同步放化疗肺癌中文版PPT课件
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16
GLOT9501
No(total) RT CT 3/4 neutropenia 3/4 oesophagitis MST 1-y survival 2-y survival
SEQ
CON
212
66Gy
66
NP 3C ind CE+CE 2C adi
87.8
75
0
26.1
13.9
15.6
56
56
23
Jeremic B, JCO 1995;13:452-458 Lee JS, JCO 1994;14:1055-101164
Meta Analysis
Results (52 trials,9387 pts)
2-year survival 4%。 Hazard ratio: 0.87。
NSCLC CG, BMJ 1995;311:899-909
RT60Gy 152 11.4 47 21 11 6
CT+RT 152 13.2 59 32 17 11 0.04
H-RT69.6Gy 154 12 52 24 14 9
Sause W,JNCI1995;87:198-205 Sause W, CHEST2000;117:358-3564
OS
6
7
64.8/CE 18 23
H-RT/CT 56
64.8/CE 13 16
CT: weekly,100mg/m2 CBP D1,D2; 100mg/m2 VP-16 D1-3
CT:200mg/m2 CBP D1,D2; 100mg/m2 VP-16 D1-5, the first, third, and fifth weeks
35
Pierre F, PASCO 2001;abstrac1t7:1246
furuse RTOG GLOT Czech BROCAT ACR427
MST
OS
S
CS
C
13.3 16.5 9 16(5)
14.6 17.1 12 21(4)
13.9 15.6 24 35(2)
13.2 20.6 15 42(2)
40
55
13
26
11
23
7
19
0.0066
Dillman RO , NEJM 323:940-945, 1990
Dillman RO, JNCI 88:1210-1215, 14 996
RTOG8808
No MST 1-year survival 2 -year survival 3 -year survival 5 -year survival P value
15
ACR427(phase Ⅱ)
seq No(total)
RT
63
CT
PC2
MST
12.5
Esophogitis(≥3） 4
Con(ind/con) 276
63 PC2+CON
11 20
Con(con/adi)
63 CON+PC2
16.1 28
Choy H, PASCO 2002;abstract:1160
14.0 19.0 -
-
13.8 17.4 31 33(2)
E-toxicity
S
C
4Βιβλιοθήκη Baidu
23
4
25
3
17
4
28
0
26
3
28
18
CALGB9431
G/P
P/P
N/P
No.
62
58
55
RR
74
67
73
1-y Sur
68
62
65
3-y Sur
28
19
23
MST
18.3
14.8
17.7
DFS
8.4
9.1
11.5
19
30
PDD(D)+RT 311 54 26 16 0.009 31 0.003
Schaake-Koning C, NEJM 1992;326:524-530
10
Intensified regimen
No methods MST 3-y survival
H-RT 61
64.8Gy 8 6.6
H-RT/CT 52
Methods:2 cycles induction followed by 2 cycles and concurrent TRT, 66Gy
56Gy/MVP2C 16.5 34.6 22.3 16.9 15.8 84
sequential 158
MVP2C+56 13.3 27.4 14.7 10.1 8.9 66
P value 0.04
0.0002
Furuse K, JCO 1999;17:2692-261949
RTOG9410
No(total)
2
Sequential chemoradiation? Radiation alone?
3
CALGB8433
No. MST
RT60Gy 77 9.7
PV2cycles＋RT60Gy 79 13.8
1-year survival 2 year survival 3 year survival 5 year survival P value
RT methods MST A-Toxicity L-Toxicity
sequential
60 PV2C 14.6
30 14
concurrent 611
60 PV2C
17 48 15
concurrent+HF
69.6 PE 15.6 62 16
Curran WJ, PASCO 2000;19:484a
8
Concurrent chemoradiation? Radiation alone?
9
No 1-y survival 2-y survival 3-y survival P value 1-y LCR P value
EORTC
RT55 311 46 13 2
PDD(W)+RT 311 44 19 13
12
Concurrent chemoradiation? Sequential chemoradiation?
13
Japan
No methods MST 2-y survival 3-y survival 4-y survival 5-y survival Response R
concurrent 156
Management of unresectable stage Ⅲ non-small cell lung cancer: the role of combined chemoradiation
1
introduction
Until the late 1980s, thoracic radiation therapy (TRT) remained the standard care for locally advanced NSCLC.
GLOT9501
No(total) RT CT 3/4 neutropenia 3/4 oesophagitis MST 1-y survival 2-y survival
SEQ
CON
212
66Gy
66
NP 3C ind CE+CE 2C adi
87.8
75
0
26.1
13.9
15.6
56
56
23
Jeremic B, JCO 1995;13:452-458 Lee JS, JCO 1994;14:1055-101164
Meta Analysis
Results (52 trials,9387 pts)
2-year survival 4%。 Hazard ratio: 0.87。
NSCLC CG, BMJ 1995;311:899-909
RT60Gy 152 11.4 47 21 11 6
CT+RT 152 13.2 59 32 17 11 0.04
H-RT69.6Gy 154 12 52 24 14 9
Sause W,JNCI1995;87:198-205 Sause W, CHEST2000;117:358-3564
OS
6
7
64.8/CE 18 23
H-RT/CT 56
64.8/CE 13 16
CT: weekly,100mg/m2 CBP D1,D2; 100mg/m2 VP-16 D1-3
CT:200mg/m2 CBP D1,D2; 100mg/m2 VP-16 D1-5, the first, third, and fifth weeks
35
Pierre F, PASCO 2001;abstrac1t7:1246
furuse RTOG GLOT Czech BROCAT ACR427
MST
OS
S
CS
C
13.3 16.5 9 16(5)
14.6 17.1 12 21(4)
13.9 15.6 24 35(2)
13.2 20.6 15 42(2)
40
55
13
26
11
23
7
19
0.0066
Dillman RO , NEJM 323:940-945, 1990
Dillman RO, JNCI 88:1210-1215, 14 996
RTOG8808
No MST 1-year survival 2 -year survival 3 -year survival 5 -year survival P value
15
ACR427(phase Ⅱ)
seq No(total)
RT
63
CT
PC2
MST
12.5
Esophogitis(≥3） 4
Con(ind/con) 276
63 PC2+CON
11 20
Con(con/adi)
63 CON+PC2
16.1 28
Choy H, PASCO 2002;abstract:1160
14.0 19.0 -
-
13.8 17.4 31 33(2)
E-toxicity
S
C
4Βιβλιοθήκη Baidu
23
4
25
3
17
4
28
0
26
3
28
18
CALGB9431
G/P
P/P
N/P
No.
62
58
55
RR
74
67
73
1-y Sur
68
62
65
3-y Sur
28
19
23
MST
18.3
14.8
17.7
DFS
8.4
9.1
11.5
19
30
PDD(D)+RT 311 54 26 16 0.009 31 0.003
Schaake-Koning C, NEJM 1992;326:524-530
10
Intensified regimen
No methods MST 3-y survival
H-RT 61
64.8Gy 8 6.6
H-RT/CT 52
Methods:2 cycles induction followed by 2 cycles and concurrent TRT, 66Gy
56Gy/MVP2C 16.5 34.6 22.3 16.9 15.8 84
sequential 158
MVP2C+56 13.3 27.4 14.7 10.1 8.9 66
P value 0.04
0.0002
Furuse K, JCO 1999;17:2692-261949
RTOG9410
No(total)
2
Sequential chemoradiation? Radiation alone?
3
CALGB8433
No. MST
RT60Gy 77 9.7
PV2cycles＋RT60Gy 79 13.8
1-year survival 2 year survival 3 year survival 5 year survival P value
RT methods MST A-Toxicity L-Toxicity
sequential
60 PV2C 14.6
30 14
concurrent 611
60 PV2C
17 48 15
concurrent+HF
69.6 PE 15.6 62 16
Curran WJ, PASCO 2000;19:484a
8
Concurrent chemoradiation? Radiation alone?
9
No 1-y survival 2-y survival 3-y survival P value 1-y LCR P value
EORTC
RT55 311 46 13 2
PDD(W)+RT 311 44 19 13
12
Concurrent chemoradiation? Sequential chemoradiation?
13
Japan
No methods MST 2-y survival 3-y survival 4-y survival 5-y survival Response R
concurrent 156
Management of unresectable stage Ⅲ non-small cell lung cancer: the role of combined chemoradiation
1
introduction
Until the late 1980s, thoracic radiation therapy (TRT) remained the standard care for locally advanced NSCLC.