同步放化疗肺癌中文版.ppt

Management of unresectable stage non-small cell lung cancer: the role of combined chemoradiation,introduction,Until the late 1980s, thoracic radiation therapy (TRT) remained the standard care for locally advanced NSCLC.,Radiation alone?,Sequential chemoradiation?,CALGB8433,Dillman RO , NEJM 323:940-945, 1990,Dillman RO, JNCI 88:1210-1215, 1996,RTOG8808,Sause W,JNCI1995;87:198-205,Sause W, CHEST2000;117:358-364,OS,Concurrent chemoradiation?,Radiation alone?,EORTC,Schaake-Koning C, NEJM 1992;326:524-530,Intensified regimen,Jeremic B, JCO 1995;13:452-458,Lee JS, JCO 1994;14:1055-1064,CT: weekly,100mg/m2 CBP D1,D2; 100mg/m2 VP-16 D1-3,CT:200mg/m2 CBP D1,D2; 100mg/m2 VP-16 D1-5, the first, third, and fifth weeks,Meta Analysis,Results (52 trials,9387 pts),2-year survival 4%。 Hazard ratio: 0.87。,NSCLC CG, BMJ 1995;311:899-909,Concurrent chemoradiation?,Sequential chemoradiation?,Furuse K, JCO 1999;17:2692-2699,Japan,RTOG9410,Curran WJ, PASCO 2000;19:484a,ACR427(phase ),Choy H, PASCO 2002;abstract:1160,GLOT9501,Pierre F, PASCO 2001;abstract:1246,CALGB9431,Methods:2 cycles induction followed by 2 cycles and concurrent TRT, 66Gy,Vokes EE, JCO 2002;20:4191-4198,CALGB9431,SWOG9019,Patients: 50 pts. IIIB Treatment: PE 2cycles/RT PE 2cycles,Albain KS, JCO 2002;20:3454-3460,SWOG9019,MST: 15months,1y-sur: 58%,2y-sur: 33%,3y-sur: 17%,5y-sur: 15%,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,SWOG9504,1y-sur: 76%,MST: 26months,2y-sur: 54%,3y-sur: 37%,SWOG9019/9504,Gandara DR, JCO 2003;21:2004-2010,Hossier Oncology Group,Induction cisplatin / etoposide TRT,Docetaxel,Observation,CALGB9801,Induction PC,No Induction PC,concurrent