中低位直肠癌新辅助放化疗研究课件

中低位直肠癌新辅助放化疗研究广西壮族自治区肿瘤医院胃肠外科覃宇周内容为什么要做新辅助放化疔?那些病人适合放化疗?背景有3/4患者就诊时已属中晚期。外科手术是直肠癌最有效的治疗手段,5年生存率徘徊在50%。■新辅助放化疗是促进肿瘤降期、提高疗效的有效措施术前放化疗vs术后放化疗一保肛率(39%vs19%)Table4.RatesofSphincter-SparingSurgeryin194PatientsDeterminedbytheSurgeonbeforeRandomizationtoRequireAbdominoperinealResection,AccordingtoActualTreatmentGivenN=38吗ChemoradiotherapyChemoradiotheriVariableN=415)pvalueSphincter-preservingsurgeryperformed-no/totalno.(%45/11(39)0.004SauerRetaL.NEnglJMed2019:351:1731-40术前放化疗vs术后放化疗(1)局部复发风险下降54%chemoradiotherapy10chemoradiotherapyP=0.006MonthsPreoperativechemo.397368312190133SauerRetal.NEnglJMed2019:351:1731-40术前放化疗vs术后放化疗(2)能显著延长PFS,复发和死亡风险下降37%A亡5年PFS:64.7%v53.4%Hazardratio=0.83:95%Cl,0.44to0.90:P=.011Freoperativepatients,51eventP=0.0ITimeSinceRandomAssignment(years)RohMsetal.JClinOncol2009:27:5124-5136术前放化疗Vs术后放化疗(2)延长总生存期B1.05年OS74.5%vs65.6%Hazardratio0.69:95%C,0.4to1.03:P=065ostoperative131patients,62deathsP=0.065TimeSinceRandomAssignment(years)PostoperatiVeRohMSetal.JClinOncol2009:27:5124术前放疗vs选择性术后放化疗1350例病人随机分组术前放疗组,674例选择性术后放疗,674例术前放疗(25Gy)614(95%接收了25Gy放疗手术631(7%)手术切除手术60697%)手术切除541(88%6)77(12%)CRMOCRM(+)53300%)57010%CRMOCRMO无术后放化疗术后放化疗Sebag-MontefloreD,etal.Lancet2009:373(9666):811-820术前放疗vs选择性术后放化疗显著降低局部复发率TotalHR=039(95%(1027058)pc00001NumberatriskPreoperativeradiotherapy674423年局部