NCCN2011版之放疗原则(PRINCIPLES-OF-RADIATION-THERAPY)

Version1.2011,10/06/10©NationalComprehensiveCancerNetwork,Inc.2010,Allrightsreserved.TheNCCNGuidelines™andthisillustrationmaynotbereproducedinanyformwithouttheexpresswrittenpermissionofNCCN®.NCCNGuidelinesIndexCervicalCancerTOCDiscussionNCCN.orgContinueVersion1.2011NCCNClinicalPracticeGuidelinesinOncology(NCCNGuidelines™)PRINCIPLESOFRADIATIONTHERAPYVersion1.2011,10/06/10©NationalComprehensiveCancerNetwork,Inc.2010,Allrightsreserved.TheNCCNGuidelines™andthisillustrationmaynotbereproducedinanyformwithouttheexpresswrittenpermissionofNCCN®.NCCNGuidelines™Version1.2011TableofContentsPrintedbycancer-china.netcancer-china.neton1/15/201110:27:08PM.Forpersonaluseonly.Notapprovedfordistribution.Copyright©2011NationalComprehensiveCancerNetwork,Inc.,AllRightsReserved.TableofContentsVersion2.2010,07/07/10©2010NationalComprehensiveCancerNetwork,Inc.Allrightsreserved.TheseguidelinesandthisillustrationmaynotbereproducedinanyformwithouttheexpresswrittenpermissionofNCCN.GuidelinesIndexHeadandNeckCancersTOCStaging,Discussion,ReferencesPracticeGuidelinesinOncology–v.2.2010NCCN®Note:Allrecommendationsarecategory2Aunlessotherwiseindicated.ClinicalTrials:NCCNbelievesthatthebestmanagementofanycancerpatientisinaclinicaltrial.Participationinclinicaltrialsisespeciallyencouraged.PRINCIPLESOFRADIATIONTHERAPY1Uninvolvednodalstations:44-64Gy(1.6-2.0Gy/fraction)ConsiderelectiveneckRTinT3-T4diseaseforperineuralinvasionorlymphovascularinvasion.Involvednodalstations:60-66Gy(2.0Gy/fraction)44-64Gy(1.6-2.0Gy/fraction)DefinitiveRTPostoperativeRTPrimaryandgrossadenopathy:66-74Gy(2.0Gy/fraction)External-beamRT±brachytherapy50-60Gywithbrachytherapy50-66GywithoutbrachytherapyNeckPrimary:60Gy(2.0Gy/fraction)NeckUninvolvednodalstations:LIP-ACanceroftheLipHeadandNeckCancers1.SeeRadiationTechniques(RAD-A)Printedbycancer-china.netcancer-china.neton1/15/201110:30:34PM.Forpersonaluseonly.Notapprovedfordistribution.Copyright©2011NationalComprehensiveCancerNetwork,Inc.,AllRightsReserved.Version2.2010,07/07/10©2010NationalComprehensiveCancerNetwork,Inc.Allrightsreserved.TheseguidelinesandthisillustrationmaynotbereproducedinanyformwithouttheexpresswrittenpermissionofNCCN.GuidelinesIndexHeadandNeckCancersTOCStaging,Discussion,ReferencesPracticeGuidelinesinOncology–v.2.2010NCCN®Note:Allrecommendationsarecategory2Aunlessotherwiseindicated.ClinicalTrials:NCCNbelievesthatthebestmanagementofanycancerpatientisinaclinicaltrial.Participationinclinicaltrialsisespeciallyencouraged.PRINCIPLESOFRADIATIONTHERAPY1OR-ACanceroftheOralCavityHeadandNeckCancersDefinitiveRTPostoperativeRTPrimaryandgrossadenopathy:Alteredfractionation:NeckUninvolvednodalstations:44-64Gy(1.6-2.0Gy/fraction)Primary:60Gy(2.0Gy/fraction)NeckpT3orpT4primary;N2orN3nodaldisease,nodaldiseaseinlevelsIVorV,perineuralinvasion,vascularembolism.Conventionalfractionation:66-74Gy(2.0Gy/fraction;dailyMonday-Friday)6fractions/weekaccelerated;66-74Gytogrossdisease,44-64Gytosubclinicaldisease.ConcomitantboostacceleratedRT:72Gy/6weeks(1.8Gy/fraction,largefield;1.5Gyboostasseconddailyfractionduringlast12treatmentdays)Hyperfractionation:81.6Gy/7weeks(1.2Gy/fraction,twicedaily)IndicatedforpT3orpT4primary;N2orN3nodaldisease,selectedpT2,N0-N1disease,nodaldiseaseinlevelsIVorV,perineuralinvasion,vascularembolism.PreferredintervalbetweenresectionandpostoperativeRTis6weeks.Involvednodalstations:60-66Gy(2.0Gy/fraction)Uninvolvednodalstations:44-64Gy(1.6-2.0Gy/fraction)PostoperativechemoradiationIndicatedforextracapsularnodalspreadand/orpositivemarginsConsiderforotherriskfeatures:Concurrentsingleagentcisplatinat100mg/mevery3wksisrecommended.2-421.234BernierJ,DomengeC,OzsahinMetal.Postoperativeirradiationwithorwithoutconcomitantchemotherapyforlocallyadvancedheadandneckcancer.NEnglJMed2004;350:1945-1952.CooperJS,PajakTF,ForastiereAAetal.Postoperativeconcurrentradiotherapyandchemotherapyforhigh-risksquamous-cellcarcinomaoftheheadandneck.NEnglJMed2004;350(19):1937-1944.BernierJ,CooperJS,PajukTF,etal.Definingrisklevelsinlocallyadvancedheadandneckcancers:AcomparativeanalysisofconcurrentpostoperativeradiationpluschemotherapytrialsoftheEORTC(#22931)andRTOG(#9501).HeadNeck2005;27:843-850.SeeRadiationTechniques(RAD-A)Printedbycancer-china.netcancer-china.neton1/15/201110:30:34PM.Forpersonaluseonly.Notapprovedfordistribution.Copyright©2011NationalComprehensiveCancerNetwork,Inc.,AllRightsReserved.Version2.2010,07/07/10©2010NationalComprehensiveCancerNetwork,Inc.Allrightsreserved.TheseguidelinesandthisillustrationmaynotbereproducedinanyformwithouttheexpresswrittenpermissionofNCCN.GuidelinesIndexHeadandNeckCancersTOCStaging,Discussion,ReferencesPracticeGuidelinesinOncology–v.2.2010NCCN®Note:Allrecommendationsarecategory2Aunlessotherwiseindicated.ClinicalTrials:NCCNbelievesthatthebestmanagementofanycancerpatientisinaclinicaltrial.Participationinclinicaltrialsisespeciallyencouraged.MucosalMelanomaHeadandNeckCancersMM-APrimarysiteresectionNeck/nodalbasindissectionDoseandFractionation:Paranasalsites:RTtoprimarysite+2-3cmm