同步放化疗肺癌中文版.ppt

* Management of unresectable stage Ⅲ 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? CALGB8433 19 7 5 year survival 23 11 3 year survival 0.0066 P value 26 13 2 year survival 55 40 1-year survival 13.8 9.7 MST 79 77 No. PV2cycles＋RT60Gy RT60Gy Dillman RO , NEJM 323:940-945, 1990 Dillman RO, JNCI 88:1210-1215, 1996 RTOG8808 0.04 6 11 21 47 11.4 152 RT60Gy 11 17 32 59 13.2 152 CT+RT 9 14 24 52 12 154 H-RT69.6Gy 5 -year survival 3 -year survival P value 2 -year survival 1-year survival MST No Sause W,JNCI1995;87:198-205 Sause W, CHEST2000;117:358-364 OS 60y survival FRANCE 50 41 1-year survival 11 5 3 -year survival 17 38 14 10 177 RT65Gy 15 26 21 12 176 CT+RT65Gy 0.001 0.08 P值 1-year LCR Metastasis rate 2 -year survival MST No Thierry Le Chevaliar,JNCI1991;83:417-423 CT: VCPC, vindesine, cyclophosphamide, cisplatin, lomustine Concurrent chemoradiation? Radiation alone? EORTC 0.009 P value 54 44 46 1-y survival 16 13 2 3-y survival 0.003 19 13 311 RT55 30 19 311 PDD(W)+RT 31 26 311 PDD(D)+RT 1-y LCR P value 2-y survival No Schaake-Koning C, NEJM 1992;326:524-530 Intensified regimen 64.8/CE 64.8/CE 64.8Gy methods 13 18 8 MST 16 23 6.6 3-y survival 61 H-RT 52 H-RT/CT 56 H-RT/CT No Jeremic B, JCO 1995;13:452-458 Lee JS, JCO 1994;14:1055-1064 CT: weekly,100mg/m2 CBP D1,D2; 100mg/m2 VP-16 D1-3 CT:200mg/m2 CBP D1,D2; 100mg/m2 VP-16 D1-5, the first, third, and fifth weeks Meta Analysis Results (52 trials,9387 pts) ?2-year survival 4%。 ?Hazard ratio: 0.87。 NSCLC CG, BMJ 1995;311:899-909 Concurrent chemoradiation? Sequential chemoradiation? MVP2C+56 56Gy/MVP2C methods 66 8.9 10.1 14.7 27.4 13.3 158 sequential 0.0002 0.04 P value 15.8 5-y survival 84 Response R 16.9 4-y survival 22.3 3-y