同步放化疗肺癌中文版

ManagementofunresectablestageⅢnon-smallcelllungcancer:theroleofcombinedchemoradiation精选pptintroduction

Untilthelate1980s,thoracicradiationtherapy(TRT)remainedthestandardcareforlocallyadvancedNSCLC.精选pptRadiationalone?Sequentialchemoradiation?精选pptCALGB8433RT60GyPV2cycles＋RT60GyNo.7779MST9.713.81-yearsurvival40552yearsurvival13263yearsurvival11235yearsurvival719Pvalue0.0066DillmanRO,NEJM323:940-945,1990DillmanRO,JNCI88:1210-1215,1996精选pptRTOG8808RT60GyCT+RTH-RT69.6GyNo152152154MST11.413.2121-yearsurvival4759522-yearsurvival2132243-yearsurvival1117145-yearsurvival6119Pvalue

0.04SauseW,JNCI1995;87:198-205SauseW,CHEST2000;117:358-364精选pptOS精选pptConcurrentchemoradiation?Radiationalone?精选pptEORTCRT55PDD(W)+RTPDD(D)+RTNo3113113111-ysurvival4644542-ysurvival1319263-ysurvival21316Pvalue0.0091-yLCR193031Pvalue0.003Schaake-KoningC,NEJM1992;326:524-530精选pptIntensifiedregimenH-RTH-RT/CTH-RT/CTNo615256methods64.8Gy64.8/CE64.8/CEMST818133-ysurvival6.62316JeremicB,JCO1995;13:452-458LeeJS,JCO1994;14:1055-1064CT:weekly,100mg/m2CBPD1,D2;100mg/m2VP-16D1-3CT:200mg/m2CBPD1,D2;100mg/m2VP-16D1-5,thefirst,third,andfifthweeks

精选pptMetaAnalysisResults(52trials,9387pts)

2-yearsurvival4%。

Hazard

ratio:0.87。NSCLCCG,BMJ1995;311:899-909精选pptConcurrentchemoradiation?Sequentialchemoradiation?精选pptconcurrentsequentialPvalueNo156158methods56Gy/MVP2CMVP2C+56MST16.513.30.042-ysurvival34.627.43-ysurvival22.314.74-ysurvival16.910.15-ysurvival15.88.9ResponseR84660.0002FuruseK,JCO1999;17:2692-2699Japan精选pptRTOG9410sequentialconcurrentconcurrent+HFNo(total)611RT606069.6methodsPV2CPV2CPEMST14.61715.6A-Toxicity304862L-Toxicity141516CurranWJ,PASCO2000;19:484a精选pptACR427(phaseⅡ)seqCon(ind/con)Con(con/adi)No(total)276RT636363CTPC2PC2+CONCON+PC2MST12.51116.1Esophogitis(≥3）42028ChoyH,PASCO2002;abstract:1160精选pptGLOT9501SEQCONNo(total)212RT66Gy66CTNP3CindCE+CE2Cadi3/4neutropenia

87.8753/4oesophagitis026.1MST13.915.61-ysurvival56562-ysurvival2335PierreF,PASCO2001;abstract:1246精选pptMSTOSE-toxicity

S

C

SCSCfuruse13.3

16.5

916(5)423RTOG14.617.1

1221(4)

425GLOT13.915.6

2435(2)317Czech13.220.6

1542(2)428BROCAT14.019.0

--026ACR42713.817.4

3133(2)328精选pptCALGB9431G/PP/PN/PNo.625855RR7467731-ySur6862653-ySur281923MST18.314.817.7DFS8.49.111.5Methods:2cyclesinductionfollowedby2cyclesandconcurrentTRT,66GyVokesEE,JCO2002;20:4191-4198精选pptCALGB9431精选pptSWOG9019Patients:

50pts.IIIB

Treatment:PE2cycles/RTPE2cyclesAlbainKS,JCO2002;20:3454-3460精选pptSWOG9019MST:15months1y-sur:58%2y-sur:33%3y-sur:17%5y-sur:15%精选pptSWOG9504Patients:

83pts.IIIB

Treatment:PE2cycles/RTDocetaxel3cycles(75mg/m2forthefirstand100mg/m2forthelasttwocycles).GandaraDR,JCO2003;21:2004-2010精选pptSWOG95041y-sur:76%MST:26months2y-sur:54%3y-sur:37%精选pptSWOG9019/9504studyNoSurvivaltime2y-Survival3y-survivalmedian95%CImedian95%CImedian95%CI9019501510-223421-47177-279504832618-355443-653722-52GandaraDR,JCO2003;21:2004-2010精选pptHossierOncologyGroupInductionc