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？,Mulvenna P,et al. Lancet. 2016 Oct 22;388(10055):2004-2014.,WBRT for NSCLC：Yes & No？,Mulvenna P,et al. Lancet. 2016 Oct 22;388(10055):2004-2014.,本研究的一般描述,a non-inferiority, phase 3 randomised trial done at 69 UK and three Australian centres. NSCLC patients with brain metastases unsuitable for surgical resection or stereotactic radiotherapy optimal supportive care (OSC) including dexamethasone plus WBRT (20 Gy in five daily fractions) or OSC alone including dexamethasone The primary outcome measure：quality-adjusted life-years (QALYs). QALYs were generated from overall survival and patients weekly completion of the EQ-5D questionnaire. Between March 2, 2007, and Aug 29, 2014, 538 patients were recruited from 69 UK and three Australian centres, and were randomly assigned to receive either OSC plus WBRT (269) or OSC alone (269).,Interpretation,Although the primary outcome measure result includes the prespecified non-inferiority margin, the combination of the small difference in QALYs and the absence of a difference in survival and quality of life between the two groups suggests that WBRT provides little additional clinically significant benefit for this patient group.,Overall Survival,Average Quality of Life,Average QALY,Forest Plot of Survival,In summary,QUARTZ provides compelling information for clinicians and patients alike; for younger patients, WBRT might offer a survival advantage but for all other groups, omitting WBRT does not significantly affect QALY or overall survival.,Nov. 2016：WBRT for NSCLC the end of an era?,Anna M.E.B, et al. J Thorac. Dis. 2016;8(11):E1525-E1527,RTOG-RPA: Class 1-3,A three-class recursive partitioning (RPA) system by the RTOG to describe different prognostic groups of patients with brain metastases. RPA Class I: the most favorable prognostic group, KPS70, an age 65 years and controlled primary tumor without extracranial metastases. RPA Class III :the poorest prognosis patients, KPS 70. RPA Class II:The remainders of patients,Gaspar LE, et al. Int J Radiat Oncol Biol Phys.2000;47:1001-6.,How to choose？,Quartz trial is groundbreaking in that it is the first prospective randomized study providing evidence that poor prognosis patients with brain metastases from NSCLC do not benefit from WBRT, and BSC should be regarded standard of care in these patients. As explained, this does not hold true for younger patients, with limited or absent extracranial disease, in whom in addition to the possibility of WBRT other treatment approaches including radiosurgery alone or systemic treatment may be indicated as an alternative to WBRT.,RTOG-GPA: Graded Prognostic Assessments,Sperduto PW, et al. Int J Radiat Oncol Biol Phys 2010; 77: 65561.,RTOG-GPA: Graded Prognostic Assessments,Sperduto PW, et al. Int J Radiat Oncol Biol Phys 2010; 77: 65561.,JCO：Jan. 2017,SRS/WBRT/EGFR-TKI,GPA:2-3.5&