于金明放射肿瘤新进展 课件.ppt

手 术 情 况 RT (n=80) 无RT (n=76) 切除 80/97 (82%) 76/94 (81%) 手术 肺叶切除 55% 64% 双肺叶切除 13% 12% 全肺切除术 29% 16% 切除 R0 90% 80% R1 6% 11% R2 3% 7% 化疗- 血液学毒性 RT 无RT 不良事件 级别 级别 2 3 4 2 3 4 贫血 15% 1% - 24% - - 白细胞减少 25% 34% 3% 30% 18% 13% 中性粒细胞减少 10% 20% 29% 10% 21% 33% 血小板减少 6% 1% 1% 4% 2% - 手 术 - 毒 性 RT (n=80) 无RT (n=76) 感染 14% 12% 支气管残端不足 4% 0% 再手术 5% 7% 其他并发症 23% 22% 术后30天内死亡 0% 1% EFS 0 24 48 72 96 120 144 0.0 0.2 0.4 0.6 0.8 1.0 RT (n=98)：中位12.8个月 无RT (n=97)：中位11.8个月 HR=0.909; 95%CI=0.647-1.276 时间 (月) EFS OS 0 24 48 72 96 120 144 0.0 0.2 0.4 0.6 0.8 1.0 RT (n=98)：中位27.1个月 无RT (n=97)：中位26.2个月 HR=1.145; 95%CI=0.786-1.669 时间 (月) OS 生 存 总 结 生存 年 RT (n=98) 无RT (n=97) EFS 1 51% 50% 2 38% 32% 3 32% 30% OS 1 76% 80% 2 56% 55% 3 45% 47% 初 步 结 论 针对研究所探索问题的首个完成的随机研究 新辅助化疗基础上联合放疗不改善 EFS、OS或局控率 总生存期结果令人鼓舞 中位OS为27个月 在目前的状态下，除临床研究以外不推荐新辅助化疗 新辅助放疗：期待LungART的研究(IFCT/EORTC)结果 有关新辅助放化疗 N2患者在NCCN成员机构中， 50%成员使用新辅助放化疗，50%使用新辅助化疗 新辅助放化疗可以有更高的病理缓解率和更多纵膈淋巴结降级率 现在没有在诱导化疗时增加放疗对比单独化疗可以改善预后证据 Phase III Trial of Concurrent Thoracic RT with Either the 1st Cycle or 3rd Cycle of Cisplatin Etoposide ChT to Determine the Optimal Timing of Thoracic-RT for Limited SCLC (NC Keunchil Park et al, Republic of Korea, ASCO?2012 Background The standard treatment of LD-SCLC is concurrent thoracic RT (TRT) with ChT However, the optimal timing of TRT has not yet been defined Limitations in early RT given with the 1st cycle of ChT Potential enlarged RT fields due to in initial planning for bulky tumors Complexity of administering TRT results delayed overall treatment for LD-SCLC This study aimed to investigate whether TRT commenced with the 3rd cycle of ChT is non-inferior to TRT commence with the 1st cycle of EP chemotherapy Study Design Consort Diagram Enrollment between July 2003 and June 2010 Median follow-up: 59.4 mons (range: 14.9–97.5 mons ) 222 patients were randomized Initial (1st cycle) Arm (N = 113) Delayed (3rdcycle) Arm (N = 108) 111 patients were analyzed 108 patients were analyzed