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单击以编辑母版标题样式,单击以编辑母版文本样式,第二级,第三级,第四级,第五级,*,Management of unresectable stage non-small cell lung cancer: the role of combined chemoradiation,Management of unresectable sta,1,introduction,Until the late 1980s, thoracic radiation therapy (TRT) remained the,standard,care for locally advanced NSCLC.,introduction Until the late 1,2,Radiation alone?,Sequential chemoradiation?,Radiation alone? Sequential ch,3,CALGB8433,RT60Gy,PV2cyclesRT60Gy,No.,77,79,MST,9.7,13.8,1-year survival,40,55,2 year survival,13,26,3 year survival,11,23,5 year survival,7,19,P value,0.0066,Dillman RO , NEJM 323:940-945, 1990,Dillman RO, JNCI 88:1210-1215, 1996,CALGB8433RT60GyPV2cyclesRT60G,4,RTOG8808,RT60Gy,CT+RT,H-RT69.6Gy,No,152,152,154,MST,11.4,13.2,12,1-year survival,47,59,52,2 -year survival,21,32,24,3 -year survival,11,17,14,5 -year survival,6,11,9,P value,0.04,Sause W,JNCI1995;87:198-205,Sause W, CHEST2000;117:358-364,RTOG8808RT60GyCT+RTH-RT69.6GyN,5,OS,OS,6,60y survival,60y survival,7,FRANCE,RT65Gy,CT,+RT65Gy,P值,No,177,176,MST,10,12,0.08,1-year survival,41,50,2 -year survival,14,21,3 -year survival,5,11,Metastasis rate,38,26,0.001,1-year LCR,17,15,Thierry Le Chevaliar,JNCI1991;83:417-423,CT: VCPC, vindesine, cyclophosphamide, cisplatin, lomustine,FRANCERT65GyCT+RT65GyP值No17717,8,Concurrent chemoradiation?,Radiation alone?,Concurrent chemoradiation?Radi,9,EORTC,RT55,PDD(W)+RT,PDD(D)+RT,No,311,311,311,1-y survival,46,44,54,2-y survival,13,19,26,3-y survival,2,13,16,P value,0.009,1-y LCR,19,30,31,P value,0.003,Schaake-Koning C, NEJM 1992;326:524-530,EORTCRT55PDD(W)+RTPDD(D)+RTNo3,10,Intensified regimen,H-RT,H-RT/,CT,H-RT/,CT,No,61,52,56,methods,64.8Gy,64.8/CE,64.8/CE,MST,8,18,13,3-y survival,6.6,23,16,Jeremic B, JCO 1995;13:452-458,Lee JS, JCO 1994;14:1055-1064,CT: weekly,100mg/m,2,CBP D1,D2; 100mg/m,2,VP-16 D1-3,CT:200mg/m2 CBP D1,D2; 100mg/m2 VP-16 D1-5,the first, third, and fifth weeks,Intensified regimenH-RTH-RT/CT,11,Meta Analysis,Results,(52 trials,9387 pts),2-year survival,4%,。,Hazard,ratio:,0.87,。,NSCLC CG, BMJ 1995;311:899-909,Meta AnalysisResults (52 trial,12,Concurrent chemoradiation?,Sequential chemoradiation?,Concurrent chemoradiation?Sequ,13,concurrent,sequential,P value,No,156,158,methods,56Gy/MVP2C,MVP2C+56,MST,16.5,13.3,0.04,2-y survival,34.6,27.4,3-y survival,22.3,14.7,4-y survival,16.9,10.1,5-y survival,15.8,8.9,Response R,84,66,0.0002,Furuse K, JCO 1999;17:2692-2699,Japan,concurrentsequentialP valueNo1,14,RTOG9410,sequential,concurrent,concurrent+HF,No(total),611,RT,60,60,69.6,methods,PV2C,PV2C,PE,MST,14.6,17,15.6,A-Toxicity,30,48,62,L-Toxicity,14,15,16,Curran WJ, PASCO 2000;19:484a,RTOG9410sequentialconcurrentco,15,ACR427(phase ),seq,Con(ind/con),Con(con/adi),No(total),276,RT,63,63,63,CT,PC2,PC2+CON,CON+PC2,MST,12.5,11,16.1,Esophogitis(3）,4,20,28,Choy H, PASCO 2002;abstract:1160,ACR427(phase )seqCon(ind/con),16,GLOT9501,SEQ,CON,No(total),212,RT,66Gy,66,CT,NP 3C ind,CE+CE 2C adi,3/4 neutropenia,87.8,75,3/4 oesophagitis,0,26.1,MST,13.9,15.6,1-y survival,56,56,2-y survival,23,35,Pierre F, PASCO 2001;abstract:1246,GLOT9501SEQCONNo(total)212RT66,17,MST,OS,E-toxicity,S,C,S C,S C,furuse,13.3,16.5,9 16(5),4 23,RTOG,14.6 17.1,12 21(4),4 25,GLOT,13.9 15.6,24 35(2),3 17,Czech,13.2 20.6,15 42(2),4 28,BROCAT,14.0 19.0,- -,0 26,ACR427,13.8 17.4,31 33(2),3 28,MSTOSE-toxicity S,18,CALGB9431,G/P,P/P,N/P,No.,62,58,55,RR,74,67,73,1-y Sur,68,62,65,3-y Sur,28,19,23,MST,18.3,14.8,17.7,DFS,8.4,9.1,11.5,Methods:2 cycles induction followed by 2 cycles and concurrent TRT, 66Gy,Vokes EE, JCO 2002;20:4191-4198,CALGB9431G/PP/PN/PNo.625855RR7,19,CALGB9431,CALGB9431,20,SWOG9019,Patients:,50 pts.,IIIB,Treatment:,PE 2cycles/RT,PE 2cycles,Albain KS, JCO 2002;20:3454-3460,SWOG9019Patients: 50 pts. IIIB,21,SWOG9019,MST:,15months,1y-sur:,58%,2y-sur:,33%,3y-sur:,17%,5y-sur:,15%,SWOG9019MST: 15months1y-sur: 5,22,SWOG9504,Patients:,83pts.,IIIB,Treatment:,PE 2cycles/RT,Docetaxel 3 cycles (75mg/m2 for the first and 100mg/m2 for the last two cycles).,Gandara DR, JCO 2003;21:2004-2010,SWOG9504Patients: 83pts. IIIB,23,SWOG9504,1y-sur:,76%,MST:,26months,2y-sur:,54%,3y-sur:,37%,SWOG95041y-sur: 76%MST: 26mont,24,SWOG9019/9504,study,No,Survival time,2y-Survival,3y-survival,median,95%CI,median,95%CI,median,95%CI,9019,50,15,10-22,34,21-47,17,7-27,9504,83,26,18-35,54,43-65,37,22-52,Gandara DR, JCO 2003;21:2004-2010,SWOG9019/9504studyNoSurvival t,25,Hossier Oncology Group,Induction cisplatin / etoposide TRT,Docetaxel,Observation,Hossier Oncology GroupInductio,26,CALGB9801,Induction PC,No Induction PC,concurrent carboplatin / paclitaxel TRT,CALGB9801Induction PCNo Induct,27,SWOG0023,PE/TRT,Consolidation docetaxel,Oral Gefitinib,placebo,SWOG0023PE/TRTConsolidation do,28,
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