非小细胞肺癌的放射治疗.ppt

1、第九届中国肿瘤学术大会,1,非小细胞肺癌放射治疗进展,中国医学科学院协和医科大学 肿瘤医院,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MLC,KV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

2、,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,8,Japanese 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-up Uematsu 50-60/5-10/5d 94% (47/50) 36M Kyoto 48Gy/4fr/12d 96% (49/51) 20M Arimoto 60Gy/8fr/11d 92% (22/24) 24M Onimaru 60Gy/8fr/11d: 88% (50/57) 18M Nagata Y, Kyoto Univ, IASL

3、C, 2004,第九届中国肿瘤学术大会,9,Mountain *,JCOG*,JNCCH*,Stage IA Stage IB,67% 57%,80% 63%,74% 53%,STI*,90%,84%,* Surgery,* Stereotactic Irradiation,Comparison of 5-Yr Overall Survival Between Surgery 99: 442 50,Conclusion In selected patients with pathologically proven stage IIIA-N2 NSCLC and a response to in

4、duction chemotherapy, surgical resection did not improve overall or progression-free survival 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,19,NSCLC术后放射治疗,New data support

5、s PORT in N2 cases,第九届中国肿瘤学术大会,20,PORT在N2中的作用,PORT既能够提高OS也能够提高DSS,N0,N1,N2,SEER J Clin Oncol, 2006. 24: 2998-3006,New Data from ANITA: PORT in N2 Patients,0.00,0.25,0.50,0.75,1.00,DURATION OF SURVIVAL (MONTHS),0,20,40,60,80,100,120,CT P=0.009),HR=1.08(0.791.48; P=0.64),Brian E Lally, et al. Cancer 2

6、007 110:9117,第九届中国肿瘤学术大会,25,3DCRT提高NSCLC的治疗疗效,第九届中国肿瘤学术大会,26,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,第九届中国肿瘤学术大会,27,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,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,5年OS 6.4% MST 4.5月,第九届中国肿瘤学术大会,29,局部晚期NSCLC(A/B)3DC