非小細(xì)胞肺癌放射治療進(jìn)展非小細(xì)胞肺癌的放射治療PPT學(xué)習(xí)教案

1、會(huì)計(jì)學(xué)1非小細(xì)胞肺癌放射治療進(jìn)展非小細(xì)胞肺非小細(xì)胞肺癌放射治療進(jìn)展非小細(xì)胞肺癌的放射治療癌的放射治療第九屆中國(guó)腫瘤學(xué)術(shù)大會(huì)2第1頁/共31頁第九屆中國(guó)腫瘤學(xué)術(shù)大會(huì)3精確的腫瘤定位和放射治療劑量計(jì)算精確的腫瘤定位和放射治療劑量計(jì)算第2頁/共31頁第九屆中國(guó)腫瘤學(xué)術(shù)大會(huì)4呼氣吸氣螺旋開始時(shí)相時(shí)相由吸轉(zhuǎn)呼呼氣末由呼轉(zhuǎn)吸由吸轉(zhuǎn)呼呼氣吸氣螺旋開始呼吸曲線呼吸曲線床位床位第3頁/共31頁第九屆中國(guó)腫瘤學(xué)術(shù)大會(huì)540對(duì)葉片MLCKV級(jí)X射線球管KV級(jí)探測(cè)器陣列MV級(jí)探測(cè)器陣列第4頁/共31頁第九屆中國(guó)腫瘤學(xué)術(shù)大會(huì)6第5頁/共31頁第九屆中國(guó)腫瘤學(xué)術(shù)大會(huì)7放射治療能夠使 早期NSCLC獲得治愈 第6頁/共31

2、頁第九屆中國(guó)腫瘤學(xué)術(shù)大會(huì)8Institute Dose/fx/OTT LC/Follow-upUematsu 50-60/5-10/5d 94% (47/50) 36MKyoto 48Gy/4fr/12d 96% (49/51) 20M Arimoto 60Gy/8fr/11d 92% (22/24) 24MOnimaru 60Gy/8fr/11d: 88% (50/57) 18M Nagata Y, Kyoto Univ, IASLC, 2004第7頁/共31頁第九屆中國(guó)腫瘤學(xué)術(shù)大會(huì)9Mountain *JCOG*JNCCH*Stage IAStage IB67%57%80%63%74%53

3、%STI*90% 84%* Surgery * Stereotactic IrradiationComparison of 5-Yr Overall Survival Between Surgery & STISurvival curves of operable pts irradiated with BED of 100 Gy or more according to Stagestage IA (n=47)stage IB (n=16)p = 0.2Summary of Japanese StudiesOnishi H, ASCO 2004第8頁/共31頁第九屆中國(guó)腫瘤學(xué)術(shù)大會(huì)1

4、0the therapy provided a 98% rate of local control. 第9頁/共31頁第九屆中國(guó)腫瘤學(xué)術(shù)大會(huì)11第10頁/共31頁第九屆中國(guó)腫瘤學(xué)術(shù)大會(huì)12CT/RT/S 145/202CT/RT 155/194Logrank p=0.24危險(xiǎn)比危險(xiǎn)比 = 0.87 (0.70, 1.10)存活率存活率%0255075100從隨機(jī)分組開始后的月數(shù)從隨機(jī)分組開始后的月數(shù)01224364860死亡死亡/總數(shù)總數(shù)中位中位FU 81 個(gè)月個(gè)月Albain et al. ASCO 2005. Abstract 7014.第11頁/共31頁第九屆中國(guó)腫瘤學(xué)術(shù)大會(huì)13第12頁

5、/共31頁第九屆中國(guó)腫瘤學(xué)術(shù)大會(huì)14Can we undertake surgery in patients with stage IIIA(N2) NSCLC after induction chemoradiotherapy from now on? Yes, you can BUT only selectively in patients with less extensive resection (eg, lobectomy) than pneumonectomy. Selection of patients for surgery in whom complete resection

6、 is possible after induction treatment with low morbidity and mortalityis essential.第13頁/共31頁第九屆中國(guó)腫瘤學(xué)術(shù)大會(huì)15不能手術(shù)的不能手術(shù)的ApN2病例病例誘導(dǎo)化療后即使成為可手術(shù)病例誘導(dǎo)化療后即使成為可手術(shù)病例也是應(yīng)該選擇放療而非手術(shù)治療也是應(yīng)該選擇放療而非手術(shù)治療第14頁/共31頁第九屆中國(guó)腫瘤學(xué)術(shù)大會(huì)16第15頁/共31頁第九屆中國(guó)腫瘤學(xué)術(shù)大會(huì)17第16頁/共31頁第九屆中國(guó)腫瘤學(xué)術(shù)大會(huì)18J Natl Cancer Inst 2007;99: 442 50Conclusion In select

7、ed patients with pathologically proven stage IIIA-N2 NSCLC and a response to induction chemotherapy, surgical resection did not improve overall or progression-free survival compared with radiotherapy.In view of its low morbidity and mortality, radiotherapy should be considered the preferred locoregi

8、onal treatment for these patients.第17頁/共31頁第九屆中國(guó)腫瘤學(xué)術(shù)大會(huì)19New data supports PORT in N2 cases第18頁/共31頁第九屆中國(guó)腫瘤學(xué)術(shù)大會(huì)20N0N1N2SSRSSRSSR5yOS41%31%34%30%20%27%DSS53%39%44%38%27%36%P0.04350.01960.0077PORT既能夠提高既能夠提高OS也能夠提高也能夠提高DSSN0N1N2SEER J Clin Oncol, 2006. 24: 2998-3006第19頁/共31頁CT RTCTRTOBSNew Data from ANI

9、TA:0.000.250.500.751.00DURATION OF SURVIVAL (MONTHS)020406080100120CT & RT is the bestRT is better than OBS 第20頁/共31頁01224364860728496020406080100NO PORTPORT 2 = 5.235 P=0.046時(shí)間 （月 ）生存率 （%）01224364860728496020406080100NO PORTPORT2 =6.891 P=0.009時(shí)間（月）無病生存率（%）無病生存率（%）第21頁/共31頁012243648607284960204

10、06080100S+C+RS+RS+CS時(shí)間 （月 ）生存率 （%）項(xiàng)目項(xiàng)目例數(shù)例數(shù) MST(月月) 1年年OS3年年OS5年年OSS+C+R6148.396.7%63.9%38.2%S+R3538.391.4%51.0%33.7%S+C10033.182.0%46.7%31.9%S2521.661.5%38.5%23.1%第22頁/共31頁第九屆中國(guó)腫瘤學(xué)術(shù)大會(huì)24Plot of heart disease mortality free survival for 2 different time eras stratified by postoperative radiotherapy (P

11、ORT) use先進(jìn)的放療技術(shù)降低了肺癌術(shù)后放療的遠(yuǎn)期并發(fā)癥先進(jìn)的放療技術(shù)降低了肺癌術(shù)后放療的遠(yuǎn)期并發(fā)癥HR=1.49(1.112.01; P=0.009)HR=1.08(0.791.48; P=0.64)Brian E Lally, et al. Cancer 2007 110:9117第23頁/共31頁第九屆中國(guó)腫瘤學(xué)術(shù)大會(huì)25第24頁/共31頁第九屆中國(guó)腫瘤學(xué)術(shù)大會(huì)263D vs. 2D in MEDICALLY INOPERABLE STAGE I NONSMALL-CELL LUNG CANCER(a) Overall survival(b) Disease-specific sur

12、vival第25頁/共31頁第九屆中國(guó)腫瘤學(xué)術(shù)大會(huì)273D vs. 2D in MEDICALLY INOPERABLE STAGE I NONSMALL-CELL LUNG CANCERLocal-regional control第26頁/共31頁第九屆中國(guó)腫瘤學(xué)術(shù)大會(huì)2801224364860728496 108 1200204060801003-D2-DP=0.002MonthsOS(%)分組分組例數(shù)例數(shù)1 1年年3 3年年5 5年年MSTMST常規(guī)放療常規(guī)放療27561.061.013.813.88.08.015.615.63-DCRT3-DCRT21873.373.326.126.114.414.420.120.15 5年年OS 6.4%OS 6.4%MST 4.5MST 4.5月月第27頁/共31頁第九屆中國(guó)腫瘤學(xué)術(shù)大會(huì)2901224364860728496