同步放化疗肺癌中文版.ppt

Management of unresectable stage non-small cell lung cancer:the role of combined chemoradiation introduction Until the late 1980s,thoracic radiation therapy(TRT)remained the standard care for locally advanced NSCLC.Radiation alone?Sequential chemoradiation?CALGB8433 RT60Gy PV2cyclesRT60Gy No.77 79 MST 9.7 13.8 1-year survival 40 55 2 year survival 13 26 3 year survival 11 23 5 year survival 7 19 P value 0.0066 Dillman RO,NEJM 323:940Dillman RO,NEJM 323:940-945,1990945,1990 Dillman RO,JNCI 88:1210Dillman RO,JNCI 88:1210-1215,1996 1215,1996 RTOG8808 RT60Gy CT+RT H-RT69.6Gy No 152 152 154 MST 11.4 13.2 12 1-year survival 47 59 52 2-year survival 21 32 24 3-year survival 11 17 14 5-year survival 6 11 9 P value 0.04 Sause W,JNCI1995;87:198Sause W,JNCI1995;87:198-205205 Sause W,CHEST2000;117:358Sause W,CHEST2000;117:358-364 364 OS 60y survival FRANCE RT65Gy CT+RT65Gy P值值 No 177 176 MST 10 12 0.08 1-year survival 41 50 2-year survival 14 21 3-year survival 5 11 Metastasis rate 38 26 0.001 1-year LCR 17 15 Thierry Le Chevaliar,JNCI1991;83:417Thierry Le Chevaliar,JNCI1991;83:417-423423 CT:VCPC,vindesine,cyclophosphamide,cisplatin,lomustine Concurrent chemoradiation?Radiation alone?EORTC RT55 PDD(W)+RT PDD(D)+RT No 311 311 311 1-y survival 46 44 54 2-y survival 13 19 26 3-y survival 2 13 16 P value 0.009 1-y LCR 19 30 31 P value 0.003 SchaakeSchaake-Koning C,NEJM 1992;326:524Koning C,NEJM 1992;326:524-530530 Intensified regimen H-RT H-RT/CT H-RT/CT No 61 52 56 methods 64.8Gy 64.8/CE 64.8/CE MST 8 18 13 3-y survival 6.6 23 16 Jeremic B,JCO 1995;13:452Jeremic B,JCO 1995;13:452-458458 Lee JS,JCO 1994;14:1055Lee JS,JCO 1994;14:1055-10641064 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 Meta Analysis Results(52 trials,9387 pts)2-year survival 4%。Hazard ratio:0.87。NSCLC CG,BMJ 1995;311:899NSCLC CG,BMJ 1995;311:899-909909 Concurrent chemoradiation?Sequential chemoradiation?concurrent sequential P value No 156 158 methods 56Gy/MVP2C MVP2C+56 MST 16.5 13.3 0.04 2-y survival 34.6 27.4 3-y survival 22.3 14.7 4-y survival 16.9 10.1 5-y survival 15.8 8.9 Response R 84 66 0.0002 Furuse K,JCO 1999;17:2692Furuse K,JCO 1999;17:2692-26992699 Japan RTOG9410 sequential concurrent concurrent+HF No(total)611 RT 60 60 69.6 methods PV2C PV2C PE MST 14.6 17 15.6 A-Toxicity 30 48 62 L-Toxicity 14 15 16 Curran WJ,PASCO 2000;19:484aCurran WJ,PASCO 2000;19:484a ACR427(phase)seq Con(ind/con)Con(con/adi)No(total)276 RT 63 63 63 CT PC2 PC2+CON CON+PC2 MST 12.5 11 16.1 Esophogitis(3）4 20 28 Choy H,PASCO 2002;abstract:1160Choy H,PASCO 2002;abstract:1160 GLOT9501 SEQ CON No(total)212 RT 66Gy 66 CT NP 3C ind CE+CE 2C adi 3/4 neutropenia 87.8 75 3/4 oesophagitis 0 26.1 MST 13.9 15.6 1-y survival 56 56 2-y survival 23 35 Pierre F,PASCO 2001;abstract:1246Pierre F,PASCO 2001;abstract:1246 MST OS E-toxicity S C S C S C furuse 13.3 16.5 9 16(5)4 23 RTOG 14.6 17.1 12 21(4)4 25 GLOT 13.9 15.6 24 35(2)3 17 Czech 13.2 20.6 15 42(2)4 28 BROCAT 14.0 19.0 -0 26 ACR427 13.8 17.4 31 33(2)3 28 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 Methods:2 cycles induction followed by 2 cycles and concurrent TRT,66Gy Vokes EE,JCO 2002;20:4191Vokes EE,JCO 2002;20:4191-41984198 CALGB9431 SWOG9019 Patients:50 pts.IIIB Treatment:PE 2cycles/RT PE 2cycles Albain KS,JCO 2002;20:3454Albain KS,JCO 2002;20:3454-34603460 SWOG9019 MST:15months 1y-sur:58%2y-sur:33%3y-sur:17%5y-sur:15%SWOG9504 Patients:83pts.IIIB Treatment:PE 2cycles/RT Docetaxel 3 cycles(75mg/m2 for the first and 100mg/m2 for the last two cycles).Gandara DR,JCO 2003;21:2004Gandara DR,JCO 2003;21:2004-20102010 SWOG9504 1y-sur:76%MST:26months 2y-sur:54%3y-sur:37%SWOG9019/9504 study No Survival time 2y-Survival 3y-survival median 95%CI median 95%CI median 95%CI 9019 50 15 10-22 34 21-47 17 7-27 9504 83 26 18-35 54 43-65 37 22-52 Gandara DR,JCO 2003;21:2004Gandara DR,JCO 2003;21:2004-20102010 Hossier Oncology Group Induction cisplatin/etoposide TRT Docetaxel Observation CALGB9801 Induction PC No Induction PC concurrent carboplatin/paclitaxel TRT SWOG0023 PE/TRT Consolidation docetaxel Oral Gefitinib placebo