肺癌放疗标准

Groups
Yes No
＜70岁 No.（%） 78(24.5) 241(75.5)
≥70岁 No.（%） 76(43.7) 98(56.3）
P value 0.000
•Charlson comorbidity index（CCI)
•Definition of comorbidity：1、Chronic Obstructive Pulmonary Disease （COPD）2、
1
0.8
0.6
0.4
stage IA (n=47)
0.2
stage IB (n=16)
p = 0.2
0
0
1
2
3
4
5
6
7
Time (years)
Comparison of 5-Yr Overall Survival Between Surgery & STI
Mountain * JCOG* JNCCH*
for Stage I Non–Small-Cell Lung Cancer
Outcomes of Local Resection for Stage I Non–Small-Cell Lung Cancer
Authors Ginsberg, 1995 Landreneau, 1997
Sienel, 2007 Sienel, 2008
But How Many Patients with Locally Advanced NSCLC Can Accept Concurrent Chemoradiotherapy?
Number of stage III non-small-cell lung cancer and limited disease smallcell lung cancer patients versus number of patients eligible for concurrent chemoradiotherapy per age, 2002-2005
Update in Radiotherapy for Non-Small Cell Lung Cancer
Cancer Institute & Hospital, Chinese Academy of Medical Sciences Luhua Wang
Radiotherapy for NSCLC
SBRT has been becoming standard treatment for inoperable stage I NSCLC
How about operable stage I NSCLC?
Randomized Studies are on the Way!
Definitive Radiotherapy for Early Stage NSCLC Question: Can we give a thorough staging in China ?
16
- - 67
56
45
16
18 - 71
31
45
55
6 - 48
54
27
11
9 62 74
207
31
7
15 40 -
35
51
6
30 47 61
110
41
4
8 18 -
41
25
5
- 54 -
27
25
0
--
-
14
25
14
--
-
Outcomes After Stereotactic Lung Radiotherapy for Stage I Non–Small-Cell Lung Cancer
Mediastinoscopy, Is it accepted and widely used by our thoracic surgeon, AND our patients
EBUS, what does it mean, “ if appropriable”? Without appropriate staging, How do we treat our patients?
12
13
43
82
RTOG, 0236
55
25
6
15
72
-
Summary of Japanese Studies
Survival curves of operable pts irradiated with BED of 100 Gy or more according to Stage
Overall Survival
So, before we get new evidence, surgery still is the standard care for operable early stage patients.
Definitive Concurrent Chemo-Radiotherapy for Locally Andvanced NSCLC
NS
nodes Mediastinoscopy)
Chemotherapy
16%
10%
NS
Grills et al: JCO 2010 doi: 10.1200/JCO.2009.26.5157
Outcomes After Stereotactic Lung Radiotherapy or Wedge Resection
Definitive radiotherapy for early stage non-small cell lung cancer
Definitive radiotherapy for locally advanced stage non-small cell lung cancer
Advanced technology in radiotherapy improved the treatment results
☆ ☆ ☆ ☆
Concurrent Chemo-Radiotherapy plays more important roles
Definitive Concurrent Chemo-Radiotherapy for Locally Advanced NSCLC
☆ ☆
RTOG 9410:
Concurrent vs Sequential Chemo-Radiotherapy for Stage III NSCLC
Normal tissue is properly protected
Definitive Radiotherapy for Early Stage NSCLC
the therapy provided a 98% rate of local control!
Outcomes After Stereotactic Lung Radiotherapy or Wedge Resection
Can the clinical early stage Pts be given a thorough Staging?
PET/CT scanning, how many percent can it be used in your clinical early stage patients?
Survival
100 75
Dead/Total MST Seq 50 163/199 14.6 mo. Con 1 147/200 17.1 mo.
50
25
P-value (log-rank): 0.038
0
0
1
2
3
4
5
Time after randomization
Form H Choy
Form H Choy
Data from Cancer Hospital of CAMS Comparison of comorbidity per age (1)
493 of 527 with documented information of comorbiditiy, 2000-2006
Variables Comorbidity
for Stage I Non–Small-Cell Lung Cancer
源自文库
LR
RR LRR DM FFF OS CSS
All patients n=124
SBRT
4
4
9
19
77
72
93
Wedge Resection
20
18
27
21
65
87
94
P
.07
.34
.16 .96
.37
.01
.53
Exclude T4 and no histological information n=110
SBRT
5
0
5
15
80
70
92
Wedge Resection
24
18
29
22
61
85
93
P
.05
.07 .03 .51 .12 .02
.62
Grills et al: JCO 2010 doi: 10.1200/JCO.2009.26.5157
Outcomes After Stereotactic Lung Radiotherapy or Wedge Resection
Authors
Pts MFUT RR or LR
DM
OS
CSS
Onisi, 2007
257 38
8-14
20
65
90
Negata, 2005
45
36
2
16-31
83
-
Uematsu, 2001
50
30
6
14
66
88
Zimmerman, 2006
68
17
12
16
51
73
Fakiris, 2009
70
50
for Stage I Non–Small-Cell Lung Cancer
SRBT (n=55)
Wedge Resection (n=69) P
Pulmonary Function （FEV-1） Charlson
comorbidity index
Age
1.39 (0.86-2.37)
3 (1-4) 74 (69-78)
STI**
Stage IA 67% Stage IB 57%
80% 63%
74% 53%
90% 84%
* Surgery
** Stereotactic Irradiation
Onishi H, ASCO 2004
High-Tech Radiotherapy Machine
(A)
(B)
(C)
(D)
Image-guided radiation delivery
Cardiovascular Diseases：Myocardial Ischemia、 Myocardial Infarction、Angina Pectoris、Coronary Artery Bypass Graft Surgery 3、Peripheral Artery Disease：Intermittent Claudication（Raynaud’s disease）、Abdominal Aortic Aneurysm、Surgical Intervention 4、Cerebral Vascular Diseases： Hemiplegia according to Cerebral Vascular Accidents 5、Other Diseases：severe Rheumatoid Arthritis、Renal Diseases：Glomerulonephritis，Pyelonephritis；Gastrointestinal Diseases： Gastric Ulcer，Gastrectomy，Colitis；Hepatic Diseases：Cirrhosis，Heptitis；Confusion；Chronic Infection
278 of 686 (41%) of the whole patient group was eligible for concurrent chemoradiation.
Percentage patients eligible for concurrent therapy
Ruysscher, D. D. et al. Ann Oncol 2009 20:98-102;
1.31(0.52-3.0)
4 (3-6) 78 (55-89)
NS <0.01 <0.01
Stage
T1-T2
T1-T2
NS
Greatest dimension
GTV: 2.3 (1-5.3)
Specimen：1.7 (0.4-4.7)
-
Positive mediastinal
0 (PET,
0 (Surgery)
Keenan, 2004 El-Sherif, 2006
Lee, 2003 Voynov, 2005 Birdas, 2006
* local failure
Pts
MFUT RR or LR DM OS CSS
122
54
17
- 61 75
42
29
24
- 58 38*
60
24
16
- 65 38*
49
54