肺癌放疗标准 ppt课件

Outcomes After Stereotactic Lung Radiotheraபைடு நூலகம்y or Wedge Resection
for Stage I Non–Small-Cell Lung Cancer
Grills et al: JCO 2010 doi: 10.1200/JCO.2009.26.5157
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?
Outcomes After Stereotactic Lung Radiotherapy or Wedge Resection
for Stage I Non–Small-Cell Lung Cancer
Grills et al: JCO 2010 doi: 10.1200/JCO.2009.26.5157
Outcomes After Stereotactic Lung Radiotherapy or Wedge Resection
for Stage I Non–Small-Cell Lung Cancer
Outcomes of Local Resection for Stage I Non–Small-Cell Lung Cancer
Advanced technology in radiotherapy improved the treatment results
Normal tissue is properly protected
Definitive Radiotherapy for Early Stage NSCLC
the therapy provided a 98% rate of local control!
☆ ☆ ☆ ☆
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
Outcomes After Stereotactic Lung Radiotherapy for Stage I Non–Small-Cell Lung Cancer
Summary of Japanese Studies
Survival curves of operable pts irradiated with BED of 100 Gy or more according to Stage
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?
Update in Radiotherapy for Non-Small Cell Lung Cancer
Radiotherapy for NSCLC
Definitive radiotherapy for early stage non-small cell lung cancer
Definitive radiotherapy for locally advanced stage non-small cell lung cancer
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
Overall Survival
1
0 .8
0 .6
0 .4
stage IA (n=47)
0 .2
stage IB (n=16)
p = 0.2
0
01234567
Time (years)
Comparison of 5-Yr Overall Survival Between Surgery & STI
Mountain * JCOG* JNCCH*
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
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 ?
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