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  • 2018

    (2017/11/01)

  • i

    EBM

    50

    009592-01_GL___DIC95.indd 1 17/09/25 19:36

  • i

    2009TNM20131201342017TNM8HPVp16EBER

    Quality of Life

    201710

    009592-01_GL___DIC95.indd 1 17/09/25 19:36

  • 11

    1 11

    2 11

    3 11

    4 12

    5 13

    6 13

    15

    1 15

    2 15

    19

    A

    A-1 19

    1 19

    2 19

    3 20

    4 21

    A-2 22

    1 22

    2 23

    A-3 26

    1 26

    2 26

    3 27

    A-4 28

    1 28

    2 29

  • 3 30

    A-5 33

    1 33

    2 33

    3 36

    4 37

    5 39

    A-6 41

    1 41

    2 42

    B 45

    B-1 45

    1 45

    2 47

    47

    B-2 49

    1 49

    2 51

    51

    B-3 53

    1 53

    2 54

    54

    B-4 56

    1 56

    2 58

    59

    B-5 62

    1 62

    2 63

    65

  • B-6 68

    1 68

    2 70

    72

    B-7 75

    1 75

    2 76

    3 78

    B-8 83

    1 83

    2 84

    3 85

    85

    B-9 87

    1 87

    2 88

    89

    91

    1 91

    CQ1-1 N CT 91

    CQ1-2 T MRI 92

    CQ1-3 93

    CQ1-4 94

    CQ1-5 95

    CQ1-6 FDG-PET 96

    CQ1-7 98

    CQ1-8 100

    2 102

    CQ2-1 102

    CQ2-2 104

    CQ2-3 106

  • CQ2-4 III

    108

    CQ2-5 N1

    109

    CQ2-6 111

    CQ2-7 112

    CQ2-8 114

    3 116

    CQ3-1

    116

    CQ3-2 117

    4 119

    CQ4-1

    119

    CQ4-2 120

    CQ4-3 II 122

    CQ4-4 123

    5 125

    CQ5-1-1 HPV 125

    CQ5-1-2 HPV 125

    CQ5-1-3 HPV 125

    6 127

    CQ6-1 127

    CQ6-2 128

    7 130

    CQ7-1 130

    CQ7-2 131

    CQ7-3 132

    8 135

    CQ8-1 1 cm 135

    CQ8-2 137

    CQ8-3

  • 138

    CQ8-4 140

    CQ8-5 142

    9 146

    CQ9-1 146

    CQ9-2 147

    CQ9-3 148

    CQ9-4 149

    10 152

    CQ10-1 152

    CQ10-2 p16 EBER-ISH 153

    CQ10-3 154

    CQ10-4

    155

    11 157

    CQ11-1

    157

    CQ11-2

    158

    CQ11-3

    TPF TXTCDDP5-FUTXT

    159

    CQ11-4

    161

    CQ11-5 Cmab

    163

    CQ11-6

    165

    CQ11-7 166

    CQ11-8 PD-1 168

    12 170

    CQ12-1 170

    CQ12-2

    171

  • CQ12-3 173

    CQ12-4 CRT 175

    CQ12-5 176

    CQ12-6 178

    CQ12-7 180

  • 1

    1

    2

    3

    ,-1 -2 TNMT-2-9

    009592-01_GL_01_DIC95_.indd 1 17/09/25 19:31

    11/181

  • 2

    TNM 6 1 6 2TNM 8 3CQ2001PubMedCQCQCQ

    CQ

    RCT 1

    A B C1 C2 C3 D

    4 20132

    009592-01_GL_01_DIC95_.indd 2 17/09/25 19:31

    12/181

  • 3

    5

    6 1 7 22010 42016 5 6

    6

    1 62018 2 72015 3 Sobin LH, Wittekind ChUICCTNMTNM8

    2017 4 20101

    2010 5 201642016 6 2015

    009592-01_GL_01_DIC95_.indd 3 17/09/25 19:31

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  • 14/181

  • 1

    1

    XUSCTMRICTMRICTMRIMRI1-3

    USUS4,5CTMRI

    CTMRIT16-1112,13

    USCTMRI

    XPET-CT14-21X

    XCTCTMRI

    2 1995714.5

    1

    009592-01_GL_02_DIC95_.indd 1 17/09/25 19:31

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  • 22,23

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    2 LeslieA,FyfeE,GuestP,etal.StagingofSquamousCellCarcinomaoftheOralCavityandOrophar-ynxAComparisonofMRIandCTinT-andN-Staging.JComputAssistTomogr.19992343-9.

    3 BolzoniA,CappielloJ,PiazzaC,etal.Diagnosticaccuracyofmagneticresonanceimagingintheas-

    sessmentofmandibularinvolvementinoral-oropharyngealsquamouscellcarcinomaaprospectivestudy.ArchOtolaryngolHeadNeckSurg.2004130837-43.

    4 ParkJS,SonKR,NaDG,etal.Performanceofpreoperativesonographicstagingofpapillarythyroidcarcinomabasedon thesixtheditionof theAJCCUICCTNMclassification system.AJRAmJRoentgenol.200919266-72.

    5 SeiberlingKA,DutraJC,GunnJ.Ultrasound-guidedfineneedleaspirationbiopsyofthyroidnodulesperformedintheoffice.Laryngoscope.2008118228-31.

    6 CastelijnsJA,GerritsenGJ,KaiserMC,etal.Invasionoflaryngealcartilagebycancercompari-sonofCTandMRimaging.Radiology.1988167199-206.

    7 FerriT,DeThomasisG,QuarantaN,etal.ThevalueofCTscansinimprovinglaryngoscopyinpa-tientswithlaryngealcancer.EurArchOtorhinolaryngol.1999256395-9.

    8 GironJ,JoffreP,Serres-CousineO,etal.CTandMRevaluationoflaryngealcarcinomas.JOtolaryn-gol.199322284-93.

    9 LjumanoviR,LangendijkJA,SchenkB,etal.SupraglotticcarcinomatreatedwithcurativeradiationtherapyidentificationofprognosticgroupswithMRimaging.Radiology.2004232440-8.

    10 PhelpsPD.Carcinomaofthelarynxtheroleofimaginginstagingandpre-treatmentassessments.

    ClinRadiol.19924677-83. 11 ZbrenP,BeckerM,LangH.Pretherapeuticstagingof laryngealcarcinoma.Clinical findings,com-

    putedtomography,andmagneticresonance imagingcomparedwithhistopathology.Cancer.1996771263-73.

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    13 MutoM,KatadaC,SanoY,etal.Narrowbandimaginganewdiagnosticapproachtovisualizean-giogenesisinsuperficialneoplasia.ClinGastroenterolHepatol.20053S16-20.

    14 XCT199194577-86.

    15 StuckensenT,KovcsAF,AdamsS,etal.StagingoftheneckinpatientswithoralcavitysquamouscellcarcinomasaprospectivecomparisonofPET,ultrasound,CTandMRI.JCraniomaxillofacSurg.200028319-24.

    16 DietlB,MarienhagenJ,KhnelT,etal.FDG-PETinradiotherapytreatmentplanningofadvancedheadandneckcanceraprospectiveclinicalanalysis.AurisNasusLarynx.200633303-9.

    17 GordinA,DaitzchmanM,DoweckI,etal.Fluorodeoxyglucose-positronemissiontomographycom-

    putedtomographyimaginginpatientswithcarcinomaofthelarynxdiagnosticaccuracyandimpactonclinicalmanagement.Laryngoscope.2006116273-8.

    18 RumboldtZ,GordonL,GordonL,etal.Imaginginheadandneckcancer.CurrTreatOptionsOncol.2006723-34.

    19 KyzasPA,EvangelouE,Denaxa-KyzaD,etal.18F-fluorodeoxyglucosepositronemissiontomogra-

    009592-01_GL_02_DIC95_.indd 2 17/09/25 19:31

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  • 3

    phytoevaluatecervicalnodemetastasesinpatientswithheadandnecksquamouscellcarcinomaaMeta-analysis.JNatlCancerInst.2008100712-20.

    20 LiaoLJ,LoWC,HsuWL,etal.DetectionofcervicallymphnodemetastasisinheadandneckcancerpatientswithclinicallyN0neck-ameta-analysiscomparingdifferentimagingmodalities.BMCCan-cer.201212236.

    21 FletcherJW,DjulbegovicB,SoaresHP,etal.Recommendationsontheuseof18F-FDGPETinon-cology.JNuclMed.200849480-508.

    22 200329526-40.

    23 JOHNS1997131281-5.

    009592-01_GL_02_DIC95_.indd 3 17/09/25 19:31

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  • 18/181

  • 1

    A

    -A-1

    1

    TNM

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  • 2

    2

    CTMRI

    NBI

    3

    surgical site infectionSSI 1-52448

    009592-01_GL_03_A-01-06_DIC95_.indd 2 17/09/25 19:33

    20/181

  • 3

    4

    222

    5

    CQ

    1 CDC. Infection Control and Hospital Epidemiology Guideline for Prevention of Surgical Site Infection, 1999.

    2 2013 3 42014 4 CDC. Draft Guideline for the Prevention of Surgical Site Infection, 2014. 5

    2016

    009592-01_GL_03_A-01-06_DIC95_.indd 3 17/09/25 19:33

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  • 4

    -A-2QOL

    1 1

    CRT

    ICTMACH-NC 154.56.52.4-1CRT 2

    2

    CQ11-2CQ11-1CQ12-1QOLCRT 3,4 258.6

    CDDP100mgm 2

    3EGFRCmab

    CQ11-7-1 5CmabCRT 6

    CRTRTRT

    009592-01_GL_03_A-01-06_DIC95_.indd 4 17/09/25 19:33

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  • 5

    3RT

    chemoselection

    ICTCQ11-8CRTCRPRPRPRCBDCA-RTCmab-RT

    CDDP5-FUPFTXTCDDP5-FUTPF 7PFTPF 8TPFTPFCDDP-RT

    CRTCRTICT-TPFCRTCRTICTCRT 9

    TPF 10CQ2-6

    4

    CRTPFCQ12-1

    2

    QOLCDDPKey Drug

    009592-01_GL_03_A-01-06_DIC95_.indd 5 17/09/25 19:33

    23/181

  • 6

    11PF 12CDDP 100mgm 25-FU 1000mgm 2day45days370805-FUPF 13CmabCDDPPFPFPFCmabQOL 15CDDPCBDCA6coursePt5-FUCmabTPF2

    6DOCPTXS-1MTXPD-1DOCMTXCmab 16 17CQ11-8immune-related adverse eventirAE 18

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    3 Lin S, Tham IW, Pan J, et al. Combined high-dose radiation therapy and systemic chemotherapy improves survival in patients with newly diagnosed metastatic nasopharyngeal cancer. Am J Clin Oncol. 201235474-9.

    4 Chen MY, Jiang R, Guo L, et al. Locoregional radiotherapy in patients with distant metastasis of nasopharyngeal carcinoma at diagnosis. Chin J Cancer. 201332604-13.

    5 Bonner JA, Harari PM, Giralt J, et al. Radiotherapy plus cetuximab for squamous-cell carcinoma of the head and neck N Engl J Med. 200635456778.

    6 Ang KK, Zhang Q, Rosenthal DI, et al. Randomized phase trial of concurrent accelerated radiation plus cisplatin with or without cetuximab for stage to head and neck carcinomaRTOG 0522. J

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  • 7

    Clin Oncol. 2014322940-50. 7 Janoray G, Pointreau Y, Garaud P, et al. Long-term results of a multicenter randomized phase trial

    of induction chemotherapy with cisplatin, 5-fluorouracil, -docetaxel for larynx preservation. J Natl Cancer Inst. 20151084. piidjv368.

    8 Blanchard P, Bourhis J, Lacas B, et al. Taxane-cisplatin-fluorouracil as induction chemotherapy in locally advanced head and neck cancersan individual patients data meta-analysis of the meta-analysis of chemotherapy in head and neck cancer group. J Clin Oncol. 2013312854-60.

    9 Budach W, Blke E, Kammers K, et al. Induction chemotherapy followed by concurrent radio-chemotherapy versus radio-chemotherapy alone as treatment of locally advanced squamous cell carcinoma of the head and neckHNSCCa meta-analysis of randomized trials. Radiotherapy and Oncology. 2016118238-43.

    10 Zhong L, Zhang C, Ren G, et al. Randomized phase trial of induction chemotherapy with docetaxel, cisplatin, and fluorouracil followed by surgery versus up-front surgery in locally advanced resectable oral squamous cell carcinoma. J Clin Oncol. 201231744-51.

    11 Morton RP, Rugman F, Droman EB, et al. Cisplatinum and bleomycin for advanced or recurrent squamous cell carcinoma of the head and necka randomised factorial phase controlled trial. Cancer chemotherapy and pharmacology. 198515283-289.

    12 Kish JA, Weaver A, Jacob J, et al. Cisplatin and 5-fuluorouracil infusion in patients with recurrent and disseminated epidermoid cancer of the head and neck. Cancer. 1984531819-24.

    13 Gibson MK, Li Y, Murphy B, et al. Randomized Phase evaluation of cisplatin plus fluorouracil versus cisplatin plus paclitaxel in advanced head and neck cancerE1395an intergroup trial of the Eastern Cooperative Oncology Group. J Clin Oncol. 2005233562-67.

    14 Vermorken J, Mesia R, Rivera F, et al. Platinum-based chemotherapy plus cetuximab in head and neck cancer. N Engl J Med. 20083591116-27.

    15 Yoshino T, Hasegawa Y, Takahashi S, et al. Platinum-based chemotherapy plus cetuximab for the first-line treatment of Japanese patients with recurrent andor metastatic squamous cell carcinoma of the head and neckresults of a phase study trial. Jpn J Clin Oncol. 201343524-31.

    16 Ferris RL, Blumenschen G, Fayette J, et al. Nivolumab for recurrent squamous-cell carcinoma of the

    head and neck. N Engl J Med. 20163751856-67. 17 NCCN Clinical Practice Guideline in Oncology Head and Neck Cancers Version 2. 2017. httpswww.

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  • 8

    -A-3

    1 4

    1156,515 256.4HR0.82p0.000153.4HR0.92p0.003 3

    2 intensity modulated radiotherpyIMRT

    IMRT5871 IMRT Grade2 HR0.76p0.0001 4QOLIMRT 5,6IMRTIMRTQOL 7

    2016IMRT

    009592-01_GL_03_A-01-06_DIC95_.indd 8 17/09/25 19:33

    26/181

  • 9

    3

    QOL

    1 Withers HR, Taylor JM, Maciejewski B. The hazard of accelerated tumor clonogen repopulation during radiotherapy. Acta Oncol. 198827131-46.

    2 Bourhis J, Overgaard J, Audry H, et al. Hyperfractionated or accelerated radiotherapy in head and neck cancera meta-analysis. Lancet. 2006368843-54.

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    4 Marta GN, Silva V, de Andrade Carvalho H, et al. Intensity-modulated radiation therapy for head and neck cancersystematic review and meta-analysis. Radiotherapy and oncologyjournal of the European Society for Therapeutic Radiology and Oncology. 20141109-15.

    5 Tribius S, Bergelt C. Intensity-modulated radiotherapy versus conventional and 3D conformal radiotherapy in patients with head and neck canceris there a worthwhile quality of life gain? Cancer treatment reviews. 201137511-9.

    6 Klein J, Livergant J, Ringash J. Health related quality of life in head and neck cancer treated with radiation therapy with or without chemotherapya systematic review. Oral Oncol. 201450254-62.

    7 Lohia S, Rajapurkar M, Nguyen SA, et al. A comparison of outcomes using intensity-modulated radiation therapy and 3-dimensional conformal radiation therapy in treatment of oropharyngeal cancer. JAMA Otolaryngol Head Neck Surg. 2014140331-7.

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  • 10

    -A-4

    21

    Intention to treatITT

    ITT

    1

    Prevention

    ProphylacticinterventionSymptom management2

    1PreventionProphylacticintervention

    2Symptommanagement

    009592-01_GL_03_A-01-06_DIC95_.indd 10 17/09/25 19:33

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  • 11

    1

    2

    1

    /

    11-3

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  • 12

    TPLERTND

    2

    Common Terminology Criteria for Adverse EventsCTCAEGradeCTCAE v4.0 JCOG

    CTCAE v4.03MedDRA v12.0MedDRAJ v19.0httpwww.jcog.jpdoctortoolCTCAEv4J_20160310.pdf

    CTCAE

    3

    1 4113

    Grade40

    1960Nature 5B 6C1

    60Gy 7-960GyC2

    009592-01_GL_03_A-01-06_DIC95_.indd 12 17/09/25 19:33

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  • 13

    2

    2B

    3

    C2

    4

    10

    11 12B

    5

    13

    5

    009592-01_GL_03_A-01-06_DIC95_.indd 13 17/09/25 19:33

    31/181

  • 14

    1 Navari RM, Qin R, Ruddy KJ, et al. Olanzapine for the Prevention of Chemotherapy-Induced Nausea and Vomiting. The New England journal of medicine. 2016375134-42.

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    7 Bostrom A, Lindman H, Swartling C, et al. Potent corticosteroid creammometasone furoatesignifi-cantly reduces acute radiation dermatitisresults from a double-blind, randomized study. Radiother-apy and oncologyjournal of the European Society for Therapeutic Radiology and Oncology. 200159257-65.

    8 Shukla PN, Gairola M, Mohanti BK, et al. Prophylactic beclomethasone spray to the skin during post-operative radiotherapy of carcinoma breasta prospective randomized study. Indian journal of can-cer 200643180-4.

    9 Miller RC, Schwartz DJ, Sloan JA, et al. Mometasone furoate effect on acute skin toxicity in breast cancer patients receiving radiotherapya phase double-blind, randomized trial from the North Central Cancer Treatment Group N06C4. International journal of radiation oncology, biology, physics, 2011791460-6.

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    13 20162016

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  • 15

    -A-5

    1 1

    41 1,2

    23

    20138 3

    9CQ1ABC1

    32010

    CAREER 4

    2 1

    009592-01_GL_03_A-01-06_DIC95_.indd 15 17/09/25 19:33

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  • 16

    /

    WHO2002WHO

    Demands)QOL

    1 12

    1ClinicalQuestionClinicalQuestion

    1 ADLQOL B

    2 B

    3 B

    4 C1

    5 B

    6 C1

    7 B

    8 A

    9 B

    10 B

    3

    009592-01_GL_03_A-01-06_DIC95_.indd 16 17/09/25 19:33

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  • 17

    dump and swallow

    5

    2

    7VFVE

    OEPEG

    PAPPLP

    VFVE

    009592-01_GL_03_A-01-06_DIC95_.indd 17 17/09/25 19:33

    35/181

  • 18

    36482

    VF9 6

    536 7PAP3PAP 8

    3 1

    5

    21

    009592-01_GL_03_A-01-06_DIC95_.indd 18 17/09/25 19:33

    36/181

  • 19

    voice prosthesisVega TMAtos Medicalvoice prosthesis2

    75

    3 91

    85255316

    6QOLQOL 10

    52173 1120377 12

    voice prosthesisvoice prosthesisProvox 2 TM59062.8 13109066.7 14

    4 1

    QOL

    009592-01_GL_03_A-01-06_DIC95_.indd 19 17/09/25 19:33

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  • 20

    QOL

    QOL 15

    2

    VFVE1

    ST

    3VF

    VF 16

    2VF32 17

    3

    009592-01_GL_03_A-01-06_DIC95_.indd 20 17/09/25 19:33

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  • 21

    18

    5 1radical neck dissectionRND

    modified radical neck dissectionMRNDselective radical neck dissectionSND1 5

    2

    range of motionROM

    RNDMRNDSND

    33

    153036 19

    31015 20

    456150 21

    009592-01_GL_03_A-01-06_DIC95_.indd 21 17/09/25 19:33

    39/181

  • 22

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    13 Terada T, Saeki N, Toh K, et al. Voice rehabilitation with Provox2 voice prosthesis following total laryngectomy for laryngeal and hypopharyngeal carcinoma. Auris Nasus Larynx. 20073465-71.

    14 Voice prosthesis20096016-22.

    15 FRONTIER2015346-9

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    18 Nguyen NP, Moltz CC, Frank C, et alDysphagia following chemoradiation for locally advanced head and neck cancer. Ann Oncol. 200415383-8.

    19 Salerno G, Cavaliere M, Foglia A, et alThe 11 th nerve syndrome in functional neck dissection. Laryngoscope. 20021121299-307.

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    QOL 2

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  • -B-11

    B

    -B-1

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    TX T0 Tis T1 2cm5mm

    T2 2cm5mm10mm2cm4cm10mm

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    T4a

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    M

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    009592-01_GL_03_B-01-09_DIC95_.indd 2 17/09/25 19:34

    46/181

  • -B-13

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    T3

    N0

    N

    T4

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    CQ11-4

    T1T2T31-4CQ2-1

    5-10CQ2-2CQ2-311,12CQ2-4

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  • -B-25

    -B-2

    1 T

    TX T0 Tis T1 T2

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    M

    M0 M1

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    009592-01_GL_03_B-01-09_DIC95_.indd 6 17/09/25 19:34

    50/181

  • -B-27

    2

    T1

    N0

    N

    T2

    N0

    N

    T3

    N0

    N

    T4a

    N0

    N

    6070Gy303567

    1-56intensitymodulatedradiotherapyIMRTCQ11-5

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  • -B-39

    -B-3

    1 T

    TX T0 Tis T1

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    T2 N0N1 M0 T1T2 N2 M0 T3 N0N1N2 M0A T4 N0N1N2 M0A T N3 M0B T N M1

    2

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    2

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    2

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    4 CQ4-2

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    4050Gy

    6070Gy303567CT

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  • -B-311

    IMRT1,2CTMRIPETPET-CT

    3-7CQ4-14

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  • 12

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    1 T

    p16TX T0 Tis T1 2cmT2 2cm4cmT3 4cmT4a /

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  • -B-413

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    M

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    p160 Tis N0 M0 T1 N0 M0 T2 N0 M0 T3 N0 M0 T1T2T3 N1 M0

    009592-01_GL_03_B-01-09_DIC95_.indd 13 17/09/25 19:34

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  • 14

    A T1T2T3 N2 M0 T4a N0N1N2 M0B T4b N M0 T N3 M0C T N M1p16

    0 Tis N0 M0 T1T2 N0N1 M0 T1T2 N2 M0 T3 N0N1N2 M0 T1T2T3 N3 M0 T4 N M0 T N M1

    2

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    N0

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  • -B-415

    T2

    N0

    N

    TN

    T

    N

    T

    N

    T3T4

    N0

    N

    TN

    1HPVHPV1,2TNMUICC/AJCC82017HPVp16HPVp16HPVN

    HPVp16HPV3,4

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    CQ5-1

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    6070Gy3035675HPV6,7

    T12

    8HPV3,4pull throughlevel9,1011

    HPV3,4

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    -B-5

    1 T

    TX T0 Tis T1 12cmT2 1

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    N

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    N3a 6cmN3b

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  • -B-519

    M

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    0 Tis N0 M0 T1 N0 M0 T2 N0 M0 T3 N0 M0 T1T2T3 N1 M0A T1T2T3 N2 M0 T4a N0N1N2 M0B T4b N M0 T N3 M0C T N M1

    2

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  • 20

    T2

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    T3

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    T4a

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    64/181

  • -B-521

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    6070Gy303567

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    5-910-1213-1516

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    -B-6

    1 T

    TX T0 Tis

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  • -B-625

    T1 T2 T3 T4a

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    N

    NX N0 N1 3cmN2

    N2a3cm6cm

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    N3a 6cmN3b

    M

    M0 M1

    0 Tis N0 M0 T1 N0 M0 T2 N0 M0 T3 N0 M0 T1T2T3 N1 M0

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    A T4a N0N1 M0 T1T2T3T4a N2 M0B T4b N M0 T N3 M0C T N M1

    2

    Tis

    T

    N

    T1

    N0

    N

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    1

    1

    1

    TN

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  • -B-627

    T

    N

    T2

    N0

    N

    1

    1

    1

    1

    TN

    1

    T3

    N0

    N

    1

    1

    T4a, N03

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    2CQ11-4

    1CQ7-1

    X46MV3

    212Gy5T160

    66Gy3033T270Gy352-42T21

    56

    78

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