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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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More information1) Asa, S. L., et al.: Immunohistochemical localization of neuron-specific enolase in the human hypophysis and pituitary adenoma, Arch. Pathol. Lab. Med., 108: 40 `43, 1984. 2) Chi, B. H. and Kim, R. C.:
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乃木坂 RT2013 第 11 章小児 良性 疾患の放射線治療 国際医療福祉大学病院 放射線治療 核医学センター北原規 1. 小児腫瘍 1) 頻度 2) 横紋筋肉腫 3) ウイルムス腫瘍 4) 神経芽細胞腫 5) 小児白血病 1. 小児腫瘍 小児腫瘍 : 頻度 急性白血病 24% ----ALL 18% AML 4% 中枢神経系 18%-----glial tumors 12% medulloblastoma
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