广泛期小细胞肺癌治疗进展解读.ppt

* Results: Sixty-four patients were accrued: 48 patients in the sensitive cohort and 16 in the refractory group. One CR and 10 PRs were noted in sensitive patients [ORR, 23%; 95% confidence interval (CI), 12%–37%]. Two PRs were seen in the refractory cohort (ORR, 13%; 95% CI, 2%–38%). As second- and third-line treatment, the ORR was 22% (95% CI, 9%–40%) and 19% (95% CI, 7%–36%), respectively. Among patients with target brain lesions, 38% had a CR or PR (95% CI, 14%–68%). Grade ≥3 thrombocytopenia and neutropenia were observed in nine patients (14%). * * * * * 入组271例病人 * 放疗时间选择对局限期小细胞肺癌预后影响的META分析： 最终纳入分析的文章6篇，共1190例患者，早放组587例，晚放组602例。二组相比，二者2/3年生存优势差别无统计学意义。P=0.093 * 小细胞肺癌的预防性脑照射研究EORTC08993-22993随机对照研究，286例治疗缓解的ED-SCLC, 脑预放 ※ 该项研究显示了对化疗后缓解的ED-SCLC行PCI的生存优势 PCI 对照组 一年累积脑转移发生率 14.6% 40.4% 一年生存率 27.1% 13.3% 广泛期小细胞肺癌PCI对OS的意义 小细胞肺癌的一线治疗--局限期 胸部病灶放疗的时间 小细胞肺癌的一线治疗--局限期局部放疗 2004年Fried DB等回顾分析1524例局限期SCLC患者 ＊早期参与组(化疗开始后9周内)与晚期参与组(9周之后)比较,2ys提高5% ＊联合铂类化疗更具优势 谢 谢 * Govindan et al reviewed the Surveillance, Epidemiologic, and End Results Cancer Incidence Public Use Database from 1973 to 2002.3 They found that the proportion of SCLC among all lung cancer histologies decreased from 17.62% in 1986 to 12.95% in 2002 (Figure 1). Since 1989, the absolute incidence of SCLC has decreased at an annual rate of 2.4%. This downward trend is highly, statistically significant (P 0.0001), providing convincing evidence that the observation is not merely random statistical fluctuation. These investigators also noted that the male predominance for this disease has decreased markedly during the same time period. In 1973, 72% of small cell cases occurred in men, but by 2002, the proportion decreased to 50% (Figure 2). The reasons behind these significant changes are not * 局限期者中孤立骨髓转移者为5%。 * 广泛期小细胞肺癌患者LDH（-）、单部位转移者，预后较好。 女性、年龄小于70岁、I期患者预后较好 双侧肺门、双侧锁骨上淋巴结肿大为局限期有争议。 * * * 局限期者治疗目标是改善生存期、治愈疾病。 广泛期者治疗目标是改善生活质量，控制疾病，延长生存时间。 1、JCOG9511中关于广泛期小细胞肺癌的结果(伊立替康 /顺铂优于VP-16/顺铂)是否同样适用于更大样本量的试