1、中国医学科学院协和医科大学中国医学科学院协和医科大学肿瘤医院肿瘤医院 王绿化王绿化12精确的肿瘤定位和放射治疗剂量计算精确的肿瘤定位和放射治疗剂量计算3呼气吸气螺旋开始时相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呼吸曲线床位床位4 40对叶片MLCKV级X射线球管KV级探测器阵列MV级探测器阵列56放射治疗能够使 早期NSCLC获得治愈 7Institute 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/1
2、1d 92%(22/24)24MOnimaru 60Gy/8fr/11d:88%(50/57)18M Nagata Y,Kyoto Univ,IASLC,20048Mountain*JCOG*JNCCH*Stage IAStage IB67%57%80%63%74%53%STI*90%84%*Surgery*Stereotactic IrradiationComparison of 5-Yr Overall Survival Between Surgery&STISurvival curves of operable pts irradiated with BED of 100 Gy or m
3、ore according to Stagestage IA(n=47)stage IB(n=16)p=0.2Summary of Japanese StudiesOnishi H,ASCO 20049the therapy provided a 98%rate of local control.10局部晚期非小细胞肺癌局部晚期非小细胞肺癌 放疗放疗/化疗化疗+手术手术 的治疗的治疗11CT/RT/S 145/202CT/RT 155/194Logrank p=0.24危险比危险比=0.87(0.70,1.10)存活率存活率%0255075100从随机分组开始后的月数从随机分组开始后的月数01
4、224364860死亡死亡/总数总数中位中位FU 81 个月个月Albain et al.ASCO 2005.Abstract 7014.12Interpretation Chemotherapy plus radiotherapy with or without resection(preferably lobectomy)are options for patients with stage IIIA(N2)non-small-cell lung cancer.13Can we undertake surgery in patients with stage IIIA(N2)NSCLC a
5、fter 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 morbidity and mortalityis essential.14 E
6、ORTC 08941 A：Unresectable pN2不能手术的不能手术的ApN2病例病例诱导化疗后即使成为可手术病例诱导化疗后即使成为可手术病例也是应该选择放疗而非手术治疗也是应该选择放疗而非手术治疗151617J Natl Cancer Inst 2007;99:442 50Conclusion In selected patients with pathologically proven stage IIIA-N2 NSCLC and a response to induction chemotherapy,surgical resection did not improve ove
7、rall 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.18New data supports PORT in N2 cases19N0N1N2SSRSSRSSR5yOS41%31%34%30%20%27%DSS53%39%44%38%27%36%P0.04350.0
8、1960.0077PORT既能够提高既能够提高OS也能够提高也能够提高DSSN0N1N2SEER J Clin Oncol,2006.24:2998-300620CT RTCTRTOBS0.000.250.500.751.00DURATION OF SURVIVAL(MONTHS)020406080100120CT&RT is the bestRT is better than OBS 2101224364860728496020406080100NO PORTPORT 2=5.235 P=0.046时间（月）生存率（%）01224364860728496020406080100NO PORT
9、PORT2=6.891 P=0.009时间（月）无病生存率（%）无病生存率（%）2201224364860728496020406080100S+C+RS+RS+CS时间（月）生存率（%）项目项目例数例数 MST(月月)1年年OS3年年OS5年年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%23Plot of heart disease mortality free survival for 2 different time eras stra
10、tified by postoperative radiotherapy(PORT)use先进的放疗技术降低了肺癌术后放疗的远期并发症先进的放疗技术降低了肺癌术后放疗的远期并发症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 110:911724253D vs.2D in MEDICALLY INOPERABLE STAGE I NONSMALL-CELL LUNG CANCER(a)Overall survival(b)Disease-specific survival263D
11、vs.2D in MEDICALLY INOPERABLE STAGE I NONSMALL-CELL LUNG CANCERLocal-regional control2701224364860728496 108 1200204060801003-D2-DP=0.002MonthsOS(%)分组分组例数例数1 1年年3 3年年5 5年年MSTMST常规放疗常规放疗27561.061.013.813.88.08.015.615.63-DCRT3-DCRT21873.373.326.126.114.414.420.120.15 5年年OS 6.4%OS 6.4%MST 4.5MST 4.5月月2801224364860728496 108 1200204060801003-D2-DP=0.000MonthsCSS(%)分组分组例数例数1 1年年3 3年年5 5年年常规放疗常规放疗27565.165.116.716.711.211.23-DCRT3-DCRT21879.079.033.333.320.820.829与常规放射治疗技术相比与常规放射治疗技术相比3DCRT 能够提能够提高高NSCLC的生存率的生存率3DCRT应作为非小细胞肺癌的标准治疗应作为非小细胞肺癌的标准治疗技术技术3031
