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1、非小細(xì)胞肺癌放射治療進(jìn)展中國(guó)醫(yī)學(xué)科學(xué)院協(xié)和醫(yī)科大學(xué)腫瘤醫(yī)院王綠化1第九屆中國(guó)腫瘤學(xué)術(shù)大會(huì)影像技術(shù)和計(jì)算機(jī)技術(shù)的進(jìn)步為精確放射治療的實(shí)現(xiàn) 提供可能2第九屆中國(guó)腫瘤學(xué)術(shù)大會(huì)精確的腫瘤定位和放射治療劑量計(jì)算3第九屆中國(guó)腫瘤學(xué)術(shù)大會(huì)照射中腫瘤運(yùn)動(dòng)的監(jiān)測(cè)和控制呼氣吸氣螺旋開(kāi)始時(shí)相由吸轉(zhuǎn)呼呼氣末由呼轉(zhuǎn)吸由吸轉(zhuǎn)呼呼氣吸氣螺旋開(kāi)始呼吸曲線(xiàn)床位4第九屆中國(guó)腫瘤學(xué)術(shù)大會(huì)影像引導(dǎo)放射治療技術(shù)IGRT40對(duì)葉片MLCKV級(jí)X射線(xiàn)球管KV級(jí)探測(cè)器陣列MV級(jí)探測(cè)器陣列5第九屆中國(guó)腫瘤學(xué)術(shù)大會(huì)在線(xiàn)校正—影像匹配6第九屆中國(guó)腫瘤學(xué)術(shù)大會(huì)早期非小細(xì)胞肺癌的放射治療放射治療
2、能夠使早期NSCLC獲得治愈7第九屆中國(guó)腫瘤學(xué)術(shù)大會(huì)JapaneseStudiesI期NSCLC大劑量分割SRT獲得滿(mǎn)意的局部控制率InstituteDose/fx/OTTLC/Follow-upUematsu50-60/5-10/5d94%(47/50)36MKyoto48Gy/4fr/12d96%(49/51)20MArimoto60Gy/8fr/11d92%(22/24)24MOnimaru60Gy/8fr/11d:88%(50/57)18MNagataY,KyotoUniv,IASLC,20048第九屆中國(guó)腫瘤學(xué)術(shù)大會(huì)Mounta
3、in*JCOG*JNCCH*StageIAStageIB67%57%80%63%74%53%STI**90%84%*Surgery**StereotacticIrradiationComparisonof5-YrOverallSurvivalBetweenSurgery&STISurvivalcurvesofoperableptsirradiatedwithBEDof100GyormoreaccordingtoStagestageIA(n=47)stageIB(n=16)p=0.2OverallSurvivalTime(years)Sum
4、maryofJapaneseStudiesOnishiH,ASCO20049第九屆中國(guó)腫瘤學(xué)術(shù)大會(huì)thetherapyprovideda98%rateoflocalcontrol.10第九屆中國(guó)腫瘤學(xué)術(shù)大會(huì)局部晚期非小細(xì)胞肺癌放療/化療+手術(shù)的治療11第九屆中國(guó)腫瘤學(xué)術(shù)大會(huì)CT/RT/S145/202CT/RT155/194Logrankp=0.24危險(xiǎn)比=0.87(0.70,1.10)存活率%0255075100從隨機(jī)分組開(kāi)始后的月數(shù)01224364860死亡/總數(shù)INT0139:相同的總生存率！中位FU81個(gè)月Albainetal.A
5、SCO2005.Abstract7014.12第九屆中國(guó)腫瘤學(xué)術(shù)大會(huì)InterpretationChemotherapyplusradiotherapywithorwithoutresection(preferablylobectomy)areoptionsforpatientswithstageIIIA(N2)non-small-celllungcancer.13第九屆中國(guó)腫瘤學(xué)術(shù)大會(huì)CanweundertakesurgeryinpatientswithstageIIIA(N2)NSCLCafterinductionchemoradio
6、therapyfromnowon?Yes,youcan—BUTonlyselectivelyinpatientswithlessextensiveresection(eg,lobectomy)thanpneumonectomy.Selectionofpatientsforsurgeryinwhomcompleteresectionispossibleafterinductiontreatmentwithlowmorbidityandmortalityisessential.14第九屆中國(guó)腫瘤學(xué)術(shù)大會(huì)EORTC08941ⅢA：Unresec
7、tablepN2不能手術(shù)的ⅢApN2病例誘導(dǎo)化療后即使成為可手術(shù)病例也是應(yīng)該選擇放療而非手術(shù)治療15第九屆中國(guó)腫瘤學(xué)術(shù)大會(huì)16第九屆中國(guó)腫瘤學(xué)術(shù)大會(huì)17第九屆中國(guó)腫瘤學(xué)術(shù)大會(huì)JNatlCancerInst2007;99:442–50ConclusionInselectedpatientswithpathologicallyprovenstageIIIA-N2NSCLCandaresponsetoinductionchemotherapy,surgicalresectiondidnotimproveoverallorprogression-
8、freesurvivalcomparedwithradiotherapy.Inviewofitslowmorbidityandmortality,radiotherapyshouldbecon
