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1

2

3 Glioma 28% astrocytoma (WHO I) 0.28 anaplastic (WHO II/III) 0.18 Glioblastoma (WHO IV) 0.32 others 0.22 Meningioma partly malignant) 26% Pituitary adenoma 17% Neurinoma 11% Craniopharyngioma etc 5% Others 13% (

4 1 A: WHO II fibrillary astrocytoma B: WHO III anaplastic astrocytoma C: WHO IV glioblastoma

5 2 A: medulloblastoma B: oligodendroglioma C: ependymoma D: benign meningioma

6 SEER) 2-Y-S (%) 5-Y-S (%) Glioblastoma 6 1 Astrocytoma Oligodendroglioma Medulloblastoma Ependymoma 83 60

7

8

9 1.8-2Gy or Gy 0.5 cm 2 cm , ---AVM

10 PNET (primitive neuroectodermal tumor)

11 1/3 2/3 3/3 TD5/5 60Gy 50Gy 40Gy TD50/5 75Gy 65Gy 60Gy TD5/ TD50/ TD5/5 10 TD50/5 18 TD5/5 50 TD50/5 65

12 - 24Gy ---

13

14 (glioblastoma) anaplastic astrocytoma) Malignant glioma--- glioblastoma--- : grade IV anaplastic astrocytoma--- : grade III

15 nitrosourea ---ACNU, MCNU 1 2 Interferon Glioblastoma---5-Y-S: 0-2% 4-5M, 10-13M Anaplastic astrocytoma---5-y-s: 20% Glioblastoma) PS

16 Recursive Partitioning Analysis RPA 2-Y-S I AA, 50 < 58.6( 76 II AA, 50y>,PS>70,sym 3M III GBM, <50y, PS IV GBM, >50y, PS<90, V GBM, >50y, PS>70, VI GBM 50 PS<70 4

17 T2WI 3 4cm 1.8-2Gy 60Gy Glioblastoma 65Gy 60-90Gy 60Gy

18 Non-coplanar RT

19 GBM temozolomide New England J Medicine 35: 987, % temozolomide 26.5%

20 New England J Med 35: 987,

21 GBM algorithm

22

23 GBM 3-4cm 60-65Gy TMZ) Glioblastoma M 10-13M Anaplastic astrocytoma---5-y-s: 20% PS

24 Astrocytoma, low grade) Pilocytic, Xanthomatous, Giant cell astrocytoma--- Gemistocytic---Grade III Ordinary astrocytoma cm 50-60Gy 5-Y-S 50%, 10-Y-S 30% Optic glioma Y-S 80-90%

25 WHO II astrocytoma 64.8Gy

26 Pilocytic, Xanthomatous, Giant cell Gemistocytic cm 50-60Gy 5-Y-S 50%, 10-Y-S 30%

27 Ependymoma Ependymoma, Anaplastic ependymoma Ependymoblastoma--- 10% 5-15 high grade 50-60Gy ( 30Gy 25Gy ) 5-Y-S low gr: 60-80%, high gr: 10-40%

28 % high grade 50-60Gy low grade 60-80% high grade 10-40%

29 95% glioma brain stem glioma 2cm 60Gy low grade 50-55Gy 5-Y-S 10-20% high grade 6-8

30 glioma 60Gy low grade50-55gy % high grade 6-8

31 Medulloblastoma Pineoblastoma PNET 40% Gy 20Gy 5-Y-S 55-75% 30%

32 IMRT Hinson et al. : Wake Forest University

33 PNET 40% 30-35Gy 20Gy %

34 Germinoma % Germ cell tumor Choriocarcinoma, yolk sac tumor, teratoma 40-50Gy pure germinoma Gy) 24Gy 85%

35 AIDS CT mass effect % 10% 40Gy 15-20Gy 5 10% MTX 5-Y-S 50% J Clin Oncol 20:4643, 2002 & 18:3144, 2000)

36 AIDS CT 10% 40Gy 15-20Gy 10% MTX

37 Craniopharyngioma %, % 0.5-1cm 50-55Gy 10-Y-S 80-90% ( Favorable: 5

38 algorithm

39 Stereotactic conformal RT chiasm SRS

40 50-55Gy %

41 Meningioma cm 50-60Gy 10 61% (Royal Marsden H) ---5-Y-S 17%

42 50-60Gy 10 61% (Royal Marsden H) dural tail sign

43 10 ACTH releasing adenoma prolactin (PRL) nonfunctioning adenoma nonfuctioning/gh PRL/ACTH Hormone PRL 28%, GH 23%, ACTH 8%, gonadotropin 6%, TSH 1%, nonfunctioning 33%

44 sellar and parasellar region

45 Pituitary adenoma with extrasellar extensions

46 prolactinoma

47 1 medical therapy: dopamine agonist bromocriptine 2) surgery: 3 RT Gy/28 SRS SRT 8Gy

48 3

49 GHacromegaly

50

51 algorithm

52 1 3 / 45 / /

53 Stereotactic Radiosurgery : SRS Stereotactic Radio herapy : SRT

54

55 Stereotactic Radio Surgery ; SRS ( ) 1

56 minimum requirement 1 CT/MR)

57 MFH 2)

58 1 RT

59 MFH

60 Ewing sarcoma) LDH Gy, Gy, Gy, Gy

61 M 22.6M 11.8M 3.6M

62 X X 34/118(29%), /125(26%), 172/844(20%), /1,143(19%)

63 LDH,ALP, CEA,CA SCC PSA CTP,,P1CP X-P CT MR

64 Showa Univ.

65 Showa Univ.

66 Showa Univ.

67 Showa Univ.

68 Showa Univ.

69 1.

70 / RI I- Sr- IVR TAE,

71 -50Gy (1/8-2.2Gy/ Gy ( Gy/ Gy (3Gy x 10 Gy /15 20Gy/4

72 X P Osteolytic meta 50y.o. F

73

74

75 Sr-89

76 MS 10mg MS 60mg =155,952 27,000 3,300 3Gy 10 93, ,300 cost-effective

77 Sr-89 DIC

78 Bone seeking agent labeled with beta emitter Possible agents in Japan Strontium-89 Sm-153 EHDP now on re-evaluation now on Phase I, II study 58

79

80

81 Kasabach-Merritt DIC

82 Letterer-Siwe HAND-Schuller-Christian Gy

83 Langerhans HistiocytosisX Langerhans CD1a,S-100 Letterer-Siwe Hand-Schuller-Christian

84 Gy Gy

85 MFH

86 MFH MPNST

87 MFH)..

88 Gy

89 G MHF Gy

90 phase phase Gy/16f/4

91 4 SCC / BCC SCC

92 SCC), BCC) MCC) Kaposi

93

94

95

96

97

98

99

100 BCC/SCC/MCC X V) X V) X SCC,BCC Gy

101 DAV DTIC,ACNU,VCD DAV CDV CDDP,DTIC,VDS

102 A Asymmetry B Borderline irregularity( C Color variegation( D Diameter enlargement E Elevation surface (

103

104 2(

105 2009

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