授课用食管癌同步放化疗资料课件.ppt

1、SECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XIAN JIAOTONG UNIVERSITYSECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XIAN JIAOTONG UNIVERSITYSECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XIAN JIAOTONG UNIVERSITYSECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XIAN JIAOTONG UNIVERSITYSECOND A

2、FFILIATED HOSPITAL OF MEDICAL COLLEGE OF XIAN JIAOTONG UNIVERSITYSECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XIAN JIAOTONG UNIVERSITY我国食管癌我国食管癌SECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XIAN JIAOTONG UNIVERSITYSECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XIAN JIAOTONG UNIVERSITY治疗手段治疗

3、手段SECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XIAN JIAOTONG UNIVERSITYSECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XIAN JIAOTONG UNIVERSITY局部病变局部病变肿瘤治愈肿瘤治愈SECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XIAN JIAOTONG UNIVERSITYSECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XIAN JIAOTONG

4、UNIVERSITYSECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XIAN JIAOTONG UNIVERSITYSECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XIAN JIAOTONG UNIVERSITY机制机制SECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XIAN JIAOTONG UNIVERSITYSECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XIAN JIAOTONG UNIV

5、ERSITY机制机制SECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XIAN JIAOTONG UNIVERSITYSECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XIAN JIAOTONG UNIVERSITYSECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XIAN JIAOTONG UNIVERSITYSECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XIAN JIAOTONG UNIVERSI

6、TYSECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XIAN JIAOTONG UNIVERSITYSECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XIAN JIAOTONG UNIVERSITY5FuSECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XIAN JIAOTONG UNIVERSITYSECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XIAN JIAOTONG UNIVERSITYSEC

7、OND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XIAN JIAOTONG UNIVERSITYSECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XIAN JIAOTONG UNIVERSITY甲酰四氢叶酸甲酰四氢叶酸顺铂顺铂加强加强5 5FuFu生化调节机制生化调节机制4 4 用药时间用药时间放疗后放疗后5min5min8h8h5 5 用药量用药量200200375mg/m375mg/m2 25 5FuFu特点：特点：SECOND AFFILIATED HOSPITAL OF MEDICAL COLL

8、EGE OF XIAN JIAOTONG UNIVERSITYSECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XIAN JIAOTONG UNIVERSITY新一代新一代 替加氟替加氟 Tegafur Injection 放疗外照射5560Gy/5060d,同步13周期FP方案化疗,随后腔内照射1012Gy/23次。2B级是基于低水平证据，专家组无统一认识，但争议不大Decrease in tumor mass and reoxygenationCA Cancer J Clin.Oxaliplatin in combination with p

9、rotracted-infusion fluorouracil and radiation:report of a clinical trial for patients with esophageal cancer.The recommended dose wasDrug:OncoGel(Paclitaxel gel);Drug:cisplatin;Drug:5-FU;Radiation:radiation therapy;Procedure:esophageal resectionCell apoptosis西安交通大学医学院第二附属医院Temporal cooperationEsopha

10、geal Neoplasms续贯放化疗对于局部控制和生存率方面没有益处。其作用机理与氟尿嘧啶相同，Drug:CDGP/5-FU;Radiation:ChemoradiotherapyInterventions:SECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XIAN JIAOTONG UNIVERSITYSECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XIAN JIAOTONG UNIVERSITYSECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF

11、XIAN JIAOTONG UNIVERSITYSECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XIAN JIAOTONG UNIVERSITYSECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XIAN JIAOTONG UNIVERSITYSECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XIAN JIAOTONG UNIVERSITY顺铂顺铂 Cisplatin,PDD，DDP 1 铂的金属络合物，作用似烷化剂铂的金属络合物，作用似烷化剂2 主要

12、作用靶点为主要作用靶点为DNA作用于作用于DNA链间及链内交链，形成链间及链内交链，形成DDPDNA复合物复合物干扰干扰DNA复制，或与核蛋白及胞浆蛋白结合。复制，或与核蛋白及胞浆蛋白结合。3 属周期非特异性药属周期非特异性药SECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XIAN JIAOTONG UNIVERSITYSECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XIAN JIAOTONG UNIVERSITY浓度依赖性浓度依赖性时间依赖性时间依赖性顺铂小剂量长期用药顺铂小剂量长期用药抑制抑

13、制肿瘤细胞对放疗所致亚致死性损伤肿瘤细胞对放疗所致亚致死性损伤修复修复抑制抑制和潜在致死性损伤的和潜在致死性损伤的修复修复顺铂顺铂最低临床应用剂量最低临床应用剂量 6mg/m2/dSECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XIAN JIAOTONG UNIVERSITYSECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XIAN JIAOTONG UNIVERSITYSECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XIAN JIAOTONG U

14、NIVERSITYSECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XIAN JIAOTONG UNIVERSITY5Fu顺铂顺铂二者对放射增敏有协同作用二者对放射增敏有协同作用增敏效果与给药时间有关增敏效果与给药时间有关顺铂在放疗前顺铂在放疗前16h5Fu持续给药持续给药增敏效果最佳增敏效果最佳SECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XIAN JIAOTONG UNIVERSITYSECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XIAN

15、JIAOTONG UNIVERSITYSECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XIAN JIAOTONG UNIVERSITYSECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XIAN JIAOTONG UNIVERSITY 泰素、紫素、特素、紫脘素，泰素、紫素、特素、紫脘素，Paclitaxel,Taxol,PTX机制机制SECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XIAN JIAOTONG UNIVERSITYSECOND AFFI

16、LIATED HOSPITAL OF MEDICAL COLLEGE OF XIAN JIAOTONG UNIVERSITY机制机制SECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XIAN JIAOTONG UNIVERSITYSECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XIAN JIAOTONG UNIVERSITY健择健择gemcitabine hydrochloride,盐酸盐酸吉西吉西他滨他滨细胞周期特异性抗代谢类药物细胞周期特异性抗代谢类药物 作用于作用于DNADNA合成期（合成期

17、（S S期）的肿瘤细胞期）的肿瘤细胞在一定的条件下，可以阻止在一定的条件下，可以阻止G1G1期向期向S S期的进展期的进展 SECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XIAN JIAOTONG UNIVERSITYSECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XIAN JIAOTONG UNIVERSITYSECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XIAN JIAOTONG UNIVERSITYSECOND AFFILIATED H

18、OSPITAL OF MEDICAL COLLEGE OF XIAN JIAOTONG UNIVERSITYSECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XIAN JIAOTONG UNIVERSITYSECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XIAN JIAOTONG UNIVERSITYSECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XIAN JIAOTONG UNIVERSITYSECOND AFFILIATED HOSPITAL

19、OF MEDICAL COLLEGE OF XIAN JIAOTONG UNIVERSITYSECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XIAN JIAOTONG UNIVERSITYSECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XIAN JIAOTONG UNIVERSITY1级级NCCNSECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XIAN JIAOTONG UNIVERSITYSECOND AFFILIATED HOSPITAL O

20、F MEDICAL COLLEGE OF XIAN JIAOTONG UNIVERSITYSECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XIAN JIAOTONG UNIVERSITYSECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XIAN JIAOTONG UNIVERSITYSECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XIAN JIAOTONG UNIVERSITYSECOND AFFILIATED HOSPITAL OF MEDICA

21、L COLLEGE OF XIAN JIAOTONG UNIVERSITYSECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XIAN JIAOTONG UNIVERSITYSECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XIAN JIAOTONG UNIVERSITYSECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XIAN JIAOTONG UNIVERSITYSECOND AFFILIATED HOSPITAL OF MEDICAL COLLEG

22、E OF XIAN JIAOTONG UNIVERSITYSECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XIAN JIAOTONG UNIVERSITYSECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XIAN JIAOTONG UNIVERSITYSECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XIAN JIAOTONG UNIVERSITYSECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XIA

23、N JIAOTONG UNIVERSITYSECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XIAN JIAOTONG UNIVERSITYSECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XIAN JIAOTONG UNIVERSITYSECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XIAN JIAOTONG UNIVERSITYSECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XIAN JIAOTO

24、NG UNIVERSITYSECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XIAN JIAOTONG UNIVERSITYSECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XIAN JIAOTONG UNIVERSITYYamada K,MurakamiM,Okamoto Y,et al.Treatment results of chemoradiotherapy for clinical stage I(T1N0M0)esophageal carcinoma J.Int J Radiat Onc

25、ol Biol Phys,2006,64(4):1106-1111.SECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XIAN JIAOTONG UNIVERSITYSECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XIAN JIAOTONG UNIVERSITY第第49届届ASTRO年会报道年会报道(三三)食管癌放疗进展食管癌放疗进展 北京医院放疗科 高鸿 李高峰 SECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XIAN JIAOTONG UNIV

26、ERSITYSECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XIAN JIAOTONG UNIVERSITYSECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XIAN JIAOTONG UNIVERSITYSECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XIAN JIAOTONG UNIVERSITY 2B2B2B级是基于低水平证据，专家组无统一认识，但争议不大级是基于低水平证据，专家组无统一认识，但争议不大 J Clin Oncol,2007,2

27、5(10):1160-1168.紫杉类醇药物(taxanes)SECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XIAN JIAOTONG UNIVERSITY同步放化疗后是否可以延缓手术,也是目前研究的热点法国Bedenne1999 May 5;281(17):1623-7.西安交通大学医学院第二附属医院docetaxel(levels 1,2,3,2.术后病理残存肿瘤组的3年OS率也达到了36%(RTOG 8501试验的3年OS率为30%)。Advanced Oesophageal Cancer Study to Compare Qualit

28、y of Life and Palliation of Dysphagia.Drug:carboplatin,5FU,Taxol and radiationRESULTS:For the 218 eligible patients,there was no significant difference in median survival(13.Radiation Therapy Oncology Group.J Clin Oncol.然后 fluorouracil paclitaxel50.SECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XI

29、AN JIAOTONG UNIVERSITY西安交通大学医学院第二附属医院7%;T1a、T1b 5年无疾病生存率分别为84.SECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XIAN JIAOTONG UNIVERSITYSECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XIAN JIAOTONG UNIVERSITYSECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XIAN JIAOTONG UNIVERSITYSECOND AFFILIATED H

30、OSPITAL OF MEDICAL COLLEGE OF XIAN JIAOTONG UNIVERSITYSECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XIAN JIAOTONG UNIVERSITYSECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XIAN JIAOTONG UNIVERSITYSECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XIAN JIAOTONG UNIVERSITYSECOND AFFILIATED HOSPITAL

31、OF MEDICAL COLLEGE OF XIAN JIAOTONG UNIVERSITYSECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XIAN JIAOTONG UNIVERSITYSECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XIAN JIAOTONG UNIVERSITYSECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XIAN JIAOTONG UNIVERSITYSECOND AFFILIATED HOSPITAL OF MEDIC

32、AL COLLEGE OF XIAN JIAOTONG UNIVERSITYSECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XIAN JIAOTONG UNIVERSITYSECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XIAN JIAOTONG UNIVERSITYSECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XIAN JIAOTONG UNIVERSITYSECOND AFFILIATED HOSPITAL OF MEDICAL COLLE

33、GE OF XIAN JIAOTONG UNIVERSITY以上以上20多项临床试验，涉及以上的药物多项临床试验，涉及以上的药物以及以及3DCRT，分段放疗，分段放疗，后程加速超分割等放疗方法。后程加速超分割等放疗方法。SECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XIAN JIAOTONG UNIVERSITYSECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XIAN JIAOTONG UNIVERSITY2BJ Clin Oncol.2003 Aug 1;21(15):2926-32.Pha

34、se I trial of escalating-dose irinotecan given weekly with cisplatin and concurrent radiotherapy in locally advanced esophageal cancer.SECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XIAN JIAOTONG UNIVERSITYSECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XIAN JIAOTONG UNIVERSITYSECOND AFFILIATED H

35、OSPITAL OF MEDICAL COLLEGE OF XIAN JIAOTONG UNIVERSITYSECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XIAN JIAOTONG UNIVERSITYInt J Radiat Oncol Biol Phys.2005 May 1;62(1):91-6.Phase I trial of oxaliplatin in combination with cisplatin,protacted-infusion fluorouracil,and radiotherapy in advanced es

36、ophageal and gastroesophageal carcinoma.SECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XIAN JIAOTONG UNIVERSITYSECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XIAN JIAOTONG UNIVERSITY SECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XIAN JIAOTONG UNIVERSITYSECOND AFFILIATED HOSPITAL OF MEDICAL CO

37、LLEGE OF XIAN JIAOTONG UNIVERSITYSECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XIAN JIAOTONG UNIVERSITYSECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XIAN JIAOTONG UNIVERSITYSECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XIAN JIAOTONG UNIVERSITYSECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF

38、 XIAN JIAOTONG UNIVERSITYSECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XIAN JIAOTONG UNIVERSITYSECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XIAN JIAOTONG UNIVERSITYSECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XIAN JIAOTONG UNIVERSITYSECOND AFFILIATED HOSPITAL OF MEDICAL COLLEGE OF XIAN JIAOTONG UNIVERSITY