肺癌放疗标准s

54
27
11
9 62 74
207
31
7
15 40 -
35
51
6
30 47 61
110
41
4
8 18 -
41
25
5
- 54 -
27
25
0
--
-
14
25
14
--
-
Outcomes After Stereotactic Lung Radiotherapy for Stage I Non–Small-Cell Lung Cancer
Outcomes After Stereotactic Lung Radiotherapy or Wedge Resection
for Stage I Non–Small-Cell Lung Cancer
SRBT (n=55)
Wedge Resection (n=69) P
Pulmonary Function （FEV-1） Charlson
12
13
43
82
RTOG, 0236
55
25
6
15
72
-
Summary of Japanese Studies
Survival curves of operable pts irradiated with BED of 100 Gy or more according to Stage
Overall Survival
Authors
Pts MFUT RR or LR
DM
OS
CSS
Onisi, 2007
257 38
8-14
20
65
90
Negata, 2005
45
36
2
16-31
83
-
Uematsu, 2001
50
30
6
14
66
88
Zimmerman, 2006
68
17
12
16
51
73
Fakiris, 2009
70
50
comorbidity index
Age
1.39 (0.86-2.37)
3 (1-4) 74 (69-78)
1.31(0.52-3.0)
4 (3-6) 78 (55-89)
NS <0.01 <0.01
Stage
T1-T2
T1-T2
NS
Greatest dimension
GTV: 2.3 (1-5.3)
Lee, 2003 Voynov, 2005 Birdas, 2006
* local failure
Pts
MFUT RR or LR DM OS CSS
122
54
17
- 61 75
42
29
24
- 58 38*
60
24
16
- 65 38*
49
54
16
- - 67
56
45
16
18 - 71
31
45
55
6 - 48
肺癌放疗标准 ss
Radiotherapy for NSCLC
Definitive radiotherapy for early stage non-small cell lung cancer
Definitive radiotherapy for locally advanced stage non-small cell lung cancer
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*
STI**
Stage IA 67% Stage IB 57%
80% 63%
74% 53%
90% 84%
* Surgery
** Stereotactic Irradiation
Onishi H, ASCO 2004
High-Tech Radiotherapy Machine
No
Image
(A)
(B)
Outcomes After Stereotactic Lung Radiotherapy or Wedge Resection
for Stage I Non–Small-Cell Lung Cancer
LR
RR LRR DM FFF OS CSS
All patients n=124
SBRT
4
4
9
Outcomes of Local Resection for Stage I Non–Small-Cell Lung Cancer
Authors Ginsberg, 1995 Landreneau, 1997
Sienel, 2007 Sienel, 2008
Keenan, 2004 El-Sherif, 2006
(C)
(D)
Image-guided radiation delivery
SBRT has been becoming standard treatment for inoperable stage I NSCLC
Specimen：1.7 (0.4-4.7)
-
Positive mediastinal
0 (PET,
0 (Surgery)
NS
nodes Mediastinoscopy)
Chemotherapy
16%
10%
NS
Grills et al: JCO 2010 doi: 10.1200/JCO.2009.26.5157
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!
93
P
.05
.07 .03 .51 .12 .02
.62
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
19
77
72
93
Wedge Resection
20
18
27
21
65
87
94
P
.07
.34
Βιβλιοθήκη Baidu
.16 .96
.37
.01
.53
Exclude T4 and no histological information n=110
SBRT
5
0
5
15
80
70
92
Wedge Resection
24
18
29
22
61
85