1、Management of unresectable stage non-small cell lung cancer: the role of combined chemoradiation introduction Until the late 1980s, thoracic radiation therapy (TRT) remained the standard care for locally advanced NSCLC.Radiation alone? Sequential chemoradiation?CALGB8433RT60GyPV2cyclesRT60GyNo.7779M
2、ST9.713.81-year survival40552 year survival13263 year survival11235 year survival719P value0.0066Dillman RO , NEJM 323:940-945, 1990Dillman RO , NEJM 323:940-945, 1990Dillman RO, JNCI 88:1210-1215, 1996 Dillman RO, JNCI 88:1210-1215, 1996 RTOG8808RT60GyCT+RTH-RT69.6GyNo152152154MST11.413.2121-year s
3、urvival4759522 -year survival2132243 -year survival1117145 -year survival6119P value 0.04Sause W,JNCI1995;87:198-205Sause W,JNCI1995;87:198-205Sause W, CHEST2000;117:358-364 Sause W, CHEST2000;117:358-364 OSConcurrent chemoradiation?Radiation alone? EORTCRT55PDD(W)+RTPDD(D)+RTNo3113113111-y survival
4、4644542-y survival1319263-y survival21316P value 0.0091-y LCR193031P value 0.003Schaake-Koning C, NEJM 1992;326:524-530Schaake-Koning C, NEJM 1992;326:524-530Intensified regimenH-RTH-RT/CTH-RT/CTNo615256methods64.8Gy64.8/CE64.8/CEMST818133-y survival6.62316Jeremic B, JCO 1995;13:452-458Jeremic B, JC
5、O 1995;13:452-458Lee JS, JCO 1994;14:1055-1064Lee JS, JCO 1994;14:1055-1064CT: weekly,100mg/m2 CBP D1,D2; 100mg/m2 VP-16 D1-3CT:200mg/m2 CBP D1,D2; 100mg/m2 VP-16 D1-5, the first, third, and fifth weeks Meta AnalysisResults (52 trials,9387 pts) 2-year survival 4%。 Hazard ratio: 0.87。NSCLC CG, BMJ 19
6、95;311:899-909NSCLC CG, BMJ 1995;311:899-909Concurrent chemoradiation?Sequential chemoradiation? concurrentsequentialP valueNo156158methods56Gy/MVP2CMVP2C+56MST16.513.30.042-y survival34.627.43-y survival22.314.74-y survival16.910.15-y survival15.88.9Response R84660.0002Furuse K, JCO 1999;17:2692-26
7、99Furuse K, JCO 1999;17:2692-2699JapanRTOG9410sequentialconcurrentconcurrent+HFNo(total)611RT606069.6methodsPV2CPV2CPEMST14.61715.6A-Toxicity304862L-Toxicity141516Curran WJ, PASCO 2000;19:484aCurran WJ, PASCO 2000;19:484aACR427(phase )seqCon(ind/con)Con(con/adi)No(total) 276RT636363CTPC2PC2+CONCON+P
8、C2MST12.51116.1Esophogitis(3）42028Choy H, PASCO 2002;abstract:1160Choy H, PASCO 2002;abstract:1160GLOT9501SEQCONNo(total)212RT66Gy66CTNP 3C indCE+CE 2C adi3/4 neutropenia 87.8753/4 oesophagitis 026.1MST13.915.61-y survival56562-y survival2335Pierre F, PASCO 2001;abstract:1246Pierre F, PASCO 2001;abs
9、tract:1246MSTOSE-toxicity S C S C S Cfuruse13.3 16.5 9 16(5) 4 23RTOG14.6 17.1 12 21(4) 4 25GLOT13.9 15.6 24 35(2) 3 17Czech13.2 20.6 15 42(2) 4 28BROCAT14.0 19.0 - - 0 26ACR42713.8 17.4 31 33(2) 3 28CALGB9431G/PP/PN/PNo.625855RR7467731-y Sur6862653-y Sur281923MST18.314.817.7DFS8.49.111.5Methods:2 c
10、ycles induction followed by 2 cycles and concurrent TRT, 66GyVokes EE, JCO 2002;20:4191-4198Vokes EE, JCO 2002;20:4191-4198CALGB9431SWOG9019Patients: 50 pts. IIIB Treatment: PE 2cycles/RT PE 2cyclesAlbain KS, JCO 2002;20:3454-3460Albain KS, JCO 2002;20:3454-3460SWOG9019MST: 15months1y-sur: 58%2y-sur
11、: 33%3y-sur: 17%5y-sur: 15%SWOG9504Patients: 83pts. IIIB Treatment: PE 2cycles/RT Docetaxel 3 cycles (75mg/m2 for the first and 100mg/m2 for the last two cycles).Gandara DR, JCO 2003;21:2004-2010Gandara DR, JCO 2003;21:2004-2010SWOG95041y-sur: 76%MST: 26months2y-sur: 54%3y-sur: 37%SWOG9019/9504study
12、 NoSurvival time2y-Survival3y-survivalmedian95%CImedian 95%CImedian95%CI9019501510-223421-47177-279504832618-355443-653722-52Gandara DR, JCO 2003;21:2004-2010Gandara DR, JCO 2003;21:2004-2010Hossier Oncology GroupInduction cisplatin / etoposide TRTDocetaxelObservationCALGB9801Induction PCNo Induction PCconcurrent carboplatin / paclitaxel TRTSWOG0023PE/TRTConsolidation docetaxelOral Gefitinibplacebo
