肺癌脑转移的治疗课件

肺癌脑转移的治疗进展江浩肿瘤放疗中心蚌埠医学院第一附属医院蚌埠医学院附属肿瘤医院一石激起千重浪？MulvennaP,etal.Lancet.

2016Oct22;388(10055):2004-2014.WBRTforNSCLC：Yes&No？MulvennaP,etal.Lancet.

2016Oct22;388(10055):2004-2014.本研究的一般描述anon-inferiority,phase3randomisedtrialdoneat69UKandthreeAustraliancentres.NSCLCpatientswithbrainmetastasesunsuitableforsurgicalresectionorstereotacticradiotherapyoptimalsupportivecare(OSC)includingdexamethasoneplusWBRT(20Gyinfivedailyfractions)orOSCaloneincludingdexamethasoneTheprimaryoutcomemeasure：quality-adjustedlife-years(QALYs).QALYsweregeneratedfromoverallsurvivalandpatients’weeklycompletionoftheEQ-5Dquestionnaire.BetweenMarch2,2007,andAug29,2014,538patientswererecruitedfrom69UKandthreeAustraliancentres,andwererandomlyassignedtoreceiveeitherOSCplusWBRT(269)orOSCalone(269).InterpretationAlthoughtheprimaryoutcomemeasureresultincludestheprespecifiednon-inferioritymargin,thecombinationofthesmalldifferenceinQALYsandtheabsenceofadifferenceinsurvivalandqualityoflifebetweenthetwogroupssuggeststhatWBRTprovideslittleadditionalclinicallysignificantbenefitforthispatientgroup.OverallSurvivalAverageQualityofLifeAverageQALYForestPlotofSurvivalInsummaryQUARTZprovidescompellinginformationforcliniciansandpatientsalike;foryoungerpatients,WBRTmightofferasurvivaladvantagebutforallothergroups,omittingWBRTdoesnotsignificantlyaffectQALYoroverallsurvival.Nov.2016：WBRTforNSCLC

theendofanera?AnnaM.E.B,etal.JThorac.Dis.2016;8(11):E1525-E1527RTOG-RPA:Class1-3Athree-classrecursivepartitioning(RPA)systembytheRTOGtodescribedifferentprognosticgroupsofpatientswithbrainmetastases.RPAClassI:themostfavorableprognosticgroup,KPS≥70,anage≤65yearsandcontrolledprimarytumorwithoutextracranialmetastases.RPAClassIII:thepoorestprognosispatients,KPS<70.RPAClassII:TheremaindersofpatientsGasparLE,etal.IntJRadiat

Oncol

BiolPhys.2000;47:1001-6.Howtochoose？QuartztrialisgroundbreakinginthatitisthefirstprospectiverandomizedstudyprovidingevidencethatpoorprognosispatientswithbrainmetastasesfromNSCLCdonotbenefitfromWBRT,andBSCshouldberegardedstandardofcareinthesepatients.Asexplained,thisdoesnotholdtrueforyoungerpatients,withlimitedorabsentextracranialdisease,inwhominadditiontothepossibilityofWBRTothertreatmentapproachesincludingradiosurgeryaloneorsystemictreatmentmaybeindicatedasanalternativetoWBRT.RTOG-GPA:GradedPrognostic

AssessmentsSperdutoPW,etal.IntJRadiat

Oncol

BiolPhys2010;77:655–61.RTOG-GPA:GradedPrognostic

AssessmentsSperdutoPW,etal.IntJRadiat

Oncol

BiolPhys2010;77:655–61.JCO：Jan.2017SRS/WBRT/EGFR-TKIGPA:2-3.5&0-1.5?结论与争议结论：对于不适合行手术/SRS放疗的非小细胞肺癌患者可以选择一激素