非小細胞肺癌放射治療進展-非小細胞肺癌的放射治療

1、非小細胞肺癌放射治療進展-非小細胞肺癌的放射治療第九屆中國腫瘤學術(shù)大會2影像技術(shù)和計算機技術(shù)的進步為精確放射治療的實現(xiàn)提供可能第九屆中國腫瘤學術(shù)大會3精確的腫瘤定位和放射治療劑量計算第九屆中國腫瘤學術(shù)大會4照射中腫瘤運動的監(jiān)測和控制呼氣吸氣螺旋開始時相由吸轉(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床位第九屆中國腫瘤學術(shù)大會5影像引導放射治療技術(shù)IGRT 40對葉片MLCKV級X射線球管KV級探測器陣列MV級探測器陣列第九屆中國腫瘤學術(shù)大會6在線校正影像匹配第九屆中國腫瘤學術(shù)大會7早期非小細胞肺癌的放射治療 放射治療能夠使 早期NSCLC獲得治愈 第九屆中國腫瘤學術(shù)大會8Japanese

2、 StudiesI期NSCLC大劑量分割SRT獲得滿意的局部控制率Institute 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第九屆中國腫瘤學術(shù)大會9Mountain *JCOG*JNCCH*Stage IAStage IB67%57

3、%80%63%74%53%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 = 0.2Overall SurvivalTime (years)Summary of Japanese StudiesOni

4、shi H, ASCO 2004第九屆中國腫瘤學術(shù)大會10the therapy provided a 98% rate of local control. 第九屆中國腫瘤學術(shù)大會11局部晚期非小細胞肺癌 放療/化療+手術(shù) 的治療第九屆中國腫瘤學術(shù)大會12CT/RT/S 145/202CT/RT 155/194Logrank p=0.24危險比 = 0.87 (0.70, 1.10)存活率%0255075100從隨機分組開始后的月數(shù)01224364860死亡/總數(shù)INT0139: 相同的總生存率！中位FU 81 個月Albain et al. ASCO 2005. Abstract 7014.

5、第九屆中國腫瘤學術(shù)大會13Interpretation Chemotherapy plus radiotherapy with or without resection (preferably lobectomy) are options for patients with stage IIIA(N2) non-small-cell lung cancer.第九屆中國腫瘤學術(shù)大會14Can we undertake surgery in patients with stage IIIA(N2) NSCLC after induction chemoradiotherapy from now o

6、n? 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 is possible after induction treatment with low morbidity and mortalityis essential.第九屆中國腫瘤學術(shù)大會15 EORTC 08941 A：Unresectable

7、pN2不能手術(shù)的ApN2病例誘導化療后即使成為可手術(shù)病例也是應該選擇放療而非手術(shù)治療第九屆中國腫瘤學術(shù)大會16第九屆中國腫瘤學術(shù)大會17第九屆中國腫瘤學術(shù)大會18J Natl Cancer Inst 2007;99: 442 50Conclusion In selected patients with pathologically proven stage IIIA-N2 NSCLC and a response to induction chemotherapy, surgical resection did not improve overall or progression-free s

8、urvival compared with radiotherapy.In view of its low morbidity and mortality, radiotherapy should be considered the preferred locoregional treatment for these patients.第九屆中國腫瘤學術(shù)大會19NSCLC術(shù)后放射治療New data supports PORT in N2 cases第九屆中國腫瘤學術(shù)大會20PORT在N2中的作用N0N1N2SSRSSRSSR5yOS41%31%34%30%20%27%DSS53%39%44%

9、38%27%36%P0.04350.01960.0077PORT既能夠提高OS也能夠提高DSSN0N1N2SEER J Clin Oncol, 2006. 24: 2998-3006CT RTCTRTOBSNew Data from ANITA: PORT in N2 Patients0.000.250.500.751.00DURATION OF SURVIVAL (MONTHS)020406080100120CT & RT is the bestRT is better than OBS Retrospective results from Cancer Hospital & Institu

10、te of CAMS治療模式與生存率 項目例數(shù)MST(月)1年OS3年OS5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%第九屆中國腫瘤學術(shù)大會24Plot of heart disease mortality free survival for 2 different time eras stratified by postoperative radiotherapy (PORT) use先進的放療技術(shù)降低了肺癌術(shù)后放療的遠期并發(fā)癥HR=1

11、.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第九屆中國腫瘤學術(shù)大會253DCRT提高NSCLC的治療療效 第九屆中國腫瘤學術(shù)大會26Int. J. Radiation Oncology Biol. Phys., Vol. 66, No. 1, pp. 108116, 20063D vs. 2D in MEDICALLY INOPERABLE STAGE I NONSMALL-CELL LUNG CANCER(a) Overall survival(b) Disease-specific survival第九屆中國腫瘤學術(shù)大會27Int. J. Radiation Oncology Biol. Phys., Vol. 66, No. 1, pp. 108116, 20063D vs. 2D in MEDICALLY INOPERABLE STAGE I NONSMALL-CELL LUNG CANCERLocal-regional control第九屆中國腫瘤學術(shù)大會28局部晚期NSCLC（A/B）3DCRT vs 常規(guī)放療分組例數(shù)1年3年5年MST常規(guī)放療27561.013.88.015.63-DCRT2187