非小细胞肺癌的放射治疗

1非小细胞肺癌放射治疗进展2影像技术和计算机技术的进步为精确放射治疗的实现

提供可能3精确的肿瘤定位和放射治疗剂量计算4照射中肿瘤运动的监测和控制呼气吸气螺旋开始时相由吸转呼呼气末由呼转吸由吸转呼呼气吸气螺旋开始呼吸曲线床位5影像引导放射治疗技术

IGRT

40对叶片MLCKV级X射线球管KV级探测器阵列MV级探测器阵列6在线校正—影像匹配7早期非小细胞肺癌的放射治疗

放射治疗能够使早期NSCLC获得治愈

8JapaneseStudies

I期NSCLC大剂量分割SRT获得满意的局部控制率

Institute Dose/fx/OTT

LC/Follow-up Uematsu 50-60/5-10/5d94%

(47/50)36M Kyoto 48Gy/4fr/12d96%

(49/51)20M

Arimoto 60Gy/8fr/11d92%

(22/24)24M Onimaru

60Gy/8fr/11d:88%

(50/57)18MNagataY,KyotoUniv,IASLC,20049Mountain*JCOG*JNCCH*StageIAStageIB67%57%80%63%74%53%STI**90%

84%*Surgery**StereotacticIrradiationComparisonof5-YrOverallSurvivalBetweenSurgery&STISurvivalcurvesofoperableptsirradiated

withBEDof100GyormoreaccordingtoStagestageIA(n=47)stageIB(n=16)p=0.2OverallSurvivalTime(years)SummaryofJapaneseStudiesOnishiH,ASCO200410thetherapyprovideda98%rateoflocalcontrol.11局部晚期非小细胞肺癌

放疗/化疗+手术的治疗12CT/RT/S

145/202CT/RT

155/194Logrankp=0.24危险比=0.87(0.70,1.10)存活率%0255075100从随机分组开始后的月数01224364860死亡/总数INT0139:相同的总生存率！中位FU81个月Albainetal.

ASCO2005.Abstract7014.13InterpretationChemotherapyplusradiotherapywithorwithoutresection(preferablylobectomy)areoptionsforpatientswithstageIIIA(N2)non-small-celllungcancer.14CanweundertakesurgeryinpatientswithstageIIIA(N2)NSCLCafterinductionchemoradiotherapyfromnowon?Yes,youcan—BUTonlyselectivelyinpatientswithlessextensiveresection(eg,lobectomy)thanpneumonectomy.Selectionofpatientsforsurgeryinwhomcompleteresectionispossibleafterinductiontreatmentwithlowmorbidityandmortalityisessential.15

EORTC08941ⅢA：UnresectablepN2不能手术的ⅢApN2病例诱导化疗后即使成为可手术病例也是应该选择放疗而非手术治疗161718JNatlCancerInst2007;99:442–50ConclusionInselectedpatientswithpathologicallyprovenstageIIIA-N2NSCLCandaresponsetoinductionchemotherapy,surgicalresectiondidnotimproveoverallorprogression-freesurvivalcomparedwithradiotherapy.Inviewofitslowmorbidityandmortality,radiotherapyshouldbeconsideredthepreferredlocoregionaltreatmentforthesepatients.19NSCLC术后放射治疗NewdatasupportsPORTinN2cases20PORT在N2中的作用N0N1N2SSRSSRSSR5yOS41%31%34%30%20%27%DSS53%39%44%38%27%36%P0.04350.01960.0077PORT既能够提高OS也能够提高DSSN0N1N2SEERJClinOncol,2006.24:2998-3006CTRTCTRTOBSNewDatafromANITA:

PORTinN2Patients0.000.250.500.751.00DURATIONOFSURVIVAL(MONTHS)020406080100120CT&RTisthebestRTisbetterthanOBS21Retrospectiveresultsfrom

CancerHospital&InstituteofCAMS22治疗模式与生存率项目例数MST(月)1年OS3年OS5年OSS+C+R6148.396.7%63.9%38.2%S+R3538.391.4%51.0%33.7%S+C10033.182.0%46.7%31.9%S2521.661.5%38.5%23.1%2324Plotofheartdiseasemortalityfreesurvival

for2differenttimeerasstratifiedbypostoperativeradiotherapy(PORT)use先进的放疗技术降低了肺癌术后放疗的远期并发症HR=1.49(1.11–2.01;P=0.009)HR=1.08(0.79–1.48;P=0.64)BrianELally,etal.Cancer2007110:911–7253DCRT提高NSCLC

的治疗疗效26Int.J.RadiationOncologyBiol.Phys.,Vol.66,No.1,pp.108–116,20063Dvs.2DinMEDICALLYINOPERABLESTAGEINON–SMALL-CELLLUNGCANCER(a)Overallsurvival(b)Disease-specificsurvival27Int.J.RadiationOncologyBiol.Phys.,Vol.66,No.1,pp.108–116,20063Dvs.2DinMEDICALLYINOPERABLESTAGEINON–SMALL-CELLLUNGCANCERLocal-regionalcontrol28局部晚期NSCLC（ⅢA/B）

3DCRTvs常规放疗分组例数1年3年5年MST常规放疗27561.013.88.015.63-DCRT21873.326.114.420.15年O