第九届中国肿瘤学术大会,1,非小细胞肺癌放射治疗进展,中国医学科学院协和医科大学 肿瘤医院,第九届中国肿瘤学术大会,2,影像技术和计算机技术的进步为精确放射治疗的实现 提供可能,第九届中国肿瘤学术大会,3,精确的肿瘤定位和放射治疗剂量计算,第九届中国肿瘤学术大会,4,照射中肿瘤运动的监测和控制,呼气,吸气,螺旋开始,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,床位,第九届中国肿瘤学术大会,5,影像引导放射治疗技术 IGRT,40对叶片MLC,KV级X射线球管,KV级探测器阵列,MV级探测器阵列,第九届中国肿瘤学术大会,6,在线校正影像匹配,第九届中国肿瘤学术大会,7,早期非小细胞肺癌的放射治疗,放射治疗能够使早期NSCLC获得治愈,第九届中国肿瘤学术大会,8,Japanese Studies I期NSCLC大剂量分割SRT获得满意的局部控制率,Institute 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/11d 92% (22/24) 24MOnimaru 60Gy/8fr/11d: 88% (50/57) 18M Nagata Y, Kyoto Univ, IASLC, 2004,第九届中国肿瘤学术大会,9,Mountain *,JCOG*,JNCCH*,Stage IA Stage IB,67% 57%,80% 63%,74% 53%,STI*,90%,84%,* Surgery,* Stereotactic Irradiation,Comparison of 5-Yr Overall Survival Between Surgery & STI,Survival curves of operable pts irradiated with BED of 100 Gy or more according to Stage,Summary of Japanese Studies,Onishi H, ASCO 2004,第九届中国肿瘤学术大会,10,the therapy provided a 98% rate of local control.,第九届中国肿瘤学术大会,11,局部晚期非小细胞肺癌放疗/化疗+手术 的治疗,第九届中国肿瘤学术大会,12,CT/RT/S 145/202 CT/RT 155/194,Logrank p=0.24 危险比 = 0.87 (0.70, 1.10),存活率%,0,25,50,75,100,从随机分组开始后的月数,0,12,24,36,48,60,死亡/总数,INT0139: 相同的总生存率!,中位FU 81 个月,Albain et al. ASCO 2005. Abstract 7014.,第九届中国肿瘤学术大会,13,Interpretation Chemotherapy plus radiotherapy with or without resection (preferably lobectomy) are options for patients with stage IIIA(N2) non-small-cell lung cancer.,第九届中国肿瘤学术大会,14,Can we undertake surgery in patients with stage IIIA(N2) NSCLC after 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.,第九届中国肿瘤学术大会,15,EORTC 08941A:Unresectable pN2,不能手术的ApN2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,第九届中国肿瘤学术大会,16,第九届中国肿瘤学术大会,17,第九届中国肿瘤学术大会,18,J Natl Cancer Inst 2007;99: 442 50,Conclusion In selected patients with pathologically proven stage IIIA-N2 NSCLC and a response to induction chemotherapy, surgical resection did not improve overall or progression-free survival compared withradiotherapy. In view of its low morbidity and mortality, radiotherapy should be considered the preferred locoregional treatment for these patients.,第九届中国肿瘤学术大会,19,NSCLC术后放射治疗,New data supports PORT in N2 cases,第九届中国肿瘤学术大会,20,PORT在N2中的作用,PORT既能够提高OS也能够提高DSS,N0,N1,N2,SEER J Clin Oncol, 2006. 24: 2998-3006,New Data from ANITA: PORT in N2 Patients,0.00,0.25,0.50,0.75,1.00,DURATION OF SURVIVAL (MONTHS),0,20,40,60,80,100,120,CT & RT is the best,RT is better than OBS,Retrospective results from Cancer Hospital & Institute of CAMS,治疗模式与生存率,第九届中国肿瘤学术大会,24,Plot of heart disease mortality free survival for 2 different time eras stratified 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,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 110:9117,第九届中国肿瘤学术大会,25,3DCRT提高NSCLC 的治疗疗效,第九届中国肿瘤学术大会,26,Int. J. Radiation Oncology Biol. Phys., Vol. 66, No. 1, pp. 108116, 2006,3D vs. 2D in MEDICALLY INOPERABLE STAGE I NONSMALL-CELL LUNG CANCER,(a) Overall survival,(b) Disease-specific survival,第九届中国肿瘤学术大会,27,Int. J. Radiation Oncology Biol. Phys., Vol. 66, No. 1, pp. 108116, 2006,3D vs. 2D in MEDICALLY INOPERABLE STAGE I NONSMALL-CELL LUNG CANCER,Local-regional control,第九届中国肿瘤学术大会,28,局部晚期NSCLC(A/B) 3DCRT vs 常规放疗,5年OS 6.4% MST 4.5月,第九届中国肿瘤学术大会,29,局部晚期NSCLC(A/B) 3DCRT vs 常规放疗,第九届中国肿瘤学术大会,30,结论,与常规放射治疗技术相比3DCRT 能够提高NSCLC的生存率 3DCRT应作为非小细胞肺癌的标准治疗技术,第九届中国肿瘤学术大会,31,Thanks 谢谢,