非小细胞肺癌放射治疗进展-非小细胞肺癌的放射治疗

1、非小细胞肺癌放射治疗进展-非小细胞肺癌的放射治疗第九届中国肿瘤学术大会2影像技术和计算机技术的进步为精确放射治疗的实现提供可能第九届中国肿瘤学术大会3精确的肿瘤定位和放射治疗剂量计算第九届中国肿瘤学术大会4照射中肿瘤运动的监测和控制呼气吸气螺旋开始时相由吸转呼呼气末由呼转吸由吸转呼呼气吸气螺旋开始呼吸曲线床位第九届中国肿瘤学术大会5影像引导放射治疗技术IGRT 40对叶片MLCKV级X射线球管KV级探测器阵列MV级探测器阵列第九届中国肿瘤学术大会6在线校正影像匹配第九届中国肿瘤学术大会7早期非小细胞肺癌的放射治疗 放射治疗能够使 早期NSCLC获得治愈 第九届中国肿瘤学术大会8Japanese

2、 StudiesI期NSCLC大剂量分割SRT获得满意的局部控制率Institute Dose/fx/OTT LC/Follow-upUematsu 50-60/5-10/5d 94% (47/50) 36MKyoto 48Gy/4fr/12d 96% (49/51) 20M Arimoto 60Gy/8fr/11d 92% (22/24) 24MOnimaru 60Gy/8fr/11d: 88% (50/57) 18M Nagata Y, Kyoto Univ, IASLC, 2004第九届中国肿瘤学术大会9Mountain *JCOG*JNCCH*Stage IAStage IB67%57

3、%80%63%74%53%STI*90% 84%* Surgery * Stereotactic IrradiationComparison of 5-Yr Overall Survival Between Surgery & STISurvival curves of operable pts irradiated with BED of 100 Gy or more according to Stagestage IA (n=47)stage IB (n=16)p = 0.2Overall SurvivalTime (years)Summary of Japanese StudiesOni

4、shi H, ASCO 2004第九届中国肿瘤学术大会10the therapy provided a 98% rate of local control. 第九届中国肿瘤学术大会11局部晚期非小细胞肺癌 放疗/化疗+手术 的治疗第九届中国肿瘤学术大会12CT/RT/S 145/202CT/RT 155/194Logrank p=0.24危险比 = 0.87 (0.70, 1.10)存活率%0255075100从随机分组开始后的月数01224364860死亡/总数INT0139: 相同的总生存率！中位FU 81 个月Albain et al. ASCO 2005. Abstract 7014.

5、第九届中国肿瘤学术大会13Interpretation Chemotherapy plus radiotherapy with or without resection (preferably lobectomy) are options for patients with stage IIIA(N2) non-small-cell lung cancer.第九届中国肿瘤学术大会14Can we undertake surgery in patients with stage IIIA(N2) NSCLC after induction chemoradiotherapy from now o

6、n? Yes, you can BUT only selectively in patients with less extensive resection (eg, lobectomy) than pneumonectomy. Selection of patients for surgery in whom complete resection is possible after induction treatment with low morbidity and mortalityis essential.第九届中国肿瘤学术大会15 EORTC 08941 A：Unresectable

7、pN2不能手术的ApN2病例诱导化疗后即使成为可手术病例也是应该选择放疗而非手术治疗第九届中国肿瘤学术大会16第九届中国肿瘤学术大会17第九届中国肿瘤学术大会18J Natl Cancer Inst 2007;99: 442 50Conclusion In selected patients with pathologically proven stage IIIA-N2 NSCLC and a response to induction chemotherapy, surgical resection did not improve overall or progression-free s

8、urvival compared with radiotherapy.In view of its low morbidity and mortality, radiotherapy should be considered the preferred locoregional treatment for these patients.第九届中国肿瘤学术大会19NSCLC术后放射治疗New data supports PORT in N2 cases第九届中国肿瘤学术大会20PORT在N2中的作用N0N1N2SSRSSRSSR5yOS41%31%34%30%20%27%DSS53%39%44%

9、38%27%36%P0.04350.01960.0077PORT既能够提高OS也能够提高DSSN0N1N2SEER J Clin Oncol, 2006. 24: 2998-3006CT RTCTRTOBSNew Data from ANITA: PORT in N2 Patients0.000.250.500.751.00DURATION OF SURVIVAL (MONTHS)020406080100120CT & RT is the bestRT is better than OBS Retrospective results from Cancer Hospital & Institu

10、te of CAMS治疗模式与生存率 项目例数MST(月)1年OS3年OS5年OSS+C+R6148.396.7%63.9%38.2%S+R3538.391.4%51.0%33.7%S+C10033.182.0%46.7%31.9%S2521.661.5%38.5%23.1%第九届中国肿瘤学术大会24Plot of heart disease mortality free survival for 2 different time eras stratified by postoperative radiotherapy (PORT) use先进的放疗技术降低了肺癌术后放疗的远期并发症HR=1

11、.49(1.112.01; P=0.009)HR=1.08(0.791.48; P=0.64)Brian E Lally, et al. Cancer 2007 110:9117第九届中国肿瘤学术大会253DCRT提高NSCLC的治疗疗效 第九届中国肿瘤学术大会26Int. J. Radiation Oncology Biol. Phys., Vol. 66, No. 1, pp. 108116, 20063D vs. 2D in MEDICALLY INOPERABLE STAGE I NONSMALL-CELL LUNG CANCER(a) Overall survival(b) Disease-specific survival第九届中国肿瘤学术大会27Int. J. Radiation Oncology Biol. Phys., Vol. 66, No. 1, pp. 108116, 20063D vs. 2D in MEDICALLY INOPERABLE STAGE I NONSMALL-CELL LUNG CANCERLocal-regional control第九届中国肿瘤学术大会28局部晚期NSCLC（A/B）3DCRT vs 常规放疗分组例数1年3年5年MST常规放疗27561.013.88.015.63-DCRT2187