原发性肝癌放射治疗.pptx

1、RT for hepatocelluar carcinomaQifeng WangDepartment of Radiation Oncology, Sichuan Cancer HospitalEpidemiology (worldwide)Liver cancer incidence trend for selected registries 1993-2002Center MM, et al. Cancer Epidemiol Biomarkers Prev 2011; 20(11): 23622368.Epidemiology (worldwide)Annual incidence r

2、ate by age group for selected registries 1998-2002Center MM, et al. Cancer Epidemiol Biomarkers Prev 2011; 20(11): 23622368.Epidemiology (China)Age-standardized rate of liver cancerChen JG, et al. Chin J Prev Med 2010; 44(5): 383-389.Topics Liver function tests Staging systems Treatment guidelines R

3、adiotherapy Toxicities Quality Of LifeTopics Liver function tests Staging systems Treatment guidelines Radiotherapy Toxicities Quality Of LifeLiver function testsLiver Function1. Uptake2. Metabolism3. Conjugation4. Excretion5. immunologyLiver function testsLiver function tests Mechanism FactorsPassi

4、ve tests Bilirubin Indirect information on the uptake, conjugation and excretion functionInfluenced by organic anion transporting polypeptide expression, and hemolysisAlbumin and coagulation factorsIndirect indicators of synthesis function -Dynamic quantitative testsIndocyanine green clearance testI

5、ts exclusively cleared by hepaocytes, and excreted into the bile like bilirubin.Its dependent on hepatic blood flow, cellular uptake, and biliary excresion, just like intrhepatic shunting or thrombosis, steatosis, cholestatic patients. It reflects global liver function but not regional variations.Ga

6、lactose elimination capacity testThe metabolic capacity of the liver Its altered in environmental conditions or liver metabolism like liver regeneration and fasting.Hoekstra LT, et al. Ann Surg 2013; 257: 27-36.Conventional testsLiver function tests (clinical grading systems)Variable Score1 2 3Serum

7、 bilirubin (mg/dl) 3.0Serum albumin (g/dl) 3.5 2.8-3.5 6sChild-Pugh Class ScoreA 5-6B 7-9C 10-15Child-Pugh scoring systemLiver function testsLiver function tests Mechanism Characteristics99mTc-Galactosyl serum albumin scintigraphy/SPECTIt binds to asialoglycoprotein receptors only on the hepatocyte

8、cell membrane.It demonstrated a good relationship with conventional liver function tests and is not influenced by hyperbilirubinemia. It could distinguish between functional and nonfunctional liver tissue and predict postoperative complication with high accuracy.99mTc-Mebrofenin hepatobiliary scinti

9、graphy/SPECTSimilar to indocyanine green, it is taken up by hepaocyte via organic anion transporting polypeptide and undergoes biliary excretion without biotransformation.Cause of rapid biliary excretion, it is used for dynamic assessment of liver function. It measure functional remnant liver accurately. However, the uptake of mebrofenin can be affected by hyperbilirubinemia and hypoalbuminemia.Hoekstra LT, et al. Ann Surg 2013; 257: 27-36.Molecular tests