食管癌放疗进展ppt课件

Meta-analysis (2007) : Eight randomized studies with
1,724 Pts evaluating chT+S vs. S alone. Pre-op Chemo improved survival in adenoCA, but not in SCC
with 36 months in the ChT-RT group The ChT-RT group had better 3-yr survival rates (50% vs 41%) and 3-yr relapse-free survival (RFS) rates (48% vs 31%) than the surgery only group
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术前化疗:尚存争议
RTOG 8911/INT133: Phase III 467 Pts with T1-2NxM0
SCC and adenoCA randomized to surgery alone vs. preop chemo×3c PF→surgery. Pre-op chemo did not improve OS
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结论：对于潜在可根治食管癌或胃食管交界癌患者，术前放化疗 显著延长生存期，不良事件率可接受
Van P, et al. N Engl J Med 2012; 366:2074-2084. Roth BJ, et al. J Clin Oncol 2012.
术后放化疗: 严格指证
SWOG 9008/INT-0116
生 存 率
放疗 手术
﹥ 吻合口瘘：1.4% ﹥ 吻合口狭窄：25%
﹥ 胃食管返流：40%
» 放疗并发症
﹥ III-IV级食管炎：9.0% ﹥ III级肺炎：4.4%
生存时间(月) J Clin Oncol 2006;24:181 中华肿瘤杂志 2006;28:784
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放疗Baidu Nhomakorabea手术对照研究:ASCO 2006
术前放化疗：疗效获益
食管和胃食管交界癌总生存翻倍
NTR-487 1.0 0.8 OS 0.6 0.4 CRT+手术 (n=178)：中位49.4个月 手术 (n=188)：中位24.0个月
0.2 0.0
0
HR=0.657; 95%CI=0.495-0.871; P=0.003 12 24 时间 (月) 36 48

Randomly assigned 556 Pts with resected adenoCA of the EGJ to surgery plus post-op ChT-RT or surgery alone Median OS in the surgery only group was 27 months, as compared
» 完成269例食管癌精确放疗与手术随机分组临床研究
﹥精确放疗组3年和5年生存率与手术组相近，并发症明显降低
2006年美国临床肿瘤学年会做大会报告，Malcolm Moore教授（加拿大 国立癌症研究院胃肠肿瘤分会主席）在The Oncology Report 评价: “该研究支持放射治疗可作为手术切除的有效替代手段” » 手术并发症
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食管癌治疗方案选择
Tr Protocle of EPC in China
woperable Inoperable
Operable
Conc. RT+ ChT RT+ChT+C225 RT Alone
Surgery Alone NAT ChT/RT+S S+AdJ-ChT & RT
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食管癌精确放疗可以替代手术治疗
Surgery
Radiotherapy Chemotherapy
放疗疗效取决于：1. 靶区勾画 2. 射线施照 3. 放疗与其它治疗的联合
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东西方食管癌治疗有明显差异
But As We Know That
中国食管癌的治疗原则不可以照搬美国治疗指南 国际指南缺乏包括中国的国际多中心大样本研究
东西方在流行病学 发病特征 临床疗效 治疗耐受等均不同
Esophageal Cancer Working Group (2008): Phase III
802 Pts with SCC & adeno randomized to surgery alone vs. pre-op chemo×2c PF→surgery. Survival advantage was seen in both adeno(17 vs.24%) & SCC (18 vs.23%) 10

Post-OP ChT-RT significantly improved OS and RFS for all Pts at high risk for recurrence of adenoCa of the EGJ The results have established post-OP ChT-RT as a reasonable option for Pts with EGJ adenoCA
食管癌个体化放疗
Advance & Challenge
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治疗现状
Current Status
2
例
中国肿瘤发病率占世界肿瘤发病率的比
2008年新发中国肿瘤患者占世界肿瘤患者比例
1800000
中国以外世界
中国
1600000
1400000 1200000
46.5%
35.6% 52.1% 51.2% 58.8% 27.0%
我国乳腺癌的治疗令人鼓舞
GLOBOCAN. 2012; 中国肿瘤登记年报. 2012
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Poly-Targeted Therapy for EPC
Immuno-targeted therapy Molecular targeted therapy
Anti-angiogenesis therapy
Supportive Care
1000000
800000 600000 400000 200000 0 食道癌
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胃癌
结直肠癌
肝癌
肺癌
乳腺癌
1. Jemal A, et al. CA Cancer J Clin 2011; 61(2):69-90. 2. Zheng R, et al. China Cancer 2012; 21(1):1-12.