pack techniques is all false.The temple neck cancer close quarter cures currently of the amount of learn to request with the ICRU38 numberses report for standard, with point quantity and some noodles quantity(like 60 Gies) Be tumor quantity analysis index sign.This report has already announce for 20 years, obviously limitted sex currently, with outside project light upon a technical development to compare to have an obvious margin.The temple neck treatment dissimilarity of the cancer close quarter treatment technique level of request BE:



LEVEL 1:BE the most simple treatment method, cure a planned choice with every time Shi Yuan2 Qi4 transplant an ex- clinical check is basis, according to check focus and womb size make sure from already give settle of treatment plan the mode win election to choose a suitable plan to carry on a treatment and have no individuation and of amount of measure of excellent turn a processing.Shi Yuan2 Qi4 needs and can take a χ article for the backup after transplant.Many local hospitals are placed in this level currently.



LEVEL 2:BE currently still more the forerunner's level, make sure that the focus size tie department expands a circumstance, choose all of the types of Shi Yuan2 Qi4, apply χ line image a reconstruction Shi Yuan2 Qi4 and OAR to make reference to the space position of point, carry on curing a planned design according to the clinical check before Shi Yuan2 Qi4 transplant, application step into source technique according to the size of the Ba area and of the OAR quantity restriction excellent turn the improvement amount of to distribute.The treatment plan with physical volume and point quantity for foundation.



LEVEL 3:It is the forerunner's accurate treatment level.The application can used for Shi Yuan2 Qi4 of CT/MRI, transplant a juniors line to break 1 F image to scan each time at Shi Yuan2 Qi4, describe a Ba physical volume and endanger the position of organ on the 3D image, take 3D image as foundation to design a treatment plan, can carry on Ba physical volume and OAR amount of excellent turn, use DVH analysis judgment.The whole process complications time-consuming, but can precision show that Ba area and OAR measure, make use of new of the standard carry on amount of valuation.On the current ASTRO meeting, R.Y.Kin etc. which comes from Birmingham reported to combine 3D treatment and IMRT of the HDR close quarter the amount of of the treatment temple neck cancer to learn analysis article, they think that treatment and IMRT of the HDR close quarter of applied normal regulations combine treatment temple neck in the past research the amount of of the cancer learn analysis article, they think the HDR close quarter of applied normal regulations in the past research the treatment only can include 56.8% GTVs, combine the IMRT and 3 DHDRs' application can GTV V 95% attain 92.2%.This the result learns analysis to make the person encourage very much from the amount of, but clinical application very time-consuming, not easy expansion.



The GEC-ESTRO established a GYN work a set in 2004 and exclusively study a 3 D the image especially takes MRI as basal temple neck cancer close quarter to cure a plan design problem and the purpose puts forward basic concept and technical term of the 3 D close quarter treatment which cans be provided to communicate to compare according to the clinical fulfillment.Considered close quarter while study the treatment is mainly a temple neck cancer treatment of one part, Ba area while diagnose, close quarter treatment beginning and treatment the variety in period, according to tumor burden and the dangerous degree for relapse, is divided into three CTVs:High Wei CTV, medium Wei CTV with low Wei CTV.Need at diagnosis and each time close quarter treatment system description GTV and CTV.The concept dissimilarity that concept and outside of GTV and CTV that it put forward project light upon.GTV:At the 3 D close quarter treatment plan in can is divided into diagnosis GTV and close quarter cure GTV.The former's point is especially while diagnosing before cure learned data by the clinical check and the image the tumor scope see by MRI and mean for the GTVD.The latter point checked ago in the close quarter treatment in every time see of GTV, mean for the GTVB1, the GTVB was 2 ……be patient when carried on a close quarter treatment, the GTVB equaled GTVD.



High Risk CTV(HR CTV):Describe when every time close quarter cure.BE mean high tumor burden area, in order to can see without the aid of instruments tumor area, included all temple necks and close quarter to affirm before cure of the tumor expands area.The amount of of the HR CTV presses the tumor physical volume and divides to expect to make sure with treatment method.Intermediate Risk CTV(IR CTV):Describe when every time close quarter cure.Mean the obvious microscope descends tumor area, is the safe edge area with 5~10 mms which wraps to round HR CTV.This safe edge really certainly needs to make reference to original tumor size, position, the tumor that is probably expands to cure behind with tumor of back a slow circumstance and cure a way.Low Risk CTV(LR CTV):Point the possible microscope descends tumor to sow to spread area, can project light upon a processing with surgical operation or outside, don't concretely describe when the close quarter cure.The report of GEC-ESTRO contain very important function to the temple neck that will soon extensively apply's cancer's 3 Wei plan close quarter techniques, probably will by the root change the amount of that the past gynecology close quarter packs a treatment behind to learn idea.



MRI the value of curative effect judgment is subjected to people's more values after the temple diagnosis and treatment of the neck cancer.The MRI has advantage to the manifestation basin chamber organization, can more and so show the correlation between tumor and surroundings organ, specially can show a stalk, the Shi form and coronal image, Shi form for project light upon a wild design helpful, at this ASTRO meeting top W.T.Yuh etc. report way application MRI dynamic state observation tumor physical volume variety, judgment treatment effect.Cure 79 patients, at before cure, under medical treatment(2-2.5 week), cure after(4-5 week), cure to end for 1-2 months, the juniors goes a MRI check.With visit for 6.2 years, analyze the 3 D tumor variety.Show as a result that while putting to treat a 40-50 Gies, the tumor survive physical volume for cure above 20% of ex- physical volume at first, partial control rate and livability of tumor are all worse;1-2 months after putting to treat, if above 10% of the still survive and original physical volume of the tumor physical volume, the disease free survival rate is only 16.7%, but is 78.3% at below 10%.Can see from the above-mentioned result, use rate and long-term existence rate of the MRI estimate tumor control is very beneficial.