食管癌同步放化疗

1、会计学1食管癌同步放化疗食管癌同步放化疗SECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XIAN JIAOTONG UNIVERSITYSECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XIAN JIAOTONG UNIVERSITYSECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XIAN JIAOTONG UNIVERSITY我国食管癌SECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XIAN JI

2、AOTONG UNIVERSITYSurgical OncologyRadiation OncologyMedical OncologyBiological and Target TherapyThe traditional Chinese medicine治疗手段SECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XIAN JIAOTONG UNIVERSITY局部病变肿瘤治愈SECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XIAN JIAOTONG UNIVERSITYSECOND AFFILI

3、ATED HOSPITAL OF MEDICAL COLLEGE OF XIAN JIAOTONG UNIVERSITY机制SECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XIAN JIAOTONG UNIVERSITY机制SECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XIAN JIAOTONG UNIVERSITYn一线药物一线药物n（9090年代以前的年代以前的 ）顺铂、顺铂、5 5FuFu、阿霉素、阿霉素n二线药物二线药物n（9090年代以后）年代以后）泰素、泰索蒂、诺维本、健择、泰素、

4、泰索蒂、诺维本、健择、 半合成的喜树碱衍生物、新一代铂类半合成的喜树碱衍生物、新一代铂类n生物靶向药物生物靶向药物SECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XIAN JIAOTONG UNIVERSITYSECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XIAN JIAOTONG UNIVERSITY5Fu1.抗代谢药抗代谢药2. 在体内转变为在体内转变为5氟尿嘧啶脱氧核苷氟尿嘧啶脱氧核苷 抑制胸腺嘧啶核甙合成酶，影响抑制胸腺嘧啶核甙合成酶，影响DNA的生物合成的生物合成3、能掺入、能掺入R

5、NA中干扰蛋白质合成中干扰蛋白质合成4. 对有氧和乏氧细胞有相同的杀伤作用对有氧和乏氧细胞有相同的杀伤作用n5FuSECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XIAN JIAOTONG UNIVERSITYSECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XIAN JIAOTONG UNIVERSITY甲酰四氢叶酸顺铂加强5Fu生化调节机制4 用药时间放疗后5min8h5 用药量200375mg/m25Fu特点：n特点：吸收后在体内逐渐变为氟尿嘧啶而起作用特点：吸收后在体内逐渐变为氟尿嘧啶而起

6、作用n 其作用机理与氟尿嘧啶相同，其作用机理与氟尿嘧啶相同，n 在体内能干扰、阻断在体内能干扰、阻断DNA、RNA及蛋白质及蛋白质的合成的合成n 其毒性只有氟尿嘧啶的其毒性只有氟尿嘧啶的1/41/7n 化疗指数为氟尿嘧啶的化疗指数为氟尿嘧啶的2倍倍n 血液中半衰期为血液中半衰期为5hn 用药量，一般用药量，一般5001000mg/dayn慢性毒性试验中未见到严重的骨髓抑制，对免疫慢性毒性试验中未见到严重的骨髓抑制，对免疫的影响较为轻微。的影响较为轻微。SECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XIAN JIAOTONG UNIVERSIT

7、Y新一代 替加氟 Tegafur Injection n特点：特点：不需经过肝脏的药物代谢而释放出不需经过肝脏的药物代谢而释放出5-Fu5-Fun在血液、淋巴液、腹腔积液以及肿瘤组织中保持在血液、淋巴液、腹腔积液以及肿瘤组织中保持高浓度。高浓度。SECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XIAN JIAOTONG UNIVERSITYSECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XIAN JIAOTONG UNIVERSITYSECOND AFFILIATED HOSPITAL OF M

8、EDICAL COLLEGE OF XIAN JIAOTONG UNIVERSITY顺铂 Cisplatin,PDD，DDP 1 铂的金属络合物，作用似烷化剂2 主要作用靶点为DNA作用于DNA链间及链内交链，形成DDPDNA复合物干扰DNA复制，或与核蛋白及胞浆蛋白结合。3 属周期非特异性药n顺铂的抗肿瘤作用顺铂的抗肿瘤作用SECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XIAN JIAOTONG UNIVERSITY浓度依赖性时间依赖性顺铂小剂量长期用药抑制肿瘤细胞对放疗所致亚致死性损伤修复抑制和潜在致死性损伤的修复顺铂最低临床应用剂量 6

9、mg/m2/dSECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XIAN JIAOTONG UNIVERSITYSECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XIAN JIAOTONG UNIVERSITY5Fu顺铂二者对放射增敏有协同作用增敏效果与给药时间有关顺铂在放疗前16h5Fu持续给药增敏效果最佳n在乏氧的条件下卡铂的增敏作用高于顺铂在乏氧的条件下卡铂的增敏作用高于顺铂n奥沙利铂（乐沙定奥沙利铂（乐沙定, , 草酸铂）草酸铂）nL-OHPL-OHP复合体复合体nDDPDDP复合体复合体

10、靶分子和作用机制不同靶分子和作用机制不同 抗瘤谱不同抗瘤谱不同萘达铂萘达铂 肾毒性、胃肠道反应及骨髓抑制均较肾毒性、胃肠道反应及骨髓抑制均较DDPDDP轻轻SECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XIAN JIAOTONG UNIVERSITYSECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XIAN JIAOTONG UNIVERSITY 泰素、紫素、特素、紫脘素，Paclitaxel, Taxol, PTX机制SECOND AFFILIATED HOSPITAL OF MEDICAL

11、COLLEGE OF XIAN JIAOTONG UNIVERSITY机制SECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XIAN JIAOTONG UNIVERSITY健择gemcitabine hydrochloride,盐酸吉西他滨细胞周期特异性抗代谢类药物 作用于DNA合成期（S期）的肿瘤细胞在一定的条件下，可以阻止G1期向S期的进展 SECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XIAN JIAOTONG UNIVERSITYSECOND AFFILIATED HOSPITAL OF

12、 MEDICAL COLLEGE OF XIAN JIAOTONG UNIVERSITYSECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XIAN JIAOTONG UNIVERSITYMETHODS. This phase III prospective, randomized, and stratified trial was undertaken to evaluate the efficacy of four courses of combined fluorouracil (1000 mg per square meter of bod

13、y-surface area daily for four days) and cisplatin (75 mg per square meter on the first day) plus 5000 cGy of radiation therapy, as compared with 6400 cGy of radiation therapy alone, in patients with squamous-cell carcinoma or adenocarcinoma of the thoracic esophagus. RESULTS. The median survival was

14、 8.9 months in the radiation-treated patients, as compared with 12.5 months in the patients treated with chemotherapy and radiation therapy. In the former group, the survival rates at 12 and 24 months were 33 percent and 10 percent, respectively, whereas they were 50 percent and 38 percent in the pa

15、tients receiving combined therapy (P less than 0.001). Seven patients in the radiotherapy group and 25 in the combined-therapy group were alive at the time of the analysis.SECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XIAN JIAOTONG UNIVERSITYSECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XIAN J

16、IAOTONG UNIVERSITY1级NCCNSECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XIAN JIAOTONG UNIVERSITYSECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XIAN JIAOTONG UNIVERSITY by chemoradiation in patients with localized carcinoma of the esophagus: RTOG 0113.SECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE

17、OF XIAN JIAOTONG UNIVERSITYSECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XIAN JIAOTONG UNIVERSITYexternal beam boost irradiation.SECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XIAN JIAOTONG UNIVERSITYSECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XIAN JIAOTONG UNIVERSITYSECOND AFFILIATED HOSP

18、ITAL OF MEDICAL COLLEGE OF XIAN JIAOTONG UNIVERSITYSECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XIAN JIAOTONG UNIVERSITYSECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XIAN JIAOTONG UNIVERSITYSECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XIAN JIAOTONG UNIVERSITYYamada K, MurakamiM,Okamoto Y,

19、 et al. Treatment results of chemoradiotherapy for clinical stage I ( T1N0M0) esophageal carcinoma J . Int J Radiat Oncol Biol Phys, 2006, 64 ( 4 ) : 1106- 1111. SECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XIAN JIAOTONG UNIVERSITY第49届ASTRO年会报道(三)食管癌放疗进展 北京医院放疗科 高鸿 李高峰 SECOND AFFILIATED HOSPITAL

20、 OF MEDICAL COLLEGE OF XIAN JIAOTONG UNIVERSITYSECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XIAN JIAOTONG UNIVERSITY 2B2B级是基于低水平证据，专家组无统一认识，但争议不大 SECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XIAN JIAOTONG UNIVERSITY/SECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XIA

21、N JIAOTONG UNIVERSITYSECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XIAN JIAOTONG UNIVERSITYSECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XIAN JIAOTONG UNIVERSITYSECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XIAN JIAOTONG UNIVERSITYSECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XIAN JIAOTO

22、NG UNIVERSITYSECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XIAN JIAOTONG UNIVERSITY，Bevacizumab 羟羟(基基)脲脲奈达铂奈达铂奥沙利铂奥沙利铂依立替康依立替康多西他赛多西他赛紫杉醇紫杉醇,红杉醇红杉醇表柔比星表柔比星卡培他滨卡培他滨SECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XIAN JIAOTONG UNIVERSITY以上20多项临床试验，涉及以上的药物以及3DCRT，分段放疗，后程加速超分割等放疗方法。SECOND AFFILIATED

23、 HOSPITAL OF MEDICAL COLLEGE OF XIAN JIAOTONG UNIVERSITY2BJ Clin Oncol. 2003 Aug 1;21(15):2926-32. Phase I trial of escalating-dose irinotecan given weekly with cisplatin and concurrent radiotherapy in locally advanced esophageal cancer.SECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XIAN JIAOTONG

24、UNIVERSITYSECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XIAN JIAOTONG UNIVERSITYInt J Radiat Oncol Biol Phys. 2005 May 1;62(1):91-6. Phase I trial of oxaliplatin in combination with cisplatin, protacted-infusion fluorouracil, and radiotherapy in advanced esophageal and gastroesophageal carcinoma.

25、 docetaxel (levels 1, 2, 3, 2.5: 20, 30, 40, 35 mg/m(2)cisplatin (40 mg/m(2) on days 1, 15, 29, and 43 5-fluorouracil (400mg/m(2)/day) on days 1-5, 15-19, 29-33, and 43-47. continuous infusion 61.2 Gy/34 fractions/7 weeks of concurrent radiotherapy. RESULTS: Therefore, level 2.5：35 mg/m(2) was recom

26、mended for phase II studies. This regimen was tolerable and highly active.SECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XIAN JIAOTONG UNIVERSITY SECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XIAN JIAOTONG UNIVERSITYSECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XIAN JIAOTONG UNIVERSITY学者学者方法

27、方法时间时间例数例数用药用药生存率生存率 1 1年年3 3年年5 5年年刘劲松刘劲松常规同步常规同步2001200140405 Fu、DDP、HCPT75 %42 .5 %单放单放40405 7.5 %2 0 %赵献光赵献光常规同步常规同步2002200235355 Fu、PDD74.3%34.3%单放单放333348.5 %2 1.2 %季斌季斌常规同步常规同步200220023939盖诺盖诺2530mg/m2,d1,d5 ;顺顺铂铂 2530mg/m2 ,dl,d2,24cycle季斌季斌常规同步常规同步2002200282825 5-FUFU 500mg/m2，d1-,5d ;顺铂顺铂

28、60mg/m2,d1;平阳霉素平阳霉素 8mg/次次, dl,d3，3cycle22.0 %单放单放808013.8%SECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XIAN JIAOTONG UNIVERSITY学者学者方法方法时间时间例数例数用药用药生存率生存率 1 1年年3 3年年5 5年年陈俊强陈俊强后程同步后程同步20032003404077.4%77.4%单放单放404055.1%55.1%陈友山陈友山常规同步常规同步200520057272DFDF77.8%77.8%44.4%44.4%单放单放707052.9%52.9%24.3

29、%24.3%朱振胜朱振胜后程同步后程同步200620063838顺铂顺铂20mg,d120mg,d1d5,d28d5,d28d32,d32,放疗放疗卡莫氟卡莫氟(HCFU)200mg/(HCFU)200mg/次次,3,3次次/d,/d,全程全程73.7%73.7%单纯后程单纯后程343455.9%,55.9%,赵快乐赵快乐后程同步后程同步200620065454顺铂顺铂25mg/m2d1-d3,25mg/m2d1-d3,氟尿嘧氟尿嘧啶啶600mg/ m2, d1-600mg/ m2, d1-d3,4cycled3,4cycle67%67%44%44%40%,40%, 单纯后程单纯后程 5757

30、 77%77%39%39%28%,28%,SECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XIAN JIAOTONG UNIVERSITY学者学者方法方法时间时间例数例数用药用药生存率生存率 1 1年年3 3年年5 5年年高丽莉高丽莉3DCRT +3DCRT +化化疗疗2008200846465 5- -FU 500mg/mFU 500mg/m2 2 + DDP + DDP 20mg/m20mg/m2 2 , , d1-d5,4- d1-d5,4-6cycle6cycle7979. .8%8%5050. .1%1%3DCRT3DCRT44446

31、969. .2%2%3838. .0%0%陈伟陈伟常规同步常规同步200820083030NVB NVB 30mg/m30mg/m2,2,d1,d8 +d1,d8 +DDP DDP 20mg/m20mg/m2 2 , , d1-d5, d1-d5, 2cycle2cycle7676. .6%6%4040. .0%0%单放单放32324242. .0%0%1818. .0%0%李国忠李国忠常规同步常规同步200720078888多西他赛多西他赛20mg/w20mg/w8989. .8%8%3939. .7%7% 王惠王惠常规同步常规同步200820083333PTXPTX 60mg/w 60mg/w8484. .6%6%单放单放22226060. .6%6%SECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XIAN JIAOTONG UNIVERSITYSECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XIAN JIAOTONG UNIVERSITYSECON