非小細(xì)胞肺癌放射治療進展非小細(xì)胞肺癌放射治療

1、第九屆中國腫瘤學(xué)術(shù)大會,1,非小細(xì)胞肺癌放射治療進展,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,第九屆中國腫瘤學(xué)術(shù)大會,2,影像技術(shù)和計算機技術(shù)的進步為精確放射治療的實現(xiàn)提供可能,第九屆中國腫瘤學(xué)術(shù)大會,3,精確的腫瘤定位和放射治療劑量計算,第九屆中國腫瘤學(xué)術(shù)大會,4,照射中腫瘤運動的監(jiān)測和控制,,呼氣,,吸氣,,,,螺旋開始,,,,,,時相,,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

2、曲線,,床位,第九屆中國腫瘤學(xué)術(shù)大會,5,影像引導(dǎo)放射治療技術(shù)IGRT,,40對葉片MLC,KV級X射線球管,KV級探測器陣列,MV級探測器陣列,第九屆中國腫瘤學(xué)術(shù)大會,6,在線校正—影像匹配,第九屆中國腫瘤學(xué)術(shù)大會,7,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,第九屆中國腫瘤學(xué)術(shù)大會,8,Japanese StudiesI期NSCLC大劑量分割SRT獲得滿意的局部控制率,

3、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:

4、 88% (50/57) 18M Nagata Y, Kyoto Univ, IASLC, 2004,,第九屆中國腫瘤學(xué)術(shù)大會,9,,,Mountain *,JCOG*,JNCCH*,Stage IAStage IB,67%57%,80%63%,74%53%,STI**,90%,84%,* Surgery,** Stereotactic Irradiation,,,Comparison of 5-

5、Yr Overall Survival Between Surgery & STI,Survival curves of operable pts irradiated with BED of 100 Gy or more according to Stage,Summary of Japanese Studies,,Onishi H, ASCO 2004,第九屆中國腫瘤學(xué)術(shù)大會,10,,,the therapy provide

6、d a 98% rate of local control.,第九屆中國腫瘤學(xué)術(shù)大會,11,局部晚期非小細(xì)胞肺癌 放療/化療+手術(shù) 的治療,第九屆中國腫瘤學(xué)術(shù)大會,12,,,,CT/RT/S 145/202CT/RT 155/194,Logrank p=0.24危險比 = 0.87 (0.70, 1.10),,,,,,,,,,,,,,,,,,,,,,存活率%,0,25,50,75,100,,,

7、,,,,,,,,,從隨機分組開始后的月數(shù),0,12,24,36,48,60,,,,,,,,,,,,死亡/總數(shù),INT0139: 相同的總生存率！,中位FU 81 個月,,,Albain et al. ASCO 2005. Abstract 7014.,第九屆中國腫瘤學(xué)術(shù)大會,13,,Interpretation Chemotherapy plus radiotherapy with or without resection (prefe

8、rably lobectomy) are options for patients with stage IIIA(N2) non-small-cell lung cancer.,第九屆中國腫瘤學(xué)術(shù)大會,14,,Can we undertake surgery in patients with stage IIIA(N2) NSCLC after induction chemoradiotherapy from now on?

9、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 w

10、ith low morbidity and mortalityis essential.,第九屆中國腫瘤學(xué)術(shù)大會,15,EORTC 08941 ⅢA：Unresectable pN2,不能手術(shù)的ⅢApN2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,第九屆中國腫瘤學(xué)術(shù)大會,16,,,第九屆中國腫瘤學(xué)術(shù)大會,17,第九屆中國腫瘤學(xué)術(shù)大會,18,J Natl Cancer Inst 2007;99: 442 –

11、50,Conclusion 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 survival compared with radiot

12、herapy.In view of its low morbidity and mortality, radiotherapy should be considered the preferred locoregional treatment for these patients.,第九屆中國腫瘤學(xué)術(shù)大會,19,NSCLC術(shù)后放射治療,New data supports PORT in N2 cases,第九屆中國腫瘤學(xué)術(shù)大會,2

13、0,PORT在N2中的作用,PORT既能夠提高OS也能夠提高DSS,N0,N1,N2,,SEER J Clin Oncol, 2006. 24: 2998-3006,New Data from ANITA: PORT in N2 Patients,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,

14、,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0.00,0.25,0.50,0.75,1.00,,DURATION OF SURVIVAL (MONTHS),,,,,,,,0,20,40,60,80,100,120,,,,,

15、,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,

16、,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,CT & RT is the best,,RT is better than OBS,,,Retrospective results from Cancer Hospital & Institute of CAMS,治療模式與生存率,,,,第九屆中國腫瘤學(xué)術(shù)大會,24,Plot of heart disea

17、se mortality free survival for 2 different time eras stratified by postoperative radiotherapy (PORT) use,先進的放療技術(shù)降低了肺癌術(shù)后放療的遠(yuǎn)期并發(fā)癥,HR=1.49(1.11–2.01; P=0.009),HR=1.08(0.79–1.48; P=0.64),Brian E Lally, et al. Cancer 2007 11

18、0:911–7,第九屆中國腫瘤學(xué)術(shù)大會,25,3DCRT提高NSCLC的治療療效,第九屆中國腫瘤學(xué)術(shù)大會,26,Int. J. Radiation Oncology Biol. Phys., Vol. 66, No. 1, pp. 108–116, 2006,3D vs. 2D in MEDICALLY INOPERABLE STAGE I NON–SMALL-CELL LUNG CANCER,(a) Overall surviva

19、l,(b) Disease-specific survival,第九屆中國腫瘤學(xué)術(shù)大會,27,Int. J. Radiation Oncology Biol. Phys., Vol. 66, No. 1, pp. 108–116, 2006,3D vs. 2D in MEDICALLY INOPERABLE STAGE I NON–SMALL-CELL LUNG CANCER,Local-regional control,第九屆中國腫