非小细胞肺癌的放射治疗PPT课件
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pneumonitis or any pulmonary toxicity following SBRT
There did not appear to be a relaபைடு நூலகம்ionship between the
occurrence of radiation pneumonitis and normal lung tissue dose
Poor baseline PF alone did not appear to predict
decreased OS
Poor baseline PF alone within the range defining
trial eligibility should not be used to exclude early stage NSCLC pts from SBRT
IV 35-40%
Chemo±RT
15-40% <5%
From Presentation at: 2011 ASCO Annual Meeting
I期NSCLC-放射治疗
SBRT vs. 手术 SBRT靶区勾画 SBRT毒副反应
SBRT-Inoperable stage I NSCLC
Phase II trial of SBRT for medically inoperable stage I/II NSCLC-RTOG 0236
常规分割，5年生存率44-59%
ⅢA期NSCLC-放射治疗
术后放疗的价值 术后化放疗顺序 术后靶区的勾画
ⅢA期NSCLC
ⅢA期NSCLC单纯完全切除术后5年生存率约为20-35%，术 后复发率、死亡率高
The survival rate for SBRT is potentially
comparable to that for surgery
Retrospective Analysis
Int J Radiat Oncol Biol Phys.2011;81:1352-8.
SBRT VS.Surgery Trials
SBRT是无法耐受手术的外周型I期NSCLC的首选治疗
JAMA. 2010;303:1070-6.
2012
2012
2012
2012
SBRT vs 3DCRT
SBRT-Operable stage I NSCLC
SBRT is safe and promising treatment
for operable Stage I NSCLC
中方PI —于金明 ，山东省肿瘤防治研究院 美国PI—Feng-Ming (Spring) Kong，美国密西根大学肿瘤中心
RTOG foundation study 3502 is kicking off soon
I期NSCLC-中心型
中心型NSCLC（距离支气管树2cm 内）可能对临近气管、食管及大血 管造成损伤
II期NSCLC-放射治疗
II期NSCLC
II期NSCLC术后不推荐给予术后放疗 不可手术切除或患者，首选治疗为根治性放疗 同步放化疗的应用尚无明确定论 不可手术患者，根治性同步放化疗(60-74Gy)，5年OS 15-23% 肺上沟瘤易侵犯临近结构如臂丛、胸膜或肋骨，通常分期为
T3-T4
同步放化疗联合手术是可切除肺上沟瘤的首选治疗，45Gy
非小细胞肺癌 -放射治疗
Lung Cancer Screening
Stage Incidence
Treatment
5-YrSurvival
I
15-20%
Surgery or SBRT
60-80%
II
5-10% Surgery±Chemotherapy
40-50%
III 30-35% Combined-Modality Tr
between Pulmonary Function(PF) and pulmonary toxicity.
Cox proportional hazards models to evaluated
between PF \test and OS
2012
Results&Conclusions
Baseline PF was not predictive of radiation
Closed prematurely Slowly accruing
SBRT vs Surgery
A Randomized Trial in Patients with Operable Stage I Non-Small Cell Lung Cancer:Radical Resection Vs Ablative Stereotacitic Radiotherapy(POSITLV)
RTOG 0813 I/II期研究剂量爬坡 (50Gy/5f）研究适合中心型NSCLC 的分割模式及最大耐受剂量
靶区勾画-SBRT
➢ GTV在肺窗进行勾画，纵膈窗可区分邻近血管或胸壁结构 ➢ GTV不外扩，GTV=CTV ➢ GTV在水平面上外扩0.5cm，在头尾方向外扩1cm为PTV ➢4D CT设备的中心使用呼气或吸气图像或最大密度投影
(MIP)时可能会产生一个内靶区（IGTV） ➢ 无4D-CT，GTV勾画应建立在慢CT扫描的基础上 ➢PTV= IGTV+摆位 误差(根据各肿瘤中心而定）
SBRT毒副反应
55 inoperable patients with T1-2N0M0 peripheral
NSCLC
RT： 20Gy×3 （RTOG 0236） Logistic regression to investigate relationship
55 patients
➢T≤ 5 cm, N0, M0 ➢20 Gy in 3 fractions ➢over 1.5 to 2 weeks
Results
➢3-year primary tumor control rate: 97.6% ➢Disease-free survival at 3 years: 48.3% ➢Overall survival at 3 years: 55.8% ➢Median overall survival: 48.1 months
There did not appear to be a relaபைடு நூலகம்ionship between the
occurrence of radiation pneumonitis and normal lung tissue dose
Poor baseline PF alone did not appear to predict
decreased OS
Poor baseline PF alone within the range defining
trial eligibility should not be used to exclude early stage NSCLC pts from SBRT
IV 35-40%
Chemo±RT
15-40% <5%
From Presentation at: 2011 ASCO Annual Meeting
I期NSCLC-放射治疗
SBRT vs. 手术 SBRT靶区勾画 SBRT毒副反应
SBRT-Inoperable stage I NSCLC
Phase II trial of SBRT for medically inoperable stage I/II NSCLC-RTOG 0236
常规分割，5年生存率44-59%
ⅢA期NSCLC-放射治疗
术后放疗的价值 术后化放疗顺序 术后靶区的勾画
ⅢA期NSCLC
ⅢA期NSCLC单纯完全切除术后5年生存率约为20-35%，术 后复发率、死亡率高
The survival rate for SBRT is potentially
comparable to that for surgery
Retrospective Analysis
Int J Radiat Oncol Biol Phys.2011;81:1352-8.
SBRT VS.Surgery Trials
SBRT是无法耐受手术的外周型I期NSCLC的首选治疗
JAMA. 2010;303:1070-6.
2012
2012
2012
2012
SBRT vs 3DCRT
SBRT-Operable stage I NSCLC
SBRT is safe and promising treatment
for operable Stage I NSCLC
中方PI —于金明 ，山东省肿瘤防治研究院 美国PI—Feng-Ming (Spring) Kong，美国密西根大学肿瘤中心
RTOG foundation study 3502 is kicking off soon
I期NSCLC-中心型
中心型NSCLC（距离支气管树2cm 内）可能对临近气管、食管及大血 管造成损伤
II期NSCLC-放射治疗
II期NSCLC
II期NSCLC术后不推荐给予术后放疗 不可手术切除或患者，首选治疗为根治性放疗 同步放化疗的应用尚无明确定论 不可手术患者，根治性同步放化疗(60-74Gy)，5年OS 15-23% 肺上沟瘤易侵犯临近结构如臂丛、胸膜或肋骨，通常分期为
T3-T4
同步放化疗联合手术是可切除肺上沟瘤的首选治疗，45Gy
非小细胞肺癌 -放射治疗
Lung Cancer Screening
Stage Incidence
Treatment
5-YrSurvival
I
15-20%
Surgery or SBRT
60-80%
II
5-10% Surgery±Chemotherapy
40-50%
III 30-35% Combined-Modality Tr
between Pulmonary Function(PF) and pulmonary toxicity.
Cox proportional hazards models to evaluated
between PF \test and OS
2012
Results&Conclusions
Baseline PF was not predictive of radiation
Closed prematurely Slowly accruing
SBRT vs Surgery
A Randomized Trial in Patients with Operable Stage I Non-Small Cell Lung Cancer:Radical Resection Vs Ablative Stereotacitic Radiotherapy(POSITLV)
RTOG 0813 I/II期研究剂量爬坡 (50Gy/5f）研究适合中心型NSCLC 的分割模式及最大耐受剂量
靶区勾画-SBRT
➢ GTV在肺窗进行勾画，纵膈窗可区分邻近血管或胸壁结构 ➢ GTV不外扩，GTV=CTV ➢ GTV在水平面上外扩0.5cm，在头尾方向外扩1cm为PTV ➢4D CT设备的中心使用呼气或吸气图像或最大密度投影
(MIP)时可能会产生一个内靶区（IGTV） ➢ 无4D-CT，GTV勾画应建立在慢CT扫描的基础上 ➢PTV= IGTV+摆位 误差(根据各肿瘤中心而定）
SBRT毒副反应
55 inoperable patients with T1-2N0M0 peripheral
NSCLC
RT： 20Gy×3 （RTOG 0236） Logistic regression to investigate relationship
55 patients
➢T≤ 5 cm, N0, M0 ➢20 Gy in 3 fractions ➢over 1.5 to 2 weeks
Results
➢3-year primary tumor control rate: 97.6% ➢Disease-free survival at 3 years: 48.3% ➢Overall survival at 3 years: 55.8% ➢Median overall survival: 48.1 months