肺癌脑转移的治疗PPT课件.ppt

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：Yes388(10055):2004-2014.,本研究的一般描述,anon-inferiority,phase3randomisedtrialdoneat69UKandthreeAustraliancentres.NSCLCpatientswithbrainmetastasesunsuitableforsurgicalresectionorstereotacticradiotherapyoptimalsupportivecare(OSC)includingdexamethasoneplusWBRT(20Gyinfivedailyfractions)orOSCaloneincludingdexamethasoneTheprimaryoutcomemeasure：quality-adjustedlife-years(QALYs).QALYsweregeneratedfromoverallsurvivalandpatientsweeklycompletionoftheEQ-5Dquestionnaire.BetweenMarch2,2007,andAug29,2014,538patientswererecruitedfrom69UKandthreeAustraliancentres,andwererandomlyassignedtoreceiveeitherOSCplusWBRT(269)orOSCalone(269).,Interpretation,Althoughtheprimaryoutcomemeasureresultincludestheprespecifiednon-inferioritymargin,thecombinationofthesmalldifferenceinQALYsandtheabsenceofadifferenceinsurvivalandqualityoflifebetweenthetwogroupssuggeststhatWBRTprovideslittleadditionalclinicallysignificantbenefitforthispatientgroup.,OverallSurvival,AverageQualityofLife,AverageQALY,ForestPlotofSurvival,Insummary,QUARTZprovidescompellinginformationforcliniciansandpatientsalike;foryoungerpatients,WBRTmightofferasurvivaladvantagebutforallothergroups,omittingWBRTdoesnotsignificantlyaffectQALYoroverallsurvival.,Nov.2016：WBRTforNSCLCtheendofanera?,AnnaM.E.B,etal.JThorac.Dis.2016;8(11):E1525-E1527,RTOG-RPA:Class1-3,Athree-classrecursivepartitioning(RPA)systembytheRTOGtodescribedifferentprognosticgroupsofpatientswithbrainmetastases.RPAClassI:themostfavorableprognosticgroup,KPS70,anage65yearsandcontrolledprimarytumorwithoutextracranialmetastases.RPAClassIII:thepoorestprognosispatients,KPS70.RPAClassII:Theremaindersofpatients,GasparLE,etal.IntJRadiatOncolBiolPhys.2000;47:1001-6.,Howtochoose？,QuartztrialisgroundbreakinginthatitisthefirstprospectiverandomizedstudyprovidingevidencethatpoorprognosispatientswithbrainmetastasesfromNSCLCdonotbenefitfromWBRT,andBSCshouldberegardedstandardofcareinthesepatients.Asexplained,thisdoesnotholdtrueforyoungerpatients,withlimitedorabsentextracranialdisease,inwhominadditiontothepossibilityofWBRTothertreatmentapproachesincludingradiosurgeryaloneorsystemictreatmentmaybeindicatedasanalternativetoWBRT.,RTOG-GPA:GradedPrognosticAssessments,SperdutoPW,etal.IntJRadiatOncolBiolPhys2010;77:65561.,RTOG-GPA:GradedPrognosticAssessments,SperdutoPW,etal.IntJRadiatOncolBiolPhys2010;77:65561.,JCO：Jan.2017,SRS/WBRT/EGFR-TKI,GPA:2-3.5&0-1.5?,结论与争议,结论：对于