同步放化疗肺癌中文版ppt课件
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Results (52 trials,9387 pts) 2-year survival
4%。
Hazard ratio: 0.87。
NSCLC CG, BMJ 1995;311:899-909
Concurrent chemoradiation? Sequential chemoradiation?
0.04
0.0002
Furuse K, JCO 1999;17:2692-2699
RTOG9410
sequential
No(total) RT methods MST A-Toxicity L-Toxicity 60 PV2C 14.6 30 14
concurrent
611 60 PV2C 17 48 15
No 1-y survival 2-y survival 3-y survival P value 1-y LCR P value
RT55 311 46 13 2 PDD(W)+RT 311 44 19 13 PDD(D)+RT 311 54 26 16 0.009 31 0.003
19
30
Schaake-Koning C, NEJM 1992;326:524-530
FRANCE
RT65Gy CT+RT65Gy P值 0.08
No MST 1-year survival 2 -year survival 3 -year survival
Metastasis rate 1-year LCR
177 10 41 14 5
38 17
176 12 50 21 11
26 15
ห้องสมุดไป่ตู้
Japan
No methods MST 2-y survival 3-y survival 4-y survival 5-y survival Response R concurrent 156 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
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;117:358-364
OS
<60y survival
concurrent+HF
69.6 PE 15.6 62 16
Curran WJ, PASCO 2000;19:484a
ACR427(phase Ⅱ)
seq No(total) Con(ind/con) 276 Con(con/adi)
RT CT
63 PC2
63 PC2+CON 11 20
63 CON+PC2 16.1 28
C
16.5 17.1 15.6 20.6 19.0 17.4
S
9 12 24 15 31
同步放化疗肺癌 中文版
introduction
Until the late 1980s, thoracic radiation therapy
(TRT) remained the standard care for locally
advanced NSCLC.
Sequential chemoradiation? Radiation alone?
<0.001
CT: VCPC, vindesine, cyclophosphamide, cisplatin, lomustine
Thierry Le Chevaliar,JNCI1991;83:417-423
Concurrent chemoradiation? Radiation alone?
EORTC
MST 12.5 Esophogitis(≥3） 4
Choy H, PASCO 2002;abstract:1160
GLOT9501
SEQ CON
No(total) RT CT 3/4 neutropenia 3/4 oesophagitis MST 1-y survival 2-y survival
Dillman RO, JNCI 88:1210-1215, 1996
PV2cycles＋RT60Gy 79 13.8 55 26 23 19
RTOG8808
No MST 1-year survival 2 -year survival 3 -year survival 5 -year survival P value
212
66Gy NP 3C ind 87.8 0 13.9 56 23 66 CE+CE 2C adi 75 26.1 15.6 56 35
Pierre F, PASCO 2001;abstract:1246
MST
OS
E-toxicity
S
furuse RTOG GLOT Czech BROCAT ACR427 13.3 14.6 13.9 13.2 14.0 13.8
Intensified regimen
No methods MST 3-y survival
H-RT 61 64.8Gy 8 6.6
H-RT/CT 52 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
Jeremic B, JCO 1995;13:452-458 Lee JS, JCO 1994;14:1055-1064
Meta Analysis
CALGB8433
No. MST 1-year survival 2 year survival 3 year survival 5 year survival P value RT60Gy 77 9.7 40 13 11 7 0.0066
Dillman RO , NEJM 323:940-945, 1990
4%。
Hazard ratio: 0.87。
NSCLC CG, BMJ 1995;311:899-909
Concurrent chemoradiation? Sequential chemoradiation?
0.04
0.0002
Furuse K, JCO 1999;17:2692-2699
RTOG9410
sequential
No(total) RT methods MST A-Toxicity L-Toxicity 60 PV2C 14.6 30 14
concurrent
611 60 PV2C 17 48 15
No 1-y survival 2-y survival 3-y survival P value 1-y LCR P value
RT55 311 46 13 2 PDD(W)+RT 311 44 19 13 PDD(D)+RT 311 54 26 16 0.009 31 0.003
19
30
Schaake-Koning C, NEJM 1992;326:524-530
FRANCE
RT65Gy CT+RT65Gy P值 0.08
No MST 1-year survival 2 -year survival 3 -year survival
Metastasis rate 1-year LCR
177 10 41 14 5
38 17
176 12 50 21 11
26 15
ห้องสมุดไป่ตู้
Japan
No methods MST 2-y survival 3-y survival 4-y survival 5-y survival Response R concurrent 156 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
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;117:358-364
OS
<60y survival
concurrent+HF
69.6 PE 15.6 62 16
Curran WJ, PASCO 2000;19:484a
ACR427(phase Ⅱ)
seq No(total) Con(ind/con) 276 Con(con/adi)
RT CT
63 PC2
63 PC2+CON 11 20
63 CON+PC2 16.1 28
C
16.5 17.1 15.6 20.6 19.0 17.4
S
9 12 24 15 31
同步放化疗肺癌 中文版
introduction
Until the late 1980s, thoracic radiation therapy
(TRT) remained the standard care for locally
advanced NSCLC.
Sequential chemoradiation? Radiation alone?
<0.001
CT: VCPC, vindesine, cyclophosphamide, cisplatin, lomustine
Thierry Le Chevaliar,JNCI1991;83:417-423
Concurrent chemoradiation? Radiation alone?
EORTC
MST 12.5 Esophogitis(≥3） 4
Choy H, PASCO 2002;abstract:1160
GLOT9501
SEQ CON
No(total) RT CT 3/4 neutropenia 3/4 oesophagitis MST 1-y survival 2-y survival
Dillman RO, JNCI 88:1210-1215, 1996
PV2cycles＋RT60Gy 79 13.8 55 26 23 19
RTOG8808
No MST 1-year survival 2 -year survival 3 -year survival 5 -year survival P value
212
66Gy NP 3C ind 87.8 0 13.9 56 23 66 CE+CE 2C adi 75 26.1 15.6 56 35
Pierre F, PASCO 2001;abstract:1246
MST
OS
E-toxicity
S
furuse RTOG GLOT Czech BROCAT ACR427 13.3 14.6 13.9 13.2 14.0 13.8
Intensified regimen
No methods MST 3-y survival
H-RT 61 64.8Gy 8 6.6
H-RT/CT 52 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
Jeremic B, JCO 1995;13:452-458 Lee JS, JCO 1994;14:1055-1064
Meta Analysis
CALGB8433
No. MST 1-year survival 2 year survival 3 year survival 5 year survival P value RT60Gy 77 9.7 40 13 11 7 0.0066
Dillman RO , NEJM 323:940-945, 1990