同步放化疗肺癌中文

Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,*,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,第一页，共二十九页。,introduction,Until the late 1980s,thoracic radiation therapy(TRT)remained the,standard,care for locally advanced NSCLC.,第二页，共二十九页。,Radiation alone?,Sequential chemoradiation?,第三页，共二十九页。,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,第四页，共二十九页。,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,第五页，共二十九页。,OS,第六页，共二十九页。,60y survival,第七页，共二十九页。,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,第八页，共二十九页。,Concurrent chemoradiation?,Radiation alone?,第九页，共二十九页。,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,第十页，共二十九页。,Intensifiedregimen,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,JCO1995;13:452-458,LeeJS,JCO1994;14:1055-1064,CT:weekly,100mg/m,2,CBPD1,D2;100mg/m,2,VP-16D1-3,CT:200mg/m2CBPD1,D2;100mg/m2 VP-16 D1-5,thefirst,third,andfifthweeks,第十一,页,页，共,二,二十九,页,页。,Meta Analysis,Results,(52trials,9387pts),2-yearsurvival,4%,。,Hazard,ratio:0.87,。,NSCLCCG,BMJ 1995;311:899-909,第十二,页,页，共,二,二十九,页,页。,Concurrent chemoradiation?,Sequential chemoradiation?,第十三,页,页，共,二,二十九,页,页。,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,FuruseK,JCO 1999;17:2692-2699,Japan,第十四,页,页，共,二,二十九,页,页。,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,CurranWJ,PASCO 2000;19:484a,第十五,页,页，共,二,二十九,页,页。,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,ChoyH,PASCO2002;abstract:1160,第十,六,六页,，,，共,二,二十,九,九页,。,。,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,PierreF,PASCO2001;abstract:1246,第十七,页,页，共,二,二十九,页,页。,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,第十八,页,页，共,二,二十九,页,页。,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:2cycles inductionfollowedby2 cyclesandconcurrentTRT,66Gy,VokesEE,JCO 2002;20:4191-4198,第十九,页,页，共,二,二十九,页,页。,CALGB9431,第二十,页,页，共,二,二十九,页,页。,SWOG9019,Patients:,50pts.,IIIB,Treatment:,PE2cycles/RT,PE2cycles,AlbainKS,JCO2002;20:3454-3460,第二十,一,一页，,共,共二十,九,九页。,SWOG9019,MST:,15months,1y-sur:,58%,2y-sur:,33%,3y-sur:,17%,5y-sur:,15%,第二十,二,二页，,共,共二十,九,九页。,SWOG9504,Patients:83pts.,IIIB,Treatment:PE2cycles/RT,Docetaxel 3cycles(75mg/m2 forthefirstand 100mg/m2 forthelasttwocycles).,Gandara DR,JCO2003;21:2004-2010,第二十,三,三页，,共,共二十,九,九页。,SWOG9504,1y-sur:76%,MST:,26months,2y-sur:,54%,3y-sur:37%,第二十,四,四页，,共,共二十,九,九页。,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,JCO2003;21:2004-2010,第二十,五,五页，,共,共二十,九,九页。,Hossier Oncology Group,Inductioncisplatin/etoposide TRT,Docetaxel,Observation,第二十,六,六页，,共,共二十,九,九页。,CALGB9801,InductionPC,NoInductionPC,concurrent carboplatin/paclitaxelTRT,第二十,七,七页，,共,共二十,九,九页。,SWOG0023,PE/TRT,Consolidation docetaxel,Oral Gefitinib,placebo,第二十,八,八页，,共,共二十,九,九页。,内容,(nirng),总结,Management of unresectablestage,non-smallcell lungcancer:theroleofcombinedchemoradiation。2 yearsurvival,。,。2-yearsurvival。SauseW,CHEST2000,。,。ThierryLeChevaliar,JNCI1991,。,。CT:200mg/m2CBP D1,D2。P/P,第,二,二,十,十,九,九,页,页,，,，,共,共,二,二,十,十,九,九,页,页,。,。,