非小细胞肺癌放射治疗进展课件

,单击此处编辑母版标题样式,#,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,1,影像技术和计算机技术的进步为精确放射治疗的实现提供可能,1影像技术和计算机技术的进步为精确放射治疗的实现提供可能,2,2,3,3,4,屏气技术举例,:,Elekta ABC,4屏气技术举例:Elekta ABC,5,四维,CT,影像技术,呼气,吸气,螺旋开始,时相,由吸转呼,呼气末,由呼转吸,由吸转呼,呼气,吸气,螺旋开始,呼吸曲线,床位,5四维CT影像技术呼气吸气螺旋开始时相由吸转呼呼气末由呼转吸,6,影像引导放射治疗技术,IGRT,40,对叶片,MLC,KV,级,X,射线球管,KV,级探测器阵列,MV,级探测器阵列,6影像引导放射治疗技术IGRT 40对叶片MLCKV级X射,7,在线校正,影像匹配,7在线校正影像匹配,involved lymph nodes,Operable a-N2,Grade 2:4.,Grage 4:1.,paclitaxel 200 mg/m2,757(P=0.,Total cases38/281(13.,RT is better than OBS.,RT is better than OBS.,Concurrent Chemo/Radio,Favor Gr HR benefit%sur%2y 5y 2y 5y,SEQ CON-QD CON-BID,二、早期非小细胞肺癌的放射治疗,Update of PORT Lung Cancer,2005.,Pulmonary disease:Positive:172,Negative:109,G3急性和晚期非血液系统毒性：,PV:顺铂/长春花碱,SEQ CON-QD CON-BID,PORT既能够提高OS也能够提高DSS,No survival benefit over concurrent therapy alone,8,一、放射治疗在肺癌治疗中的地位,二、早期,NSCL,的放射治疗,三、局部晚期,NSCL,的放疗,/,化疗,综合治疗,四、,3DCRT,提高,NSCLC,的生存率,五、术后放射治疗,involved lymph nodes8一、放射治疗在肺癌,9,一、放射治疗在肺癌治疗中的地位,应用循证医学的方法评价放射治疗在肺癌治疗中的地位。,9一、放射治疗在肺癌治疗中的地位应用循证医学的方法评价放射治,every 3 weeks X 2 cycles,Favor Gr HR benefit%sur%2y 5y 2y 5y,5%为复发和进展病例的治疗（later for recurrence or progression）,局部晚期NSCLC（A/B）3DCRT vs 常规放疗,Operable a-N2,ASCO 2007:Abstract 7512.,Epub 2007Apr,9%15.,PORT既能够提高OS也能够提高DSS,Arimoto 60Gy/8fr/11d 92%(22/24)24M,pN2 降低局部复发 对OS无明确结论,147 patients,1、Combined Treatment：,G3急性和晚期非血液系统毒性：,结论：序贯放疗/化疗优于单纯放射治疗,5年生存率 8.,RT is better than OBS.,RT 在 SCLC治疗中的地位,10,every 3 weeks X 2 cycles10,11,RT,在,SCLC,治疗中的地位,53.6%3.3%,SCLC,病例在其疾病的不同时期需要接受放射治疗,45.4%4.3%,为首程治疗,（,in the initial treatment,）,.,8.2%1.5%,为复发和进展病例的治疗（,later for recurrence or progression,）,11RT 在 SCLC治疗中的地位53.6%3.3%SC,12,RT,在,NSCLC,治疗中的地位,64.3%4.7%,of NSCLC cases require RT.,45.9%4.3%,in their initial treatment.,18.3%1.8%,later in the couse of the illness,12 RT 在 NSCLC 治疗中的地位64.3%4.7%,13,二、,早期非小细胞肺癌的放射治疗,放射治疗能够使,早期,NSCLC,获得治愈,13二、早期非小细胞肺癌的放射治疗 放射治疗能够使,14,Japanese Studies,I,期,NSCLC,大剂量分割,SRT,获得满意的局部控制率,Institute Dose/fx/OTT,LC/Follow-up,Uematsu 50-60/5-10/5d,94%,(47/50)36M,Kyoto 48Gy/4fr/12d,96%,(49/51)20M,Arimoto 60Gy/8fr/11d,92%,(22/24)24M,Onimaru,60Gy/8fr/11d:,88%,(50/57)18M,Nagata Y,Kyoto Univ,IASLC,2004,14Japanese StudiesI期NSCLC大剂量分,15,Summary of Japanese Studies,Total cases：281,Age:39-92(median 76)years,Pulmonary disease:Positive:172,Negative:109,Histology:Sqamous:122,Adeno:131,Others:28,Stage:IA:178,IB:103,Tumor diameter:7-58(median 23)mm,Medical Operability:,Inoperable:177,Operable:,104,Onishi H,ASCO 2004,15Summary of Japanese Studies,16,Local Control and Complication,Follow-up period 2-128(median 30)months,Local responseCR 26.9%,PR 59.1%,NC 14.0%,Pneumonitis(NCI-CTC)Grade 0:33.7%,Grade 1:59.9%,Grade 2:4.0%,Grade 3:1.2%,Grage 4:1.2%,Esophagitis(Grade 3)1.2%,Pleural effusion(transient)1.6%,Rib fracture1.2%,Bone marrow suppression0.0%,Onishi H,ASCO 2004,16Local Control and Complicati,17,Local Failure Rates,Total cases38/281(13.5%),BED,100 Gy17/211(8.1%),Stage IA17/177(9.6%),BED,100 Gy 9/136(6.6%),Stage IB21/102(20.6%),BED,100 Gy 8/73(11.0%),Adenocarcinoma17/122(14.0%),Squamous cell ca.18/131(13.7%),Onishi H,ASCO 2004,17Local Failure RatesTotal cas,18,Mountain*,JCOG*,JNCCH*,Stage IA,Stage IB,67%,57%,80%,63%,74%,53%,STI*,90%,84%,*Surgery,*,Stereotactic Irradiation,Comparison of 5-Yr Overall Survival Between Surgery&STI,Survival curves of,operable,pts irradiated,with,BED of 100 Gy or more,according to Stage,stage IA(n=47),stage IB(n=16),p=0.2,Overall Survival,Time(years),Summary of Japanese Studies,Onishi H,ASCO 2004,18Mountain*JCOG*JNCCH*Stage I,19,I,期非小细胞肺癌立体定向放射治疗或楔形切除后的转归,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),NS,Charlson,合并症指数,3,(1-4),4,(3-6),0.01,年龄,74(69-78),78(55-89),1 liter at study entry,地位的确立，是肺癌治疗进展中,CT+Surgery vs CT/RT,Radiation Oncology Biol.,DDP 40-120mg/m2/cycle,total dose 120-800mg/m2radiation dose 50Gy/20f-65Gy/30f,3D vs 2D in MEDICALLY INOPERABLE,pN3病例及N分期不明者,Three Clinical Research Topics in Radiotherapy of Locally Advanced NSCLC,22,作者,患者,MFUT,RR or LR,DM,OS,CSS,Onisi,2007,257,38,8-14,20,65,90,Negata,2005,45,36,2,16-31,83,-,Uematsu,2001,50,30,6,14,66,88,Zimmerman,2006,68,17,12,16,51,73,Fakiris,2009,70,50,12,13,43,82,RTOG,0236,55,25,6,15,72,-,I,期非小细胞肺癌立体定向放射治疗后的转归,60mg/m2 weekly22作者患者MFUTRR or,23,23,24,24,25,早期非小细胞肺癌的放射治疗,放射治疗成为早期,NSCLC,的另一,根治性治疗手段,放射治疗在早期,NSCLC,治疗中的,地位的确立，是肺癌治疗进展中,的一个里程碑,25早期非小细胞肺癌的放射治疗 放射治疗成为早期NSCLC的,三、局部晚期,NSCLC,的治疗,三、局部晚期NSCLC的治疗,局部晚期,NSCLC,Evolution of Treatment Strategy,Operable,：,Surgery,Surgery RT,Surgery RT CT,CT+Surgery,RT/CT+Surgery,RT/CT Surgery,RT/CT,局部晚期NSCLC Evolution of Treat,局部晚期,NSCLC,Evolution of Treatment Strategy,Inoperable :,RT,CT,+,RT,Sequential,CT,/,RT,Concurrent,?,Induction CT CT/RT CT/RT Consolidation,?,局部晚期NSCLC Evolution of Tre,neutropenia and overall maximal toxicity,Percent of patients surviving,T3-4 disease,R Rosell,M De Lena,F Carpagnano,R Ramlau,JL Gonzalez-Larriba,T Grodzki,A Le Groumelec,D Aubert,J Gasmi,JY Douillard,Induction Chemotherapy Followed by Chemoradiotherapy With Chemoradio-therapy Alone for Regionally Advanced Unresectable StageIII NonSmall-CellLung:Cancer and Leukemia GroupBCALGB 39801,中位生存期（月）13.,从随机分组开始后的月数,BED RT(60 Gy,2Gy QD),day 50,同步,:PV/RT(60 Gy,2Gy QD),day 1,同步,/HFRT,:PE/HFRT(69.2 Gy,1.2Gy BID),day 1,PV:,顺铂,/,长春花碱,PE:,顺铂,/oral,足叶乙甙,RT:,放疗,;QD:,每日一次,;HFRT:,超分隔放疗,Curran:ASCO,2000;updated IASLC 2000;ASTRO 2001,2003,RANDOM,I,ZE,RTOG 9410:III期NSCLC 同步放化疗 vs,二,.,同时化放疗,vs,序贯化放疗,(2),SEQ CON-QD CON-BID,中位生存期：,14.6 17 15.6,（月）,4,年生存率：,12%21%17%,p=0.046,G3,急性和晚期非血液系统毒性：,30%,，,48%,，,62%,和,14%,，,15%,，,16%,。,Curran W et al.Pro.Am Soc Clin Oncol.J.Clin.Oncol.2003;(abstract 2499),二.同时化放疗 vs 序贯化放疗(2),*Stereotactic Irradiation,RT/CT+Surgery vs RT/CT,DDP+Vp16/RT,3DCRT能够提高NSCLC的治疗疗效,Negata,2005,材料与方法排除标准,Radiation Pneumonitis and,RT 在 SCLC治疗中的地位,G3急性和晚期非血液系统毒性：,&Table 4.,9%15.,30%，48%，62%和 14%，15%，16%。,The MST with EP/XRT was higher than historical controls;,3 DCRT vs 常规放疗 中国医学科学院肿瘤医院 2001-2006,随访资料,RTOG 9410:III期NSCLC 同步放化疗 vs 序贯放化疗,El-Sherif,2006,Pulmonary disease:Positive:172,Negative:109,5年生存率 8.,*Stereotactic Irradiation,非小细胞肺癌放射治疗进展课件,结论：,同步放化疗优于序贯放化疗，,但是，急性毒性反应增加,结论：同步放化疗优于序贯放化疗，但是，急性毒性反应增加,同步放化疗,？诱导化疗,?,巩固化疗,同步放化疗？诱导化疗?巩固化疗,同步放化疗,诱导化疗,同步放化疗诱导化疗,Induction Chemotherapy Followed by Chemoradiotherapy With Chemoradio-therapy Alone for Regionally Advanced Unresectable StageIII NonSmall-CellLung:Cancer and Leukemia GroupB,CALGB 39801,J Clin Oncol.2007 May 1;25(13):1698-704.Epub 2007Apr,Induction Chemotherapy Followe,CALGB 39801 study design,July 1998 and was closed in May 2002,Totally 366 patients registered,CALGB 39801 study designJuly 1,Survival,intent,to,treat,Survival intent to treat,Survival of eligible patients with a,weight loss of 5%,Survival of eligible patients,Discussion,增加毒性,induction chemotherapy,increases,neutropenia and overall maximal toxicity,没有生存优势,No survival benefit,over concurrent therapy alone,同期放化疗是标准的治疗模式,Concomitant chemoradiotherapy is current standard,therapy,for unresectable stage IIIB NSCLC,Discussion 增加毒性 induction che,60mg/m2 weekly,Sienel,2007,FEV-1 1 liter at study entry,CT+Surgery,ASCO 2005.,1%33.,2、New Radiation Techniques:,Squamous cell ca.,Months Since Registration,Concurrent Chemo/Radio,序贯:PV-RT(60 Gy,2Gy QD)day 50,R+DDP 0.,3 DCRT vs 常规放疗 中国医学科学院肿瘤医院 2001-2006,RT 在 SCLC治疗中的地位,108116,2006,随访资料,放射治疗成为早期NSCLC的另一,同步:PV/RT(60 Gy,2Gy QD)day 1,N Events中位生存,PV:顺铂/长春花碱,Simultaneous Chemoradiotherapy Compared With Radiotherapy Alone After Induction Chemotherapy in Inoperable Stage IIIA or IIIB NonSmall-Cell Lung Cancer:,Study CTRT99/97 by the Bronchial Carcinoma,Therapy Group,Rudolf M.Huber,Michael Flentje,Michael Schmidt,Barbara Pllinger,Helga Gosse,Jochen Willner,and Kurt Ulm,PC x 3,诱导化疗,Randomize,RT alone,RT+Paclitaxel,60mg/m2 weekly,60mg/m2 weeklySimultaneous Che,paclitaxel 200 mg/m2,carboplatin AUC=6,every 3 weeks X 2 cycles,paclitaxel 60 mg/m2,weekly,Radiotherapy alone,paclitaxel 200 mg/m2 paclitaxe,非小细胞肺癌放射治疗进展课件,Survival after induction chemotherapy for patients with complete or partial response,Survival after induction chemo,同步放化疗,巩固化疗,同步放化疗巩固化疗,SWOG 9504,:,同步放化疗后应用泰索帝 巩固化疗治疗,IIIb,期,NSCLC,顺铂,/VP-16 X X,RT,泰索帝,X X X,顺铂,50mg/m,2,d 1,8,29,36,VP-16 50mg/m,2,d1-5,29-33,RT:61 Gy:45Gy(1.8Gy/fx),16Gy,缩野,(2Gy/fx),泰索帝,:75mg/m,2,cycle 1 -100mg/m,2,cycle 2-3,SWOG 9504:同步放化疗后应用泰索帝,SWOG 9504:,总生存,%,%,%,%,%,0,2,0,4,0,6,0,8,0,1,0,0,%,0,1,2,2,4,3,6,4,8,入组时间（月）,N Events,中位生存,8345 26,月,2,年生存率,:54%,3,年生存率,:37%,SWOG 9504:总生存%02040608010,SWOG 9504,和,SWOG 9019,比较,研究,病例,MST,(,月,),2,年生存,3,年生存,S9019,(PE/RT,PE),50,15,(10-22)*,34%,(21-47)*,17%,(7-27)*,S9504,(PE/RT,泰索帝,),83,26,(18-35)*,54%,(43-65)*,37%,(22-52)*,*95%CI,SWOG 9504 和 SWOG 9019比较研究病例MS,SWAG 0023,Concurrent Chemo/Radio,DDP+Vp16/RT,Consolidation,Chemo,Docetaxel,Maintenance,GEFITINIB,or,PLACEBO,SWAG 0023Concurrent Chemo/Radi,非小细胞肺癌放射治疗进展课件,同步放化疗,巩固化疗,Results of ASCO 2007,同步放化疗巩固化疗Results of ASCO 2007,Logrank p=0.,involved lymph nodes,R+DDP 0.,IIIa vs IIIb,108116,2006,60mg/m2 weekly,Grade 3:1.,Pleural effusion(transient)1.,（in the initial treatment）.,Local responseCR 26.,ROC curse:The area under curve in receiver operating characteristic curves based on the relationship between incidence of RP and the value of Vipsi-dose was 0.,Abstract 7014.,Pneumonitis,序贯化放疗 同时化放疗,2年OS 下降7 55%-48%,Surgery RT CT,ROC curse:The area under curve in receiver operating characteristic curves based on the relationship between incidence of RP and the value of Vipsi-dose was 0.,pN3病例及N分期不明者,HOG LUN 01-24 Phase III Study Design,Hanna et al.ASCO 2007:Abstract 7512.,ChemoRT,Cisplatin 50 mg/m,2,IV d 1,8,29,36Etoposide 50 mg/m,2,IV d 1-5&29-33Concurrent RT 59.4 Gy(1.8 Gy/fr),Stratificationat randomization,PS 0-1 vs 2,IIIA vs IIIB,CR vs non-CR,Inclusion at baseline,Unresectable stage IIIA or IIIBNSCLC,ECOG PS 0-1 at study entry(+PS2 at random),FEV-1 1 liter at study entry,203 patients,147 patients,73 patients,74 patients,Taxotere75 mg/m,2,q 3 wk,3,Observation,Primary endpoint:,OS,Secondary endpoints:,PFS,toxicity,Logrank p=0.HOG LUN 01-24 Phas,HOG LUN 01-24:OS(ITT)Randomized Patients(n=147),Hanna et al.ASCO 2007:Abstract 7512.,Months Since Registration,0,10,20,30,40,50,60,Percent of patients surviving,0%,25%,50%,75%,100%,P-value:0.940,Median,3 yearsurvival rate,Observation,18.0-34.2,27.6%,Taxotere,17-34.8,27.2%,HOG LUN 01-24:OS(ITT)Random,Comparison of Grade 3-5 Toxicities,Toxicity,SWOG 9504,SWOG 0023,HOG 01-24,Febrile Neutropenia,PE/XRT,Docetaxel,NR,9%,5%*,5%*,9.9%,10.9%,Esophagitis,17%,14%,17.2%,Pneumonitis,7%,7%,8.2%,Docetaxel-related death,4.8%,4%,5.5%,*reported as,“,infection with neutropenia,”,Comparison of Grade 3-5 Toxici,Hog LUGN o1-20/USO-023,The MST with EP/XRT was higher,than historical controls;,Consolidation D does not,further improve survival,is associated,with significant toxicity including an increased rate of hospitalization and premature death,And,should no longer be used for pts with unresectable stage III NSCLC,Conclusions,Hog LUGN o1-20/USO-023 The M,60,术前同时化放疗的临床研究,60术前同时化放疗的临床研究,61,可手术（,Operable,）,A(N2),放,/,化疗,vs,放化疗,+,手术,RTOG 93-09 INT,：,0139,61可手术（Operable）A(N2)放,62,CT/RT/S,145/202,CT/RT,155/194,Logrank p=0.24,危险比,=0.87(0.70,1.10),存活率,%,0,25,50,75,100,从随机分组开始后的月数,0,12,24,36,48,60,死亡,/,总数,INT0139,试验,:,总生存,中位,FU 81,个月,Albain et al.,ASCO 2005.Abstract 7014.,62CT/RT/S 145/202Logrank p,Observation,ROC curse:The area under curve in receiver operating characteristic curves based on the relationship between incidence of RP and the value of Vipsi-dose was 0.,BED 100 Gy 13/29(44.,SWOG 9504:总生存,Grade 3:1.,Cisplatin 50 mg/m2 IV d 1,8,29,36Etoposide 50 mg/m2 IV d 1-5&29-33Concurrent RT 59.,108116,2006,同步/HFRT:PE/HFRT(69.,Docetaxel,地位的确立，是肺癌治疗进展中,108116,2006,Surgery RT,Surgery RT,Furuse K,et al.,Three Clinical Research Topics in Radiotherapy of Locally Advanced NSCLC,pN2 降低局部复发 对OS无明确结论,7%of NSCLC cases require RT.,108116,2006,放射治疗成为早期NSCLC的另一,HOG LUN 01-24:OS(ITT)Randomized Patients(n=147),3%in their initial treatment.,63,随机分组后的月数,MS,3 yr OS,5 yr OS,19,月,36%,22%,CT/RT/S,CT/RT,存活率,%,0,25,50,75,100,0,12,24,36,48,60,/,/,/,/,/,/,/,/,/,/,29,月,45%,24%,死亡,/,总计,CT/RT/S,38/51,CT/RT,42/51,Log rank p=NS,INT0139,试验,:,肺切除亚组和相应化疗,/,放疗亚组的总生存的比较,Albain et al.,ASCO 2005.Abstract 7014.,Observation63随机分组后的月数 MS19月C,64,Logrank,p=0.002,CT/RT/S,57/90,CT/RT,74/90,死亡,/,总计,存活率,%,0,25,50,75,100,随机分组后的月数,0,12,24,36,48,60,/,/,/,/,/,/,/,/,/,/,/,/,/,/,/,/,/,/,/,/,/,/,/,MS,34,月,22,月,5 yr OS 36%18%,CT/RT/S,CT/RT,INT0139,试验,:,肺叶切除亚组和相应化疗,/,放疗亚组的总生存的比较,Albain et al.,ASCO 2005.Abstract 7014.,64Logrank p=0.002CT/RT/S 5,65,65,66,EORTC 08941,A,：,Unresectable pN2,不能手术的,ApN2,病例,通过诱导化疗后成为可手术病例,是选择手术还是选择放疗？,66 EORTC 08941不,67,67,68,68,69,69,70,70,71,四、,NSCLC,术后放射治疗,New data supports PORT in N2 cases,71四、NSCLC术后放射治疗New data suppor,72,1998 PORT,死亡风险增加,21%,2,年,OS,下降,7,55%-48%,pN0 pN1,有害,pN2,降低局部复发 对,OS,无明确结论,PORT Meta-analysis Lancet,1998.,352,:257-63,Update of PORT Lung Cancer,2005.,47,:81-3,721998 PORT死亡风险增加 21%PORT Meta,73,New Data 1,回顾分析,PORT,SEER 1988,年,2001,年,、,期,NSCLC 7465,例,根治性术后,PORT 3508,例（,47%,）,SEER J Clin Oncol,2006.24:2998-3006,预后多因素分析,HR,95%CI,P,older age,1.025,1.022-1.028,0.0001,T3-4 disease,1.288,1.117-1.484,0.0005,N2 nodal disease,1.281,1.101-1.490,0.0014,greater number of,involved lymph nodes,1.043,1.027-1.060,0.0001,PORT,1.048,0.987-1.113,0.1269,73New Data 1回顾分析PORTSEER 1988,74,PORT,在,N2,中的作用,N0,N1,N2,S,SR,S,SR,S,SR,5yOS,41%,31%,34%,30%,20%,27%,DSS,53%,39%,44%,38%,27%,36%,P,0.0435,0.0196,0.0077,PORT,既能够提高,OS,也能够提高,DSS,N0,N1,N2,74PORT在N2中的作用N0N1N2SSRSSRSSR5y,75,New Data 2,Results from ANITA,:,Phase III Adjuvant Vinorelbine and Cisplatin versus Observation in Completely Resected Non-Small-Cell Lung Cancer Patients,R Rosell,M De Lena,F Carpagnano,R Ramlau,JL Gonzalez-Larriba,T Grodzki,A Le Groumelec,D Aubert,J Gasmi,JY Douillard,on behalf of the,A,djuvant,N,avelbine,I,nternational,T,rial,A,ssociation,75New Data 2R Rosell,M De Len,76,CT RT,CT,RT,OBS,PORT in N1 Patients,RT is better than OBS.For patient who can not tolerate CT,RT would be recommended.,76CT RTCTRTOBSPORT in N1 Patie,CT RT,CT,RT,OBS,PORT in N2 Patients,0.00,0.25,0.50,0.75,1.00,DURATION OF SURVIVAL(MONTHS),0,20,40,60,80,100,120,CT&RT is the best,RT is better than OBS,CT RTCTRTOBSPORT in N2 Patient,78,New Data 3 from Cancer Hospital&Institute of CAMS,根治性切除,NSCLC,T1-3,N2,具备完整治疗信息,一般临床资料,术中所见及术后病理,治疗模式及参数,随访资料,78New Data 3 from Cancer Hosp,79,材料与方法,排除标准,T4N2,者,pN3,病例及,N,分期不明者,手术后,3,个月内死亡的患者,手术后,3,个月内肿瘤进展者,单纯探查术或纵隔镜活检术,79材料与方法排除标准T4N2者,80,材料与方法,全组,例数,PORT,无,PORT,术式,肺叶切除,197,84,113,全肺切除,24,12,12,清扫淋巴结数目,总数（枚）,1-60,3-60,1-60,中位数（枚）,21,19,22,80材料与方法全组例数PORT无PORT术式肺叶切除1978,OS,例数,MST(,月,),1,年,3,年,5,年,2,P,值,无,PORT,125,31.9,77.6,45.4,30.6,5.235,0.046,PORT,96,43.9,94.8,59.1,34.3,生存率,OS例数MST(月)1年3年5年2P值无PORT 1253,D,FS,1,年,3,年,5,年,2,P,值,无,PORT,56.4,28.2,16.5,6.891,0.009,PORT,76.1,39.8,32.1,DFS,DFS 1年3年5年2P值无PORT 56.428.216,治疗模式与生存率,项目,例数,MST(,月,),1,年,OS,3,年,OS,5,年,OS,S+C+R,61,48.3,96.7%,63.9%,38.2%,S+R,35,38.3,91.4%,51.0%,33.7%,S+C,100,33.1,82.0%,46.7%,31.9%,S,25,21.6,61.5%,38.5%,23.1%,治疗模式与生存率 项目例数MST(月)1年OS3年OS5年O,非肿瘤死亡,项目,例数,无术后放疗,术后放疗组,心功能衰竭,1,0,心肌梗死,1,0,小脑萎缩,1,0,急性胰腺炎,1,0,脓胸,1,0,脑血管意外,1,1,肺部感染,2,1,气管食管瘘,0,1,肺栓塞,0,1,不明原因消瘦,0,1,死亡原因不明,2,2,合计,10,7,有无术后放疗组的非肿瘤死亡率并无差异,（,p=0.493,）,非肿瘤死亡项目 例数无术后放疗术后放疗组,S+C+R,S+C,S+R,S,5yOS,47.0,%,34.0,%,21.3,%,16.6,%,5yOS,38.2,%,31.9,%,33.7,%,23.1,%,MST,（,M,）,47.4,23.8,22.7,12.7,MST,（,M,）,48.3,33.1,38.3,21.6,ANITA,的结果,医科院肿瘤医院的结果,完全切除的,AN2 NCSLC,推荐术后化疗,+,放疗,S+C+R5yOS5yOSMST（M）MST（M）ANITA,86,Absolute Volume of lung received 30Gy,RP(%),NO RP(%),P,340 cm,3,29.2,(7/24),70.8,(17/24),0.003,RT(60 Gy,2Gy QD),day 50,同步,:PV/RT(60 Gy,2Gy QD),day 1,同步,/HFRT,:PE/HFRT(69.2 Gy,1.2Gy BID),day 1,PV:,顺铂,/,长春花碱,PE:,顺铂,/oral,足叶乙甙,RT:,放疗,;QD:,每日一次,;HFRT:,超分隔放疗,Curran:ASCO,2000;updated IASLC 2000;ASTRO 2001,2003,RANDOM,I,ZE,RTOG 9410:III期NSCLC 同步放化疗 vs,二,.,同时化放疗,vs,序贯化放疗,(2),SEQ CON-QD CON-BID,中位生存期：,14.6 17 15.6,（月）,4,年生存率：,12%21%17%,p=0.046,G3,急性和晚期非血液系统毒性：,30%,，,48%,，,62%,和,14%,，,15%,，,16%,。,Curran W et al.Pro.Am Soc Clin Oncol.J.Clin.Oncol.2003;(abstract 2499),二.同时化放疗 vs 序贯化放疗(2),非小细胞肺癌放射治疗进展课件,105,105,106,PORT,在,N2,中的作用,N0,N1,N2,S,SR,S,SR,S,SR,5yOS,41%,31%,34%,30%,20%,27%,DSS,53%,39%,44%,38%,27%,36%,P,0.0435,0.0196,0.0077,PORT,既能够提高,OS,也能够提高,DSS,N0,N1,N2,106PORT在N2中的作用N0N1N2SSRSSRSSR5,107,Int.J.Radiation Oncology Biol.Phys.,Vol.66,No.1,pp.108,116,2006,3D vs 2D in MEDICALLY INOPERABLE,STAGE I NONSMALL-CELL LUNG CANCER,Local-regional control,107Int.J.Radiation Oncology,