肺癌脑转移治疗__培训课件.ppt

Unlike for small cell lung cancer, prophylactic cranial irradiation (PCI) has not been shown to improve survival in locally advanced NSCLC, but it significantly reduces brain metastases. In addition, it causes significant decline in memory but not in global cognitive function or quality of life. PCI is generally not recommended, but its relative risks and potential benefits should be considered on an individual patient basis。 杭州市第一人民医院集团 Thank you! There needs to be more work done in this area. 诱导化疗增加脑转移风险 解释：1. 延迟局部治疗增加转移风险； 2. 诱导化疗降低其他部位转移风险，致脑转移比例增高（竞争风险） The RTOG-0214 study was originally open to patients with stage IIIA and IIIB NSCLC who had completed all planned definitive locoregional therapy. However, the study has recently been amended to allow PCI to be performed before completion of all therapy. The above data suggest that the BM incidence could be reduced with earlier PCI intervention; however, studies directly addressing this issue should be conducted before reaching firm conclusions. In general, use of PCI reduced the rates of BM compared with non-PCI groups. However, although such nonrandomized data might be used as a base for larger randomized trials, results should be interpreted with caution due to potential biasing effects; for example, it is quite surprising to observe a 0% BM rate in 1 of the treatment groups, as reported by Strauss et al. [8] , or a large difference in 1 relatively small study, such as that reported by Stuschke et al. [6] . The interpretation of these results is difficult since the trial did not address directly the benefit of PCI. Patients in the experimental arm had also a more aggressive loco-regional treatment in the experimental arm as compared to the control arm. Prophylactic Cranial Irradiation in Lung Cancer 肺癌脑转移 脑转移日渐成为肺癌治疗失败的主要原因 诊断技术的进步 放疗技术的发展 新的药物的开发 综合治疗的应用 脑转移严重影响患者生存和生存质量 脑转移后全脑放疗中位生存期4-6月 脑转移常伴有严重症状而需要住院治疗 Langer,JCO 2005 Kepka, Acta Oncol 2005 PART 1： PCI in SCLC 首诊时约15%的病例合并脑转移 局限期SCLC治疗后达CR的患者，