肿瘤综合治疗进展1.ppt

放疗为主综合治疗进展 Multidisciplinary Management  化疗进入了平台期-个体化治疗？ECOG1594 的挑战-总生存12个月 放疗进入了平台期 Plataue for ChT RT   ASCO-2007: LA-NSCLC Data From 1965 to 2004,15000 pts out of 64 centers Sur+Cht 5y survival= 4%;RT+ChT 5y survival= 2.2% Global of Lung Ca: WCLC-2009 No significant survival increase over 30yrs 13% in 1975 Vs 15% in 2007 for 5 yr survival Personalizing RT to Cancer Pts May Need Standard RT Patients predicted to benefit radioation curable 肿瘤治疗挑战-Challenge… Identify the patients in need of further treatment Identify more effective trials for those individual patient Identify the right time really need to be treated 肿瘤细胞不断变异和分裂 不同子代肿瘤细胞具有异质性 不同肿瘤周围微环境有异质性 分子和基因的遗传学特征不同 肿瘤细胞增殖潜能和时相不同 肿瘤血供和氧合及乏氧的不同 肿瘤侵犯和其转移潜能的不同 导致肿瘤对治疗和预后明显差异 导致治疗后肿瘤复发或过度杀灭 导致了单一的治疗手段很难治愈 恶性肿瘤的主要治疗手段 Transition from Empiric to Molecular-based Therapy Empiric: current standard, takes into consideration patient characteristics and physician experience Molecular-based: mainly based on the followings Tumor molecular profile Or host genetic makeup 45%者可治愈, 22%手术;18%放疗;5%化疗 ICRU News X-ray Centenary 1995 Radiothe Oncology-2005;肿瘤治愈率55% 手术对肿瘤治愈的贡献度是49% 放疗对肿瘤治愈的贡献度是40% 化疗对肿瘤治愈的贡献度是11% 美国每年约有 60% 的癌症患者须接受放疗 Chao KSC. Radiation Oncology-2005 肿瘤的治疗策略Treatment Principle 肿瘤的治疗理念 循证医学原则 人文结合原则 肿瘤的治疗原则 避免治疗错误 减少治疗不足 减少治疗过度 影响治疗的相关因素 肿瘤综合治疗原则Local or Systemic Therapy  Early T and early N stage: Means to minimize the complications Advanced T and early N stage: RT dose escalation and may concurrent ChT/RT Early T and advanced N stage: Early do neoadjuvant or concurrent ChT/RT Advanced T and advanced N stage: concurrent ChT/RT and to deliver the maximum tolerable treatment 辅助治疗指征Adjuvant Therapy 统计学上有意义的人群 Ⅰ期NSCLC获益为43:1(x) ⅡⅢ期NSCLC获益15:1(v) 辅助治疗不是预防治疗 辅助治疗所带来的危害 第二原发癌增加 非癌症死亡增加 放化疗联合方式及疗效ChT-RT Sequence:Stage III NSCLC CCRT and Consolidation Induction ChT and CCRT CCRT(Concurrent ChTRT) Seq