肺癌放疗标准

Update in Radiotherapy for Non-Small Cell Lung Cancer,Cancer Institute & Hospital, Chinese Academy of Medical Sciences Luhua Wang,Radiotherapy for NSCLC,Definitive radiotherapy for early stage non-small cell lung cancer Definitive radiotherapy for locally advanced stage non-small cell lung cancer Advanced technology in radiotherapy improved the treatment resultsNormal tissue is properly protected,Definitive Radiotherapy for Early Stage NSCLC,the therapy provided a 98% rate of local control!,Outcomes After Stereotactic Lung Radiotherapy or Wedge Resection for Stage I NonSmall-Cell Lung Cancer,Grills et al: JCO 2010 doi: 10.1200/JCO.2009.26.5157,Outcomes After Stereotactic Lung Radiotherapy or Wedge Resection for Stage I NonSmall-Cell Lung Cancer,Grills et al: JCO 2010 doi: 10.1200/JCO.2009.26.5157,Outcomes After Stereotactic Lung Radiotherapy or Wedge Resection for Stage I NonSmall-Cell Lung Cancer,Outcomes of Local Resection for Stage I NonSmall-Cell Lung Cancer,Outcomes After Stereotactic Lung Radiotherapy for Stage I NonSmall-Cell Lung Cancer,Mountain *,JCOG*,JNCCH*,Stage IAStage IB,67%57%,80%63%,74%53%,STI*,90%,84%,* Surgery,* Stereotactic Irradiation,Comparison of 5-Yr Overall Survival Between Surgery & STI,Survival curves of operable pts irradiated with BED of 100 Gy or more according to Stage,Summary of Japanese Studies,Onishi H, ASCO 2004,(A),(B),(D),(C),Image-guided radiation delivery,High-Tech Radiotherapy Machine,SBRT has been becoming standard treatment for inoperable stage I NSCLCHow about operable stage I NSCLC?,Randomized Studies are on the Way!,Definitive Radiotherapy for Early Stage NSCLC,Question: Can we give a thorough staging in China ?,Can the clinical early stage Pts be given a thorough Staging?,PET/CT scanning, how many percent can it be used in your clinical early stage patients?Mediastinoscopy, Is it accepted and widely used by our thoracic surgeon, AND our patients EBUS, what does it mean, “ if appropriable”? Without appropriate staging,How do we treat our patients?So, before we get new evidence, surgery still is the standard care for operable early stage patients.,Definitive Concurrent Chemo-Radiotherapy for Locally Andvanced NSCLC,Concurrent Chemo-Radiotherapy plays more important roles,Definitive Concurrent Chemo-Radiotherapy for Locally Advanced NSCLC,0,25,50,75,100,0,1,2,3,4,5,Time after randomization,Survival,P-value (log-rank): 0.038,RTOG 9410: Concurrent vs Sequential Chemo-Radiotherapy for Stage III NSCLC,Form H Choy,Form H Choy,But How Many Patients with Locally Advanced NSCLC Can Accept Concurrent Chemo-radiotherapy?,278 of 686 (41%) of the whole patient group was eligible for concurrent chemoradiation.,Number of stage III non-small-cell lung cancer and limited disease small-cell lung cancer patients versus number of patients eligible for concurrent chemoradiotherapy per age, 2002-2005,Ruysscher, D. D. et al. Ann Oncol 2009 20:98-102;,Percentage patients eligible for concurrent therapy,Data from Cancer Hospital of CAMSComparison of comorbidity per age (1),493 of 527 with documented information of comorbiditiy, 2000-2006,Charlson comorbidity index（CCI)Definition of comorbidity：1、Chronic Obstructive Pulmonary Disease （COPD）2、Cardiovascular Diseases：Myocardial Ischemia、 Myocardial Infarction、Angina Pectoris、Coronary Artery Bypass Graft Surgery 3、Peripheral Artery Disease：Intermittent Claudication（Raynauds disease）、Abdominal Aortic Aneurysm、Surgical Intervention 4、Cerebral Vascular Diseases：Hemiplegia according to Cerebral Vascular Accidents 5、Other Diseases：severe Rheumatoid Arthritis、Renal Diseases：Glomerulonephritis，Pyelonephritis；Gastrointestinal Diseases：Gastric Ulcer，Gastrectomy，Colitis；Hepatic Diseases：Cirrhosis，Heptitis；Confusion；Chronic InfectionExclusion Criteria：other malignant tumors，Hypertension，Diabetes，and some Autoimmune Diseases（Sarcoidosis，Wegener granulomatosis，Systemic Lupus Erythematosus ）are not considered as comorbidities,Data from Cancer Hospital of CAMS Comparison of comorbidity per age (2),Percentage of Pts eligible for concurrent chemoradiotherapy,Define criteria of eligibility Age75 Follow CCI criteria：pt with severe comorbidity,Treatment Features,Interaction of age and systemic treatment (chemotherapy),Without chemotherapy,With chemotherapy,P=0.625,P=0.013,70,70,important implications,To clinical guidelines：adequate supportive care and efficacious combination treatmentless toxic curative treatments: Sequential chemotherapy or Radiotherapy aloneradiation with targeted agentsNew radiation techniques,New radiation techniques improved treatment results,Image-Guided Radiation Delivery IGRT,40 pairs of leavesMLC,KV-level X-ray tube,KV-level Array Detector,MV-level Array Detector,Better location for patient position,Better location for tumor,Accurate irradiation to target volume,Control tumor moving in breath,4-Direction CT imaging technique,inspiration,Spiral initiation,Phase,From inspiraion to exhalation,End of exhalation,exhalation,Breath curve,Bed position,From exhalation to inspiraion,From inspiraion to exhalation,Use of advanced radiation technologies have translated into improvement of survival,Int. J. Radiation Oncology Biol. Phys., Vol. 66, No. 1, pp. 108116, 2006,3D vs 2D in MEDICALLY INOPERABLE STAGE I NONSMALL-CELL LUNG CANCER,(a) Overall survival,(b) Disease-specific survival,Int. J. Radiation Oncology Biol. Phys., Vol. 66, No. 1, pp. 108116, 2006,3D vs 2D in MEDICALLY INOPERABLE STAGE I NONSMALL-CELL LUNG CANCER,Local-regional control,Influence of Technologic Advances on Outcomes in Patients With Unresectable, Locally Advanced NonSmall-Cell Lung Cancer Receiving Concomitant Chemoradiotherapy,Zhongxing X. Liao M.D.*, , , Ritsuko R. Komaki M.D.*, et al. International Journal of Radiation Oncology*Biology*PhysicsVolume 76, Issue 3, 1 March 2010, Pages 775-781,Conclusions1、Treatment with 4DCT/IMRT was at least as good as that with 3DCRT in terms of the rates of freedom from LRP and DM. 2、There was a significant reduction in toxicity and a significant improvement