非小細(xì)胞肺癌放射治療進(jìn)展授課課件

1影像技術(shù)和計(jì)算機(jī)技術(shù)的進(jìn)步為精確放射治療的實(shí)現(xiàn)

提供可能1影像技術(shù)和計(jì)算機(jī)技術(shù)的進(jìn)步為精確放射治療的實(shí)現(xiàn)

提供可能22334屏氣技術(shù)舉例:ElektaABC4屏氣技術(shù)舉例:ElektaABC5四維CT影像技術(shù)呼氣吸氣螺旋開始時(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床位5四維CT影像技術(shù)呼氣吸氣螺旋開始時(shí)相由吸轉(zhuǎn)呼呼氣末由呼轉(zhuǎn)吸6影像引導(dǎo)放射治療技術(shù)

IGRT

40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6影像引導(dǎo)放射治療技術(shù)

IGRT40對(duì)葉片MLCKV級(jí)X射7在線校正—影像匹配7在線校正—影像匹配108–116,2006Histology: Sqamous:122Birdas,2006SWOG9504:總生存3year

survivalrateASCO2005.是選擇手術(shù)還是選擇放療？3yLRFSur.pN0pN1有害3、NormalTissueProtection：CurranWetal.Abstract7014.757(P=0.LocalFailureRates8一、放射治療在肺癌治療中的地位二、早期NSCL的放射治療三、局部晚期NSCL的放療/化療綜合治療四、3DCRT提高NSCLC的生存率五、術(shù)后放射治療108–116,20068一、放射治療在肺癌治療中的地位9一、放射治療在肺癌治療中的地位應(yīng)用循證醫(yī)學(xué)的方法評(píng)價(jià)放射治療在肺癌治療中的地位。9一、放射治療在肺癌治療中的地位應(yīng)用循證醫(yī)學(xué)的方法評(píng)價(jià)放射治101011RT在SCLC治療中的地位53.6%±3.3%SCLC病例在其疾病的不同時(shí)期需要接受放射治療

45.4%±4.3%

為首程治療（intheinitialtreatment）.

8.2%±1.5%

為復(fù)發(fā)和進(jìn)展病例的治療（laterforrecurrenceorprogression）11RT在SCLC治療中的地位53.6%±3.3%SC12RT在NSCLC治療中的地位64.3%±4.7%ofNSCLCcasesrequireRT.

45.9%±4.3%intheirinitialtreatment.

18.3%±1.8%laterinthecouseoftheillness12RT在NSCLC治療中的地位64.3%±4.7%13二、早期非小細(xì)胞肺癌的放射治療

放射治療能夠使早期NSCLC獲得治愈

13二、早期非小細(xì)胞肺癌的放射治療放射治療能夠使14JapaneseStudies

I期NSCLC大劑量分割SRT獲得滿意的局部控制率

Institute Dose/fx/OTT

LC/Follow-up Uematsu 50-60/5-10/5d94%

(47/50)36M Kyoto 48Gy/4fr/12d96%

(49/51)20M

Arimoto 60Gy/8fr/11d92%

(22/24)24M Onimaru

60Gy/8fr/11d:88%

(50/57)18MNagataY,KyotoUniv,IASLC,200414JapaneseStudies

I期NSCLC大劑量分15SummaryofJapaneseStudies

Totalcases： 281Age: 39-92(median76)yearsPulmonarydisease: Positive:172,Negative:109Histology: Sqamous:122 Adeno:131, Others:28Stage: IA:178, IB:103Tumordiameter: 7-58(median23)mmMedicalOperability:

Inoperable:177, Operable:

104OnishiH,ASCO200415SummaryofJapaneseStudies

16LocalControlandComplicationFollow-upperiod 2-128(median30)monthsLocalresponse CR26.9% PR59.1% NC14.0%Pneumonitis(NCI-CTC) Grade0:33.7% Grade1:59.9% Grade2:4.0% Grade3:1.2% Grage4:1.2%Esophagitis(Grade3) 1.2%Pleuraleffusion(transient) 1.6%Ribfracture 1.2%Bonemarrowsuppression 0.0%OnishiH,ASCO200416LocalControlandComplicati17LocalFailureRatesTotalcases 38/281(13.5%) BED<100Gy 21/70(30.0%) BED>100Gy 17/211(8.1%)StageIA 17/177(9.6%)

BED<100Gy 8/41(19.5%) BED>100Gy 9/136(6.6%)StageIB 21/102(20.6%) BED<100Gy 13/29(44.8%) BED>100Gy 8/73(11.0%)Adenocarcinoma 17/122(14.0%)Squamouscellca. 18/131(13.7%)OnishiH,ASCO200417LocalFailureRatesTotalcas18Mountain*JCOG*JNCCH*StageIAStageIB67%57%80%63%74%53%STI**90%

84%*Surgery**StereotacticIrradiationComparisonof5-YrOverallSurvivalBetweenSurgery&STISurvivalcurvesofoperableptsirradiated

withBEDof100GyormoreaccordingtoStagestageIA(n=47)stageIB(n=16)p=0.2OverallSurvivalTime(years)SummaryofJapaneseStudiesOnishiH,ASCO200418Mountain*JCOG*JNCCH*StageI19I期非小細(xì)胞肺癌立體定向放射治療或楔形切除后的轉(zhuǎn)歸SRBT(n=55)楔形切除(n=69)P肺功能（FEV-1）1.39(0.86-2.37)1.31(0.52-3.0)NSCharlson合并癥指數(shù)

3(1-4)4(3-6)<0.01年齡74(69-78)78(55-89)<0.01分期T1-T2T1-T2NS病變最大直徑GTV:2.3(1-5.3)手術(shù)標(biāo)本：1.7(0.4-4.7)-縱隔淋巴結(jié)轉(zhuǎn)移0(PET,縱隔鏡)0(手術(shù))NS化療16%10%NSGrillsetal:19I期非小細(xì)胞肺癌立體定向放射治療或楔形切除后的轉(zhuǎn)歸SRBVP-1650mg/m2d1-5,29-33Hannaetal.HOGLUN01-24PhaseIIIStudyDesign108–116,20063Dvs2DinMEDICALLYINOPERABLELocalresponse CR26.9%Landreneau,1997JapaneseStudies

I期NSCLC大劑量分割SRT獲得滿意的局部控制率9032序貫化放療同時(shí)化放療*Surgery3、NormalTissueProtection：NagataY,KyotoUniv,IASLC,2004Birdas,200620I期非小細(xì)胞肺癌立體定向放射治療或楔形切除后的轉(zhuǎn)歸VP-1650mg/m2d1-5,29-3320I期非21作者患者M(jìn)FUTRRorLRDMOSCSSGinsberg,19951225417-6175Landreneau,1997422924-5838*602416-6538*Sienel,2007495416--67Sienel,200856451618-713145556-48Keenan,200454271196274El-Sherif,20062073171540-Lee,200335516304761Voynov,2005110414818-Birdas,200641255-54-27250---142514---I期非小細(xì)胞肺癌局部切除后的轉(zhuǎn)歸21作者患者M(jìn)FUTRRorLRDMOSCSSGinsb22作者患者M(jìn)FUTRRorLRDMOSCSSOnisi,2007257388-14206590Negata,20054536216-3183-Uematsu,200150306146688Zimmerman,2006681712165173Fakiris,2009705012134382RTOG,0236552561572-I期非小細(xì)胞肺癌立體定向放射治療后的轉(zhuǎn)歸22作者患者M(jìn)FUTRRorLRDMOSCSSOnisi2323242425早期非小細(xì)胞肺癌的放射治療

放射治療成為早期NSCLC的另一根治性治療手段放射治療在早期NSCLC治療中的地位的確立，是肺癌治療進(jìn)展中的一個(gè)里程碑25早期非小細(xì)胞肺癌的放射治療放射治療成為早期NSCLC的三、局部晚期NSCLC的治療三、局部晚期NSCLC的治療局部晚期NSCLC

EvolutionofTreatmentStrategy

Operable：

Surgery

Surgery±RTSurgery±RT±CT

CT+Surgery

RT/CT+SurgeryRT/CT±Surgery

RT/CT局部晚期NSCLCEvolutionofTreat局部晚期NSCLC

EvolutionofTreatmentStrategy

Inoperable:

RT

CT+RTSequential

CT/RTConcurrent?InductionCTCT/RTCT/RTConsolidation?

局部晚期NSCLCEvolutionofTreInoperable序貫放化綜合治療同步放化綜合治療OperableⅢa-N2RT/CT+SurgeryvsRT/CTCT+SurgeryvsCT/RTInoperable序貫化放療薈萃（META）分析22trails3033cases

FavorGrHRbenefit%sur%

2y5y2y5yChemo0.9032R+DDP0.8742151957

p=0.005

DDP40-120mg/m2/cycle,totaldose120-800mg/m2

radiationdose50Gy/20f-65Gy/30f結(jié)論：序貫放療/化療優(yōu)于單純放射治療序貫化放療薈萃（META）分析結(jié)論：序貫放療/化療優(yōu)于單純放同時(shí)化放療vs序貫化放療同時(shí)化放療vs序貫化放療

同時(shí)化放療vs序貫化放療(1)

序貫化放療同時(shí)化放療5年生存率8.9%15.8%P=0.04。中位生存期（月）13.316.53yLRFSur.21.1%33.9%同時(shí)化放療:提高局部控制率和生存率FuruseK,etal.JClin.Oncol.1999;17:2692-2699非小細(xì)胞肺癌放射治療進(jìn)展授課課件RTOG9410:III期NSCLC

同步放化療vs序貫放化療

序貫:PV-->RT(60Gy,2GyQD)day50

同步:PV/RT(60Gy,2GyQD)day1

同步/HFRT:PE/HFRT(69.2Gy,1.2GyBID)day1 PV:順鉑/長(zhǎng)春花堿

PE:順鉑/oral足葉乙甙

RT:放療;QD:每日一次;HFRT:超分隔放療Curran:ASCO,2000;updatedIASLC2000;ASTRO2001,2003RANDOMIZERTOG9410:III期NSCLC

同步放化療vs二.同時(shí)化放療vs序貫化放療(2)SEQCON-QDCON-BID

中位生存期：14.61715.6（月）

4年生存率：12%21%17%p=0.046

G3急性和晚期非血液系統(tǒng)毒性：

30%，48%，62%和14%，15%，16%。CurranWetal.Pro.AmSocClinOncol.J.Clin.Oncol.2003;(abstract2499)

二.同時(shí)化放療vs序貫化放療(2)非小細(xì)胞肺癌放射治療進(jìn)展授課課件非小細(xì)胞肺癌放射治療進(jìn)展授課課件結(jié)論：

同步放化療優(yōu)于序貫放化療，但是，急性毒性反應(yīng)增加結(jié)論：

同步放化療優(yōu)于序貫放化療，但是，急性毒性反應(yīng)增加SurvivalafterinductionchemotherapyforpatientswithcompleteorpartialresponseP-value:0.ForpatientwhocannottolerateCT,Grage4:1.1%33.paclitaxel200mg/m260mg/m2weeklyPORT在N2中的作用四、NSCLC術(shù)后放射治療PORTcanbesafelyusedwith3DCRT3Dvs2DinMEDICALLYINOPERABLELocalFailureRates?InductionCTCT/RTCT/RTConsolidation?結(jié)論：

同步放化療優(yōu)于序貫放化療，但是，急性毒性反應(yīng)增加二、早期NSCL的放射治療同步放化療？誘導(dǎo)化療?鞏固化療Survivalafterinductionchemo同步放化療誘導(dǎo)化療同步放化療誘導(dǎo)化療InductionChemotherapyFollowedbyChemoradiotherapyWithChemoradio-therapyAloneforRegionallyAdvanced

UnresectableStageIIINon–Small-Cell

Lung:CancerandLeukemiaGroupB

CALGB39801JClinOncol.2007May1;25(13):1698-704.Epub2007AprInductionChemotherapyFolloweCALGB39801studydesignJuly1998andwasclosedinMay2002,Totally366patientsregisteredCALGB39801studydesignJuly1Survival

intent

to

treatSurvivalintenttotreatSurvivalofeligiblepatientswitha

weightlossof≤5%SurvivalofeligiblepatientsDiscussion

增加毒性

inductionchemotherapyincreasesneutropeniaandoverallmaximaltoxicity

沒有生存優(yōu)勢(shì)

Nosurvivalbenefitoverconcurrenttherapyalone同期放化療是標(biāo)準(zhǔn)的治療模式

Concomitantchemoradiotherapyiscurrentstandard

therapyforunresectablestageIIIBNSCLCDiscussion增加毒性inductioncheSimultaneousChemoradiotherapyComparedWithRadiotherapyAloneAfterInductionChemotherapyinInoperableStageIIIAorIIIBNon–Small-CellLungCancer:StudyCTRT99/97bytheBronchialCarcinomaTherapyGroupRudolfM.Huber,MichaelFlentje,MichaelSchmidt,BarbaraP?llinger,HelgaGosse,JochenWillner,andKurtUlmPCx3誘導(dǎo)化療RandomizeRTaloneRT+Paclitaxel60mg/m2weeklySimultaneousChemoradiotherapypaclitaxel200mg/m2carboplatinAUC=6every3weeksX2cyclespaclitaxel60mg/m2weeklyRadiotherapyalonepaclitaxel200mg/m2paclitaxe非小細(xì)胞肺癌放射治療進(jìn)展授課課件SurvivalafterinductionchemotherapyforpatientswithcompleteorpartialresponseSurvivalafterinductionchemo同步放化療鞏固化療同步放化療鞏固化療SWOG9504:同步放化療后應(yīng)用泰索帝

鞏固化療治療IIIb期NSCLC順鉑/VP-16 X XRT泰索帝 XXX

順鉑50mg/m2d1,8,29,36VP-1650mg/m2d1-5,29-33RT:61Gy:45Gy(1.8Gy/fx),16Gy縮野(2Gy/fx)泰索帝:75mg/m2cycle1-->100mg/m2cycle2-3

SWOG9504:同步放化療后應(yīng)用泰索帝

SWOG9504:總生存%%%%%020406080100%012243648入組時(shí)間（月）

NEvents 中位生存83 45 26月2年生存率:54%3年生存率:37%SWOG9504:總生存%%%%%02040608010

SWOG9504和SWOG9019比較研究病例MST(月)2年生存3年生存S9019(PE/RTPE)5015(10-22)*

34%(21-47)*17%(7-27)*S9504(PE/RT

泰索帝)8326(18-35)*54%(43-65)*37%(22-52)**95%CISWOG9504和SWOG9019比較研究病例MSSWAG0023ConcurrentChemo/RadioDDP+Vp16/RTConsolidationChemoDocetaxelMaintenanceGEFITINIBorPLACEBOSWAG0023ConcurrentChemo/Radi非小細(xì)胞肺癌放射治療進(jìn)展授課課件同步放化療鞏固化療ResultsofASCO2007同步放化療鞏固化療ResultsofASCO2007HOGLUN01-24PhaseIIIStudyDesignHannaetal.ASCO2007:Abstract7512.ChemoRTCisplatin50mg/m2IVd1,8,29,36

Etoposide50mg/m2IVd1-5&29-33

ConcurrentRT59.4Gy(1.8Gy/fr)Stratification

atrandomization

PS0-1vs2IIIAvsIIIBCRvsnon-CR

InclusionatbaselineUnresectablestageIIIAorIIIB

NSCLCECOGPS0-1atstudyentry

(+PS2atrandom)FEV-1>1literatstudyentry203patients147patients73patients74patientsTaxotere

75mg/m2q3wk

3ObservationPrimaryendpoint:OSSecondaryendpoints:PFS,toxicityHOGLUN01-24PhaseIIIStudyHOGLUN01-24:OS(ITT)

RandomizedPatients(n=147)Hannaetal.ASCO2007:Abstract7512.MonthsSinceRegistration0102030405060Percentofpatientssurviving0%25%50%75%100%P-value:0.940Median3year

survivalrateObservation18.0-34.227.6%Taxotere17-34.827.2%HOGLUN01-24:OS(ITT)

RandomComparisonofGrade3-5ToxicitiesToxicitySWOG9504SWOG0023HOG01-24FebrileNeutropenia

PE/XRT

Docetaxel

NR9%~5%*~5%*9.9%10.9%Esophagitis17%~14%17.2%Pneumonitis7%7%8.2%Docetaxel-relateddeath4.8%4%5.5%*reportedas“infectionwithneutropenia”

ComparisonofGrade3-5ToxiciHogLUGNo1-20/USO-023

TheMSTwithEP/XRTwashigherthanhistoricalcontrols;

ConsolidationDdoesnotfurtherimprovesurvival,isassociatedwithsignificanttoxicityincludinganincreasedrateofhospitalizationandprematuredeath,AndshouldnolongerbeusedforptswithunresectablestageIIINSCLCConclusionsHogLUGNo1-20/USO-023TheM60術(shù)前同時(shí)化放療的臨床研究60術(shù)前同時(shí)化放療的臨床研究61可手術(shù)（Operable）ⅢA(N2)

放/化療vs放化療+手術(shù)

RTOG93-09INT：0139

61可手術(shù)（Operable）ⅢA(N2)

放62CT/RT/S

145/202CT/RT

155/194Logrankp=0.24危險(xiǎn)比=0.87(0.70,1.10)存活率%0255075100從隨機(jī)分組開始后的月數(shù)01224364860死亡/總數(shù)INT0139試驗(yàn):總生存中位FU81個(gè)月Albainetal.

ASCO2005.Abstract7014.62CT/RT/S145/202Logrankp63隨機(jī)分組后的月數(shù)

MS3yrOS5yrOS19月

36%22%CT/RT/SCT/RT存活率%025507510001224364860//////////29月

45%24%死亡/總計(jì)CT/RT/S38/51CT/RT42/51Logrankp=NSINT0139試驗(yàn):肺切除亞組和相應(yīng)化療/放療亞組的總生存的比較Albainetal.

ASCO2005.Abstract7014.63隨機(jī)分組后的月數(shù)MS19月CT/RT/SCT/RT64Logrank

p=0.002CT/RT/S

57/90CT/RT

74/90死亡/總計(jì)存活率%0255075100隨機(jī)分組后的月數(shù)01224364860///////////////////////MS34月22月5yrOS36%18%CT/RT/SCT/RTINT0139試驗(yàn):

肺葉切除亞組和相應(yīng)化療/放療亞組的總生存的比較Albainetal.

ASCO2005.Abstract7014.64Logrankp=0.002CT/RT/S5656566

EORTC08941ⅢA：UnresectablepN2不能手術(shù)的ⅢApN2病例通過誘導(dǎo)化療后成為可手術(shù)病例是選擇手術(shù)還是選擇放療？66EORTC08941不676768686969707071四、NSCLC術(shù)后放射治療NewdatasupportsPORTinN2cases71四、NSCLC術(shù)后放射治療Newdatasuppor721998PORT死亡風(fēng)險(xiǎn)增加21%2年OS下降7％55%----48%pN0pN1有害pN2降低局部復(fù)發(fā)

對(duì)OS無明確結(jié)論P(yáng)ORTMeta-analysisLancet,1998.352:257-63UpdateofPORTLungCancer,2005.47:81-3721998PORT死亡風(fēng)險(xiǎn)增加21%PORTMeta73NewData1

回顧分析PORTSEER1988年～2001年Ⅱ、Ⅲ期NSCLC7465例根治性術(shù)后PORT3508例（47%）SEERJClinOncol,2006.24:2998-3006

預(yù)后－多因素分析HR95%CIPolderage1.0251.022-1.0280.0001T3-4disease1.2881.117-1.4840.0005N2nodaldisease1.2811.101-1.4900.0014greaternumberofinvolvedlymphnodes1.0431.027-1.0600.0001PORT1.0480.987-1.1130.126973NewData1

回顧分析PORTSEER198874PORT在N2中的作用N0N1N2SSRSSRSSR5yOS41%31%34%30%20%27%DSS53%39%44%38%27%36%P0.04350.01960.0077PORT既能夠提高OS也能夠提高DSSN0N1N274PORT在N2中的作用N0N1N2SSRSSRSSR5y75NewData2ResultsfromANITA:PhaseIIIAdjuvantVinorelbineandCisplatinversusObservationinCompletelyResectedNon-Small-CellLungCancerPatientsRRosell,MDeLena,FCarpagnano,RRamlau,JLGonzalez-Larriba,TGrodzki,ALeGroumelec,DAubert,JGasmi,JYDouillard

onbehalfoftheAdjuvantNavelbineInternationalTrialAssociation75NewData2RRosell,MDeLen76CTRTCTRTOBSPORTinN1PatientsRTisbetterthanOBS.ForpatientwhocannottolerateCT,RTwouldberecommended.76CTRTCTRTOBSPORTinN1PatieCTRTCTRTOBSPORTinN2Patients0.000.250.500.751.00DURATIONOFSURVIVAL(MONTHS)020406080100120CT&RTisthebestRTisbetterthanOBSCTRTCTRTOBSPORTinN2Patient78NewData3from

CancerHospital&InstituteofCAMS根治性切除NSCLCT1-3,N2具備完整治療信息一般臨床資料術(shù)中所見及術(shù)后病理治療模式及參數(shù)隨訪資料78NewData3from

CancerHosp79材料與方法——排除標(biāo)準(zhǔn)T4N2者pN3病例及N分期不明者手術(shù)后3個(gè)月內(nèi)死亡的患者手術(shù)后3個(gè)月內(nèi)腫瘤進(jìn)展者單純探查術(shù)或縱隔鏡活檢術(shù)79材料與方法——排除標(biāo)準(zhǔn)T4N2者80材料與方法全組例數(shù)PORT無PORT術(shù)式肺葉切除19784113全肺切除241212清掃淋巴結(jié)數(shù)目總數(shù)（枚）1-603-601-60中位數(shù)（枚）21192280材料與方法全組例數(shù)PORT無PORT術(shù)式肺葉切除1978OS例數(shù)MST(月)1年3年5年χ2P值無PORT12531.977.645.430.65.2350.046PORT9643.994.859.134.3生存率OS例數(shù)MST(月)1年3年5年χ2P值無PORT1253DFS1年3年5年χ2P值無PORT56.428.216.56.8910.009PORT76.139.832.1DFSDFS1年3年5年χ2P值無PORT56.428.216治療模式與生存率項(xiàng)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%治療模式與生存率項(xiàng)目例數(shù)MST(月)1年OS3年OS5年O非腫瘤死亡項(xiàng)目

例數(shù)無術(shù)后放療術(shù)后放療組

心功能衰竭10心肌梗死10小腦萎縮10急性胰腺炎10膿胸10腦血管意外11肺部感染21氣管食管瘺01肺栓塞01不明原因消瘦01死亡原因不明22合計(jì)107有無術(shù)后放療組的非腫瘤死亡率并無差異（p=0.493）

非腫瘤死亡項(xiàng)目例數(shù)無術(shù)后放療術(shù)后放療組S+C+RS+CS+RS5yOS47.0%34.0%21.3%16.6%5yOS38.2%31.9%

33.7%23.1%MST（M）47.423.822.712.7MST（M）48.333.138.321.6ANITA的結(jié)果醫(yī)科院腫瘤醫(yī)院的結(jié)果完全切除的ⅢAN2NCSLC推薦術(shù)后化療+放療S+C+R5yOS5yOSMST（M）MST（M）ANITA86AbsoluteVolumeoflungreceived30GyRP(%)NORP(%)P≥340cm329.2(7/24)70.8(17/24)0.003<340cm32.5(1/40)97.5(39/40)PORTcanbesafelyusedwith3DCRTGraph1.&Table4.ROCcurse:TheareaundercurveinreceiveroperatingcharacteristiccurvesbasedontherelationshipbetweenincidenceofRPandthevalueofVipsi-dosewas0.757(P=0.020).Graph1.&Table4.ROCcurse:TheareaundercurveinreceiveroperatingcharacteristiccurvesbasedontherelationshipbetweenincidenceofRPandthevalueofVipsi-dosewas0.757(P=0.020).Graph1.&Table4.ROCcurse:TheareaundercurveinreceiveroperatingcharacteristiccurvesbasedontherelationshipbetweenincidenceofRPandthevalueofVipsi-dosewas0.757(P=0.020).Graph1.&Table4.ROCcurse:TheareaundercurveinreceiveroperatingcharacteristiccurvesbasedontherelationshipbetweenincidenceofRPandthevalueofVipsi-dosewas0.757(P=0.020).JiWeietal:ASTROmeeting2008BostonConclusion：ItwassafeforpatientswithNSCLCtoreceivepostoperative3DCRT，ifirradiationdosetolungtissuewaswelldefined.86AbsoluteVolumeoflungrece873DCRT能夠提高NSCLC

的治療療效873DCRT能夠提高NSCLC

的治療療效88Int.J.RadiationOncologyBiol.Phys.,Vol.66,No.1,pp.108–116,20063Dvs2DinMEDICALLYINOPERABLESTAGEINON–SMALL-CELLLUNGCANCER(a)Overallsurvival(b)Disease-specificsurvival88Int.J.RadiationOncologyB89Int.J.RadiationOncologyBiol.Phys.,Vol.66,No.1,pp.108–116,20063Dvs2DinMEDICALLYINOPERABLESTAGEINON–SMALL-CELLLUNGCANCERLocal-regionalcontrol89Int.J.RadiationOncologyB903DCRTvs常規(guī)放療

中國醫(yī)學(xué)科學(xué)院腫瘤醫(yī)院

2001-2006

903DCRTvs常規(guī)放療

中國醫(yī)學(xué)科學(xué)院腫瘤91ⅠⅡ期NSCLC

適形放療vs常規(guī)放療91ⅠⅡ期NSCLC

適形放療vs常規(guī)放療體重下降(＜5%vs≥5%)108–116,2006PE/XRTOperable：STAGEINON–SMALL-CELLLUNGCANCEROS單因素及多因素COX分析3、NormalTissueProtection：RTisbetterthanOBS同時(shí)化放療vs序貫化放療61715.SWOG9504:同步放化療后應(yīng)用泰索帝

鞏固化療治療IIIb期NSCLCCRvsnon-CRLocalresponse CR26.Birdas,2006SWOG9504:總生存92局部晚期NSCLC（ⅢA/B）

3DCRTvs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-DCRT21873.326.114.420.15年OS6.4%MST4.5月體重下降(＜5%vs≥5%)92局部晚期NSCLC（ⅢA93局部晚期NSCLC（ⅢA/B）

3DCRTvs常規(guī)放療分組例數(shù)1年3年5年常規(guī)放療27565.116.711.23-DCRT21879.033.320.893局部晚期NSCLC（ⅢA/B）

3DCRTvs常規(guī)放94OS單因素及多因素COX分析變量單因素多因素危險(xiǎn)比P值危險(xiǎn)比P

值＜70vs≥70歲1.0350.744------------女性vs男性1.0750.552------------體重下降(＜5%vs≥5%)1.1220.370------------吸煙(無vs有)1.0740.522------------KPS(≥80vs＜80)1.6710.0001.5630.001IIIavsIIIb1.2640.0311.2160.089非鱗癌vs鱗癌1.0510.619------------Hb(≥120vs＜120g/L)1.6250.0001.4220.008化學(xué)治療(無vs有)0.8660.138------------50-60vs60vs＞60Gy0.7850.0010.8520.046常規(guī)放療vs三維適形0.7370.0020.7620.009CR+PRvsSD+PD1.6070.0001.5710.00194OS單因素及多因素COX分析變量單因素多因素危險(xiǎn)比P值95局部晚期NSCLC（ⅢA/B）

3DCRTvs常規(guī)放療2D3DX2P值例數(shù)（比例%）例數(shù)（比例%）食管炎＜2級(jí)135（61.9）180（65.5）0.6560.450≥2疾83（38.1）95（34.5）放射性肺炎＜2級(jí)148（67.9）202（73.5)1.8290.194≥2疾70（32.1）73(26.5)食管炎＜3級(jí)207（95.0）264（96.0）0.3120.662≥3疾11（5.0）11（4.0）放射性肺炎＜3級(jí)192(88.5)251(91.3)1.0550.363≥3疾25(11.5)24(8.7)95局部晚期NSCLC（ⅢA/B）

3DCRTvs常規(guī)放96結(jié)論與常規(guī)放射治療技術(shù)相比3DCRT能夠提高NSCLC的生存率推薦3DCRT作為非小細(xì)胞肺癌的標(biāo)準(zhǔn)治療技術(shù)96結(jié)論與常規(guī)放射治療技術(shù)相比3DCRT能夠提高NSCLC97ThreeClinicalResearchTopicsinRadiotherapyofLocallyAdvancedNSCLC1、CombinedTreatment：

ConcurrentChemoradiotherapy同時(shí)放化療中化療方案的選擇誘導(dǎo)化療或鞏固化療的必要性和化療方案放射治療與生物靶向治療的聯(lián)合應(yīng)用97ThreeClinicalResearchTopi98ThreeClinicalResearchTopicsinRadiotherapyofLocallyAdvancedNSCLC2、NewRadiationTechniques:3DRT，IMRT,IGRT,4DRT3、NormalTissueProtection：

RadiationPneumonitisandEsophagitis