非小細(xì)胞肺癌放射治療進(jìn)展-非小細(xì)胞肺癌放射治療課件

1、非小細(xì)胞肺癌放射治療進(jìn)展中國醫(yī)學(xué)科學(xué)院協(xié)和醫(yī)科大學(xué)腫瘤醫(yī)院 王綠化1第九屆中國腫瘤學(xué)術(shù)大會(huì)非小細(xì)胞肺癌放射治療進(jìn)展中國醫(yī)學(xué)科學(xué)院協(xié)和醫(yī)科大學(xué)1第九屆中影像技術(shù)和計(jì)算機(jī)技術(shù)的進(jìn)步為精確放射治療的實(shí)現(xiàn)提供可能2第九屆中國腫瘤學(xué)術(shù)大會(huì)影像技術(shù)和計(jì)算機(jī)技術(shù)的進(jìn)步為精確放射治療的實(shí)現(xiàn)提供可能2第精確的腫瘤定位和放射治療劑量計(jì)算3第九屆中國腫瘤學(xué)術(shù)大會(huì)精確的腫瘤定位和放射治療劑量計(jì)算3第九屆中國腫瘤學(xué)術(shù)大會(huì)照射中腫瘤運(yùn)動(dòng)的監(jiān)測和控制呼氣吸氣螺旋開始時(shí)相由吸轉(zhuǎn)呼呼氣末由呼轉(zhuǎn)吸由吸轉(zhuǎn)呼呼氣吸氣螺旋開始呼吸曲線床位4第九屆中國腫瘤學(xué)術(shù)大會(huì)照射中腫瘤運(yùn)動(dòng)的監(jiān)測和控制呼氣吸氣螺旋開始時(shí)相由吸轉(zhuǎn)呼呼氣末影像引導(dǎo)放射治

2、療技術(shù)IGRT 40對葉片MLCKV級X射線球管KV級探測器陣列MV級探測器陣列5第九屆中國腫瘤學(xué)術(shù)大會(huì)影像引導(dǎo)放射治療技術(shù)IGRT 40對葉片MLCKV級X射線在線校正影像匹配6第九屆中國腫瘤學(xué)術(shù)大會(huì)在線校正影像匹配6第九屆中國腫瘤學(xué)術(shù)大會(huì)早期非小細(xì)胞肺癌的放射治療 放射治療能夠使 早期NSCLC獲得治愈 7第九屆中國腫瘤學(xué)術(shù)大會(huì)早期非小細(xì)胞肺癌的放射治療 放射治療能夠使7第九屆中國腫瘤學(xué)Japanese StudiesI期NSCLC大劑量分割SRT獲得滿意的局部控制率Institute Dose/fx/OTT LC/Follow-upUematsu 50-60/5-10/5d 94% (4

3、7/50) 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, 20048第九屆中國腫瘤學(xué)術(shù)大會(huì)Japanese StudiesI期NSCLC大劑量分割SMountain *JCOG*JNCCH*Stage IAStage IB67%57%80%63%74%53%STI*90% 84%* Surgery * Stereotactic IrradiationCompar

4、ison 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 StudiesOnishi H, ASCO 20049第九屆中國腫瘤學(xué)術(shù)大會(huì)Mountain *JCOG*JNCCH*Stage IA6the ther

5、apy provided a 98% rate of local control. 10第九屆中國腫瘤學(xué)術(shù)大會(huì)the therapy provided a 98% rat局部晚期非小細(xì)胞肺癌 放療/化療+手術(shù) 的治療11第九屆中國腫瘤學(xué)術(shù)大會(huì)局部晚期非小細(xì)胞肺癌11第九屆中國腫瘤學(xué)術(shù)大會(huì)CT/RT/S 145/202CT/RT 155/194Logrank p=0.24危險(xiǎn)比 = 0.87 (0.70, 1.10)存活率%0255075100從隨機(jī)分組開始后的月數(shù)01224364860死亡/總數(shù)INT0139: 相同的總生存率！中位FU 81 個(gè)月Albain et al. ASCO 2005

6、. Abstract 7014.12第九屆中國腫瘤學(xué)術(shù)大會(huì)CT/RT/S 145/202Logrank p=0Interpretation Chemotherapy plus radiotherapy with or without resection (preferably lobectomy) are options for patients with stage IIIA(N2) non-small-cell lung cancer.13第九屆中國腫瘤學(xué)術(shù)大會(huì)Interpretation Chemotherapy plCan we undertake surgery in patient

7、s with stage IIIA(N2) NSCLC after induction chemoradiotherapy from now on? 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 morbi

8、dity and mortalityis essential.14第九屆中國腫瘤學(xué)術(shù)大會(huì)Can we undertake surgery in pa EORTC 08941 A：Unresectable pN2不能手術(shù)的ApN2病例誘導(dǎo)化療后即使成為可手術(shù)病例也是應(yīng)該選擇放療而非手術(shù)治療15第九屆中國腫瘤學(xué)術(shù)大會(huì) EORTC 08941不能手16第九屆中國腫瘤學(xué)術(shù)大會(huì)16第九屆中國腫瘤學(xué)術(shù)大會(huì)17第九屆中國腫瘤學(xué)術(shù)大會(huì)17第九屆中國腫瘤學(xué)術(shù)大會(huì)J Natl Cancer Inst 2007;99: 442 50Conclusion In selected patients with patho

9、logically proven stage IIIA-N2 NSCLC and a response to induction 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 the

10、se patients.18第九屆中國腫瘤學(xué)術(shù)大會(huì)J Natl Cancer Inst 2007;99: 44NSCLC術(shù)后放射治療New data supports PORT in N2 cases19第九屆中國腫瘤學(xué)術(shù)大會(huì)NSCLC術(shù)后放射治療New data supports PPORT在N2中的作用N0N1N2SSRSSRSSR5yOS41%31%34%30%20%27%DSS53%39%44%38%27%36%P0.04350.01960.0077PORT既能夠提高OS也能夠提高DSSN0N1N2SEER J Clin Oncol, 2006. 24: 2998-300620第九屆中

11、國腫瘤學(xué)術(shù)大會(huì)PORT在N2中的作用N0N1N2SSRSSRSSR5yOSCT 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 21第九屆中國腫瘤學(xué)術(shù)大會(huì)CT RTCTRTOBSNew Data from ANITRetrospective results from Cancer Hospital & Institute of CAMS2

12、2第九屆中國腫瘤學(xué)術(shù)大會(huì)Retrospective results from C治療模式與生存率 項(xiàng)目例數(shù)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%23第九屆中國腫瘤學(xué)術(shù)大會(huì)治療模式與生存率 項(xiàng)目例數(shù)MST(月)1年OS3年OS5年OPlot of heart disease mortality free survival for 2 different time eras stratified by pos

13、toperative radiotherapy (PORT) use先進(jìn)的放療技術(shù)降低了肺癌術(shù)后放療的遠(yuǎn)期并發(fā)癥HR=1.49(1.112.01; P=0.009)HR=1.08(0.791.48; P=0.64)Brian E Lally, et al. Cancer 2007 110:911724第九屆中國腫瘤學(xué)術(shù)大會(huì)Plot of heart disease mortalit3DCRT提高NSCLC的治療療效 25第九屆中國腫瘤學(xué)術(shù)大會(huì)3DCRT提高NSCLC的治療療效 25第九屆中國腫瘤學(xué)術(shù)Int. J. Radiation Oncology Biol. Phys., Vol. 66,

14、 No. 1, pp. 108116, 20063D vs. 2D in MEDICALLY INOPERABLE STAGE I NONSMALL-CELL LUNG CANCER(a) Overall survival(b) Disease-specific survival26第九屆中國腫瘤學(xué)術(shù)大會(huì)Int. J. Radiation Oncology BioInt. J. Radiation Oncology Biol. Phys., Vol. 66, No. 1, pp. 108116, 20063D vs. 2D in MEDICALLY INOPERABLE STAGE I NONSMALL-CELL LUNG CANCERLocal-regional control27第九屆中國腫瘤學(xué)術(shù)大會(huì)Int. J. Radiation Oncology Bio局部晚期NSCLC（A/B）3DCRT vs 常規(guī)放療分組例數(shù)1年3年5年MST常規(guī)放療27561.013.88.015.63-DCRT21873.326.114.420.15年OS 6.4%MST 4.5月28第九屆中國腫瘤學(xué)術(shù)大會(huì)局部晚期NSCLC（A/B）3DCRT vs 常規(guī)放療分局部晚期NSCLC（A/B）3DCRT vs