软组织肿瘤课件

Click to edit Master text styles,Second level,Third level,Fourth level,Click to edit Master title style,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Click to edit Master text styles,Second level,Third level,Fourth level,Click to edit Master title style,Cliquez pour modifier le style du titre,Cliquez pour modifier les styles du texte du masque,Deuxime niveau,Troisime niveau,Quatrime niveau,Cinquime niveau,*,Click to edit Master text styles,Second level,Third level,Fourth level,Click to edit Master title style,*,*,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,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,*,*,软组织肿瘤,软组织肿瘤软组织肿瘤成人软组织肉瘤化疗Contents Overview,Drugs,Treatment,neoadjuvant chemotherapy,adjuvant chemotherapy,Advanced or metastatic diseases chmeotherapy,targeted therapy,摘 要： 随着新课标的实行，越来越多的学校开始把教育的重点放在对学生综合素质的开发上，这种素质不仅是让学生对现有考试体系有所认识和理解，更是一种对我国深层次文化的体会和传承。古诗词中蕴含的中国文化博大精深，学校从小学生入手，从小就对学生进行文化熏陶，对小学生的古诗词教育有更严格的要求。本文主要对当今小学语文古诗词教学的意义进行探讨，分析当今小学古诗词教学中存在的问题与不足，并针对其中问题提出一些改进策略。,从过去的小学语文教学状况来看，很多教师在教学中更习惯将教学重点放在对字词及诗词背诵默写的练习上，而往往对诗词涵义没有过多重视，导致学生学习时感觉枯燥无味，容易对学习产生厌倦懈怠的情绪，非常不利于学生对古诗词的学习与理解。从某种意义来讲，古诗词是我国古老文化的延续和发展，我们学习它不仅是为了应对考试，更多的是为了体会古代诗人对国家和社会的情感和寄托，是为了将这种文化、精神延续下去，开发学生的想象力和创造力，让学生更好地认识语文这门学科。,一、小学语文古诗词教学的意义,1.提高道德素质，弘扬民族文化,古诗词中包含古人对自然的感悟，对人生哲理的思考，对自身情感的宣泄，对生命演换的探索，从某种角度来讲，古诗词是古代诗人智慧的结晶，是我国传承文化的精髓。我国是礼仪大国，而每个人对于文化的传承都有着不可推卸的责任，因此，从小学就开始学习古诗词，让学生从小接受古诗词熏陶，体会古人的情感和思想，给学生树立正确的人生观、价值观和社会观，发扬我国的民族文化，在潜移默化中提高学生的思想道德素质。,2.培养创新思维，加强审美教育,江泽民同志说过，创新是一个民族发展的灵魂，一个国家进步的动力。学生是这个国家发展的基础和未来的希望，只有培养学生的创造力，促进他们的审美教育，才能使国家和社会发展经久不衰。古诗词将意境美、哲理美和音韵美和谐地融合在一起，学生在学习古诗词的过程中用心感受其中的美感，从而激发学生的想象力和创造力，让学生感受美、发现美、创造美，从而培养学生正确的审美观。,二、小学语文古诗词教学中存在的问题,1.教学内容死板枯燥，学生缺少学习热情,小学主要学习的内容就是古诗词，古诗词短小精悍、寓意深刻，但是对于小学生来说，学习过程最容易产生枯燥厌倦的情绪，缺少学习古诗词的热情和兴趣。从调查结果来看，很多老师将课堂教学分为两个部分，一部分是由学生自己背诵默读，另一部分是对诗词的翻译和讲解，由于学生在背诵过程中并不能深入理解诗词意境和美好，因此从心底对古诗词产生抵触思想。学生对语文古诗词的学习失去兴趣，所以老师只能让学生强硬记忆，这种恶性循环让学生对语文更厌恶，不利于今后学生的发展。,2.教师素质有限，教学内容出现偏差,教师的素质能力在很大程度上影响学生的学习与发展，但是目前小学语文古诗词教学存在很大不足，教师水平参差不齐，授课时每个老师侧重点的偏差导致学生往往会出现区域性能力差异。古诗词中蕴含的意境是需要学生用心体会感悟的，但是很多语文老师只注意直白地分析诗句，对于诗词中意境的美感和品味则选择忽视，这种偏差性的教学造成很多学生只记忆背诵的基础知识，而在情感等深层次的理解上则一概不知，面对新内容不能灵活运用，只会照搬照抄，非常不利于学生长远学习。,3.应试教育制约意境教学的发挥,从目前发展状况来看，很多小学教师进行古诗词教学时往往以考出高分为主要目的，在诗词讲解中更多的是让学生记住诗词本身和翻译，对于诗词中真正蕴含的情感和手法意义并没有过多地解释。这种教学手法使学生学习古诗词的过程中思维僵化，只知道死记硬背，不懂得发散性思考，在意境的联想与理解上出现很大偏差。不仅如此，应试的教条性教学制约着学生情感的体会与表达，对学生综合素质的发展产生很大阻碍。,三、小学语文古诗词教学的优化策略,1.优化教学分配，激发学习兴趣,兴趣是最好的老师，尤其对于小学生来说，他们的好奇心非常重，对于新鲜事物的接受和适应能力非常强。古诗词本身就是一个比较生动和有趣的事物，小学语文老师进行教学安排时要合理分配教学内容，对于理论知识和意象情感分析进行合理划分。换言之，老师不仅要注意对诗词中结构的讲解，还要对诗词蕴含的情感进行分析，从而提高学生的联想力和纵向思维能力。如望庐山瀑布这首诗中，作者将看到的瀑布比喻成了悬挂在山川间的丝绸，仿佛天上的银河倾泻而下。老师在讲解完后可以给学生观看一些瀑布的图片以加深学生的印象，同时可以让学生联想作者当时观看瀑布时的那种宏阔激动的心情，激发对古诗词学习的兴趣，进而为今后古诗词学习奠定坚实的基础。,2.提升教师素质，加强合作交流,教师的教学素质对小学语文古诗词教育有着非常重要的影响，因此，老师进行古诗词教学时要注重自身素质和才能的提升，对于其他优秀教师的教学方法和手段更要积极交流与学习。古诗词教学对教师的专业素质有着严格要求，只有老师对古诗词的内容理解得非常透彻，才能将这种意象的思想感情表达给学生。如讲解泊船瓜洲这首诗时，作者通过描写自己泊船看到的景色引发思乡之情，老师讲解时可以与其他老师交流与探讨，从而找出最适合讲解这首思乡诗的方法，不仅可以让学生更透彻地理解诗词，同时也可以进一步提高教师的教学能力。,3.打破应试制约，提倡情景教学,传统教育方式往往是针对应试考试设计的，目的是让学生在最短时间内完成对试卷的解答，但正是这种死板的教条式教学造成很多学生只会死记硬背古诗词，而对于诗词中描绘的场景，作者的情感思想几乎没有什么认知。古诗词的精华就是用优美精湛的词汇表达作者的思想感情，因此在小学古诗词教学中，老师可以采用情景教学方法，使用多媒体等技术手段，让学生对古诗词有全新的认识，从而加深对古诗词意境的理解。如学习咏柳这首诗时，老师可以查找一些关于“柳”的图片和视频给学生观看，然后引导学生发现诗中作者对柳的赞美和寓意，进而从春柳感受到大自然的美好，不断激发学生的想象力和创造力，为今后学生古诗词的学习奠定基础。,四、结语,我国古诗词中蕴含的文化是非常深厚的，不仅因为诗词种类繁多，更重要的是古诗词中蕴含的情感和道理，作者通过咏物、言志、抒情、借代等多种修辞手法对诗词中的事物或者意境进行刻画，将自己的感情和意愿融入每个词汇中，学生学习和分析时能深刻地体会到作者强烈的情感。小学正处在对外界事物敏感而好奇的阶段，老师进行古诗词讲解时要多加利用这一点，变换教学手段和课堂形式，让学生更透彻地理解古诗词的涵义，从而帮助学生更好地学习古诗词，进而为今后情感培养奠定基础，也为我国文化传承积蓄力量。,1.在对话教学时重激发兴趣,步入初中的对话教学中，许多学生中存在畏缩和倦怠情绪，只有教师有效恰当的从激发兴趣着手来指导对话教学，才能使学生更好的掌握一定的英语基础知识和听、说、读、写技能，以便形成一定的综合语言运用能力。,如：分别有提问别人姓名的句型：Whats his/her name?用游戏Guessing game,My friend isstrong.He/She hasHe/She likes描述自己的朋友，其余学生问Whats his/her name?也可教师或学生描述其喜爱的动画片中的人物、明星、伟人等特称、爱好后进行猜人物的游戏活动来操练该句型。全班参与性的游戏让学生乐在轻松愉悦的环境中学习语言，运用语言，句型的掌握效果更好。,再如：让对话中陌生的新短语巧妙、直观的传递给学生，也可帮助学生增长学习的热情和自信心。对话里This is a map,map是一新难点单词，需扫清这一拦路虎，教师可直接利用下实物道具，自己的照片介绍：Look,this is aChinese map ，再教认照片单词map及对话里的难点句，学习中多多适机巧妙的运用直观的图片道具吸引住同学们的眼球，给予强烈深刻的视听印象，效果事半功倍。,新短语的学习中，可直接在课堂中利用新短语鼓励、表扬学生来操练运用，学生表演朗读好时教师自己或趁机让全班赞扬朗读好的学生。根据初中学生的年龄特点，适宜的激励表扬让他们在活泼、愉快、肯定的学习氛围中学习，这样教师使用赞扬、鼓励、期盼等情感语言，能无声地给予学生鼓励、正确的引导和善意的鞭策，让他们的思想受到启迪，让他们的心灵受到鼓舞，尤其是让部分学生感觉到心灵安慰，学习中少一份自卑，多一点自信和动力，其学习兴趣高涨及信心倍增。,2.在对话教学重创设语境,在中学英语教学中必须为学生提供充分的运用英语口语进行交际实践的机会，使学生从中加深理解、熟悉运用、牢固掌握，从而达到学以致用的目的。而对话是在一定情景下的习惯性语言，脱离了情景，对话也就失去了意义。教学中，教师不可能将真实生活情景搬入课堂，但可以模拟真实情景，创设接近生活的真实语言环境。,如教学What would you like？Lets talk中,在操练中可启发 Everythings ready.If Im hungry.Id like someand.还可设置问题 Suppose today is your birthday,what would you like? If you have some money,what would you like to buy?这样来启发学生回答。,如让学生人手准备一张家庭合照，通过同桌互问How many people are there in your family？了解学生家庭成员多少；再用投影仪开展介绍家庭成员This is my为学生创设具体的对话情景来展开对话。对话中教师重创设情景，在情景中把课堂中的对话句型由机械学习转化为交际运用语言知识，可达到能够灵活运用语言进行交际的最终目的。,3.在对话教学重灵活操练。语言的学习需要多说多练，而会话教学的操练形式通常是以跟老师念，录音读，集体、小组、个人读的枯燥无味的形式，其实多说多练贵在操练的实用有效性，而非操练的频率多少。要融会话教学于情景表演中，要学好英语，关键是要多读、多练、多实践，而语言实践是离不开生活的。恰当选择多媒体创设的情境，能为学生在英语课堂上创设了较为真实的情境，为学生提供了使用英语的语境，使学生能够触景生话，学生一看就知道生活情境，就联想到应该用哪句英用英语去表达。让学生在这种语言情境中去练习所学到的英语，不仅降低了学习难度，大家都能积极参与课堂活动，而且还能消除了个别学生的害羞心理，人人张嘴，个个表演，从而加深了对所学内容的印象，提高了学习英语的效率。,总之，初中英语的对话教学不仅要传授语言知识，还应培养学生的交际能力。因此我们必须巧妙地将授课内容与实际生活相联系，创设多种教学情景，让学生积极主动地参与到学习过程中来，在情境中学习、运用、巩固知识，提高语言实际运用能力，并能在对话教学中要要把书面文字活化为话语，把教材内容活化为实际生活，把教学活动活化为语言交际，有效操练会话内容，灵活运用语言，使学生得到全面的发展，有效地提高英语课堂教学效果。,软组织肿瘤软组织肿瘤软组织肿瘤成人软组织肉瘤化疗Conten,1,软组织肿瘤课件,软组织肿瘤课件,软组织肿瘤课件,软组织肿瘤课件,成人软组织肉瘤（,Soft tissue sarcomas,，,STSs,），包括一组发病相对较少，组织学多样的恶性肿瘤。,起源中胚层和外胚层。,占成人恶性肿瘤的,1%,和儿童恶性肿瘤的,5%,。,尚无特别有效的治疗方法，需多学科联合。,成人软组织肉瘤（Soft tissue sarcomas ，,Categories,Sarcomas of soft tissues (including fat, muscle, nerve and nerve sheath, blood vessels, and other connective tissues),Sarcomas of bone.,Categories Sarcomas of soft ti,The anatomic site of the primary disease,Extremities (60%),the trunk (19%),retroperitoneum (15%),head and neck (9%),The anatomic site of the prima,Risk factors,Age.,Soft tissue sarcomas can occur at any age, but overall are more common in older adults. The average age at diagnosis is 57 years. Certain types of sarcomas are more common in children, however.,Chemical exposure.,Being exposed to certain chemicals, such as vinyl chloride and dioxin, can increase the risk of soft tissue sarcomas.,Radiation exposure.,Previous radiation treatment for other cancers can increase the risk of soft tissue sarcomas.,Risk factorsAge.,Signs and symptoms,a new lump or a lump that is growing anywhere in the body,may or may not cause pain,may include abdominal swelling or a lump in the abdomen,nausea,vomiting,heartburn,abdominal pain,blood in vomit or stool,Signs and symptomsa new lump o,Adult soft tissue sarcoma diagnosed,Incisional biopsy,: The removal of part of a lump or a sample of tissue.,Core biopsy,: The removal of tissue using a wide needle.,Excisional biopsy,: The removal of an entire lump or area of tissue that doesnt look normal.,Adult soft tissue sarcoma diag,core needle biopsy,core needle biopsy,Pathology and staging,the type of soft tissue sarcoma,the stage of the cancer (how far the cancer has progressed),the grade of the tumour (how abnormal the cancer cells look and behave),Pathology and stagingthe type,Pleomorphic sarcoma also known as malignant fibrous histiocytoma (MFH),GISTs,Liposarcoma,leiomyosarcoma,synovial sarcoma,malignant peripheral nerve sheath tumors,Pleomorphic sarcoma also know,Incidence of Soft Tissue Sarcoma Subtypes (1978-2001),Incidence of Soft Tissue Sarco,软组织肿瘤课件,软组织肿瘤课件,Sites of Metastasis,Gadd M, et al,Ann Surg, 1993,Sites of MetastasisGadd M, et,Contents,Overview,Drugs,Treatment,neoadjuvant chemotherapy,adjuvant chemotherapy,targeted therapy,Contents Overview,Chemotherapy,Single Agents,Doxorubicin,Ifosfamide,Dacarbazine,Gemcitabine,Paclitaxel,Docetaxel,Chemotherapy Single Agents,Chemotherapy,Pemetrexed,Temozlomide,Irinotecan,Topotecan,Pelyated liposmal doxorubicin,Trabectedin,ChemotherapyPemetrexed,Doxorubicin,The single agent response rates (RR) are in the range of 20 to 30%,survival in the range of 7.7 -12 months,The best response rates are seen with dosages in the range of 75 mg/m 2 to 90 mg/m 2,DoxorubicinThe single agent re,Doxorubicin,Epirubicin is a less cardiotoxic analog of doxorubicin, which failed to demonstrate any benefit as compared to doxorubicin,liposomal doxorubicin can be used in patients where doxorubicin is contraindicated, but the response rates of this drug as a single agent are lower than the conventional doxorubicin.,DoxorubicinEpirubicin is a les,Ifosfamide,a dose- response relationship and higher doses can be used as it lacks cardiotoxicity,monotherapy with an identical dose (9 g/m 2 ), given over three days, by either continuous infusion or three-hour infusions daily,Ifosfamidea dose- response rel,Dacarbazine,in combination with doxorubicin and ifosfamide (MAID),given as a short infusion of 1.2 g/m 2 over 20 minutes with the availability of effective antiemetics.,Dacarbazinein combination with,Temozolamide,Temozolamide, the oral equivalent of dacarbazine, appears to have the same activity against leiomyosarcoma as well.,TemozolamideTemozolamide, the,Trabectedin (Ecteinascidin-743, ET743, Yondelis),This tetrahydroisoquinsoline molecule was derived originally from a tunicate, or sea squirt,Ecteinascidia turbinate,(found in the Carribbean and Mediterranean waters),A pooled analysis of 183 patients from the three single arm phase II studies,1.5 mg/m 2 administered as a 24-hour infusion once every three weeks,In this analysis though the ORR was only 7.7%, the rate of tumor control (i.e., ORR plus minor responses plus disease stabilization) was 51%.,Trabectedin (Ecteinascidin-743,Contents,Overview,Drugs,Treatment,neoadjuvant chemotherapy,adjuvant chemotherapy,Advanced or metastatic diseases chmeotherapy,targeted therapy,Contents Overview,Treatment,surgery,Surgery is the most common treatment for many soft tissue sarcomas.,Depending on the size and location of the sarcoma, all or part of the tumour may be removed. If the whole tumour is removed, a wide margin of healthy tissue around it is also removed.,In many cases, limb-sparing surgery can be done for a soft tissue sarcoma that occurs in an arm or leg and amputation can be avoided. However, in some cases, soft tissue sarcoma in a limb may require the limb to be amputated.,radiation therapy,Radiation therapy may be used before or after surgery or, less commonly, instead of surgery.,chemotherapy,If the soft tissue sarcoma has spread to other parts of the body, chemotherapy may be used to control the cancer and relieve symptoms.,Chemotherapy is sometimes used before surgery to shrink a tumour or after surgery to help reduce the chance of the cancer recurring.,Treatmentsurgery,软组织肉瘤,:,传统治疗,局限期肉瘤,:,扩大范围的,手术,为标准治疗,对于高度或中度复发风险或者切缘阳性的软组织肉瘤而言，通常需行,术后放疗,1,三维适形放疗,近距离放疗,或调强放疗,1. Clark MA, et al. N Engl J Med. 2005;353:701-711.2. Wunder JS, et al. Lancet Oncol. 2007;8:513-524.,但是仍有,50%,的软组织肉瘤患者会出现远处转移,2,软组织肉瘤: 传统治疗局限期肉瘤: 扩大范围的手术为标准治疗,Surgical Management,Mainstay of treatment for all STS of the extremity is wide local excision,(+/-) XRT,Adjuvant/neoadjuvant,Role of neoadjuvant chemotherapy,Widen bloc resection, 1-2 cm margins in all directions, Limiting factors:,neurovascular juxtaposition,Bony juxtaposition,Surgical ManagementMainstay of,Radical Surgical Margin,Radical Surgical Margin,Amputation,Amputation,软组织肿瘤课件,新辅助化疗,134,例患者，单纯手术组与新辅助化疗,+,手术，每组,67,例。,成人高危,STSs,（肿瘤, or =8 cm,，不论分级如何；或分级为,II/III,，但肿瘤, 5 cm,，以及深部肿瘤,辅助化疗Metal分析提示辅助化疗有一定的价值，但一些大的研,Role of Adjuvant Chemotherapy,Sarcoma meta-analysis collaboration,lancet, 1997,1568 patients from 14 studies,Median follow-up 9.4 years,10-yr. DFS improved from 45 to 55% (p = 0.0001),Local 10-yr. DFS improved from 75 to 81% (p = 0.016),OS only improved from 50 to 54% (p = 0.12),Data does not support routine use of adjuvant chemotherapy outside a clinical trial,Role of Adjuvant ChemotherapyS,Adjuvant Chemotherapy Trials,Adjuvant Chemotherapy Trials,Meta-Analysis #2,Meta-Analysis #2,软组织肿瘤课件,软组织肿瘤课件,软组织肿瘤课件,Metastatic diseases chemotherapy,Metastatic diseases chemothera,An EORTC STBSG study,A total of 2,185 patients with advanced soft tissue sarcomas who had been treated in seven clinical trials,An EORTC STBSG studyA total of,Results,Results,Results,Results,软组织肿瘤课件,软组织肿瘤课件,Metastaic,Soft-Tissue Sarcomas chemotherapy,Metastaic Soft-Tissue Sarcomas,Metastaic,Soft-Tissue Sarcomas chemotherapy,Metastaic Soft-Tissue Sarcomas,Dose-intensive chemotherapy with growth factor or autologous bone marrow or stem-cell transplant support in first-line treatment of advanced or metastatic adult soft tissue sarcoma: a clinical practice guideline,Dose-intensive chemotherapy with growth factor support is not recommended in the first-line treatment of patients with inoperable locally advanced or metastatic soft tissue sarcoma.,The data are insufficient to support the use of high-dose chemotherapy with autologous bone marrow or stem-cell transplantation as first-line treatment in this group of patients.,Eligible patients should be encouraged to enter clinical trials assessing novel approaches or compounds.,Dose-intensive chemotherapy wi,Combination Regimens beyond Ifosfamide and Adriamycin,Combination Regimens beyond If,Fixed-dose rate gemcitabine plus docetaxel as first-line therapyfor metastatic uterine leiomyosarcoma: a Gynecologic OncologyGroup phase II trial,Forty-two women enrolled, with 39 evaluable for response,900 mg/m2 over 90 minutes, d1 and d8 ; docetaxel 100 mg/m2 on day 8,With granulocyte growth factor support day nine of a 21-day cycle.,Fixed-dose rate gemcitabine pl,Response,ORR 15 of 42 patients (,35.8%,overall; CR 4.8%, PR 31%, 90% CI 23.5 to 49.6%),11 (,26.2%,) SD,median progression-free survival (PFS),4.4,months (range 0.4 to 37.2+ months),Median overall survival,16+,months (range: 0.4 41.3 months),Response ORR 15 of 42 patients,Fixed-dose rate gemcitabine plus docetaxel as second-linetherapy for metastatic uterine leiomyosarcoma: a GynecologicOncology Group phase II study,Forty-one women enrolled, with 48 evaluable for response unresectable uterine leiomyosarcoma progressing after prior cytotoxic therapy,gemcitabine 900 mg/m2,d1and d8 90 minutes,docetaxel 100 mg/m2 d8 , 21-day cycle,with granulocyte growth factor,Fixed-dose rate gemcitabine pl,CR 6.3% (3/48), PR 20.8% (10/48) ORR 27% (95% confidence interval 15.3%41.8%).,An additional 50% (24/48) SD, clinical benefit rate of 77%. Median PFS for all 48 patients was 6.7+ months,(range 0.7 27+ months),CR 6.3% (3/48), PR 20.8% (10/4,Adverse events,The predominant toxicity was myelosuppression,leukopenia grade 3 (14.5%), grade 4 (8.3%),thrombocytopenia grade 3 (29%), grade 4 (10.4%),neutropenia grade 3 (12.5%), grade 4 (8.3%),anemia grade 3 (20.8%), grade 4 (4.2%).,Adverse eventsThe predominant,Randomized Phase II Study of Gemcitabine and Docetaxel Compared With Gemcitabine Alone in Patients With Metastatic Soft Tissue Sarcomas: Results of Sarcoma Alliance for Research Through Collaboration Study 002,Fixed dose rate 10mg/m2/10min infusin gemcitabine at 1200mg/m2 d1 and d8 in gemcitabine arm,Gem-Doc arm,gemcitabne dose 900mg/m2 fixed dose rate infusion 90 min,d1 and d8;docetaxel 100mg/m2 d1 60min,Repeat every 21days,Randomized Phase II Study of G,软组织肿瘤课件,软组织肿瘤课件,软组织肿瘤课件,Investigational New Drugs (targeted therapy),Mammalian target of rapamycin (mTOR) inhibitors,mTOR inhibitors in clinical development,Three rapamycin analogs: CCI-779 (temsirolimus), RAD001 (everolimus), and AP23573 (deforolimus),Insulin like growth factor 1 receptor (IGF-IR) inhibitors,Others,Investigational New Drugs (tar,软组织肿瘤课件,Angiogenesis and STSs,Angiogenesis plays an important role in the growth and dissemination of STSs,the VEGF / VEGFR pathway plays the most important role,High VEGF expression is an independent poor prognostic factor for increased risk of metastases and decreased overall survival,Angiogenesis and STSsAngiogene,Compassionate use of bevacizumab (Avastin) in children and young adults with refractory or recurrent solid tumors,Compassionate use of bevacizum,Bevacizumab was administered at 510 mg/kg,body weight intravenously every 23 weeks, Most patients received chemotherapy in addition to bevacizumab,Bevacizumab was administered a,Others,Others,软组织肿瘤课件,苹果酸舒尼替尼,索坦,：药物结构,小分子吲哚酮类化合物,分子式：,C,22,H,27,FN,4,O,2,C,4,H,6,O,5,分子量：,532.6,ATP,位点竞争性抑制剂,抑制磷酸化和激活,阻断信号传导,N,H,O,N,H,F,N,H,O,N,OH,COOH,HOOC,H,Sutent Product Monograph,苹果酸舒尼替尼 索坦：药物结构小分子吲哚酮类化合物NH,舒尼替尼主要作用靶点,*,对于,GIST,而言尤其重要；*对于,GIST/,乳腺癌和小细胞肺癌而言尤其重要,舒尼替尼同时具有抗肿瘤血管生成与抗肿瘤细胞增殖双重效应,Sandrine F, et al. Nature, 2007,舒尼替尼主要作用靶点*对于GIST而言尤其重要；*对于GI,舒尼替尼治疗腺泡软组织肉瘤,S. Stacchiotti, et al. Annal of Oncology, 2011 Feb,舒尼替尼治疗腺泡软组织肉瘤S. Stacchiotti, e,舒尼替尼治疗非,GIST,软组织肉瘤,晚期,/,转移性非,GIST,软组织肉瘤,既往可接受,1-2,个化疗方案失败，,ECOG PS 0 - 2,(N = 53),持续治疗直至疾病进展,舒尼替尼,37.5,mg,每天持续口服,II,期临床：多中心、前瞻性舒尼替尼持续,37.5mg,口服,Arm A:,血管结缔组织肿瘤,(n = 18),平滑肌肉瘤,脊索瘤,血管肉瘤,孤立的纤维瘤,硬纤维瘤,内膜肉瘤,Arm B:,高分化多形性肉瘤,(n = 21),恶性纤维组织细胞瘤,未分型肉瘤,未分化肉瘤,滑膜肉瘤,脂肪肉瘤,粗纤维增生性小圆细胞肿瘤,脂肪肉瘤,腺泡软组织肉瘤,Arm C:,脊索瘤,(n = 9),J George, et al. JCO 2009, Vol 27,舒尼替尼治疗非GIST软组织肉瘤晚期/转移性非GIST软组织,II,期临床：舒尼替尼治疗,STS,疗效,II,期临床提示舒尼替尼对,STS,具有抗肿瘤活性,根据肿瘤代谢评价疗效,PR 48%, SD 52%,J George, et al. JCO 2009, Vol 27,II期临床：舒尼替尼治疗STS疗效II期临床提示舒尼替尼对S,Conclusions,Sarcomas are a rare, heterogeneous group of diseases.,Existing challenges need to be overcome.,Progress is being made.,Conclusions Sarcomas are a ra,Cont,The data for neoadjuvant chemotherapy is robust if regional hyperthermia is added to the combination of etoposide, ifosfamide, and adriamycin,Adjuvant chemotherapy with single agent adriamycin should be considered if high-risk prognostic features are present,ContThe data for neoadjuvant,metastatic STSs or developing metastatic disease after a treatment-free interval will require a multidisciplinary discussion and chemotherapy with a single agent adriamycin or combination therapy of ifosfamide and adriamycin,Novel therapeutic approaches are needed.,Participation in clinical trials of newer targeted therapies like mTOR inhibitors, IGF-1R blockers, and VEGF inhibitors should be encouraged. The data for these newer drugs appear promising,Cont,metastatic STSs or developing,1,、最灵繁的人也看不见自己的背脊。,非洲,2,、最困难的事情就是认识自己。,希腊,3,、有勇气承担命运这才是英雄好汉。,黑塞,4,、与肝胆人共事，无字句处读书。,周恩来,5,、阅读使人充实，会谈使人敏捷，写作使人精确。,培根,1、最灵繁的人也看不见自己的背脊。非洲2、最困,78,