肺癌治疗的现状与展望 - 天津北方网——权威媒体 天津门户.pptVIP

* * * * trials served as the stimulus to investigate the safety and utility of preoperative chemoradiotherapy delivered sequentially (12, 13) or concurrently (14) for N2-positve patients * I、II期有生存区别，III期没有生存区别 * * * * * * * Induction MIC - Surgery vs SurgeryDepierre Trial in Locally Advanced NSCLC MIC + Surgery Surgery Entered 179 176 Response Rate 65% N/A Surgery 94% 99% Median DFS 26.7 mos 12.9 mos Median Survival 37 mos 26 mos 1Year Survival 77.1% 73.3% 2Year Survival 59.2% 52.3% 3 Year Survival 51.6% 41.2% 4Year Survival 43.9% 35.3% MIC = Mitomycin/Ifosfamide/Cisplatin Depierre JCO 2003 手术在N2- IIIA期NSCLC治疗中地位是否还需要手术切除 --- EORTC 08941 Intergroup 0139(RTOG 9309） The Role of Surgery ? ---EORTC 08941 研究目标定在潜在不可切除的IIIA-N2 NSCLC。 有组织学或细胞学证实。 含铂方案3周期化疗有效者332例（62%）随机分组。 手术组154例 vs 胸部放疗组155例（86%≥60Gy） 。 手术组：50%根治切除、14%单纯探查；42%发现病理降期； 6例（4%）术后死亡，5例为全肺切除。 不完全切除者术后胸部放射治疗（39%）。 The Oncologist 2006; 11: 39-50. Unresectable IIIA-N2 3 cycles platinum-based chemotherapy Study Design OR-mR: randomisation SD-PD Off study Thoracic Radiotherapy (TRT) Surgical resection (S) Postoperative Radiotherapy (PORT) if R1-2 resection von Meerbeeck et al, ASCO Abstract #7015: CT/S CT/TRT p value No. of patients 167 165 Median PFS (months ) 9.0 11.3 0.61 2-year PFS (%) 26.5 24.2 Median survival (months) 16.4 17.5 0.60 5-year survival (%) 15.7 14.0 Summary of the European Organization forResearch and Treatment of Cancer 08941 trial The Oncologist 2006; 11: 39-50. EORTC 08941 months 12 24 36 48 60 72 84 96 108 0 20 40 60 80 100 Surgery +/- PORT Radiotherapy TRT N=165 S N=167 F-up, median 73.1 67.2 OS, median (95%CI) 17.5 (15.8-23.2) 16.4 (13.3-19.0) 2y SR (%) 40.7 34.7 5y SR (%) 14.0 15.7 HR (95% CI) 1 1.06 (0.84-1.35) Overall Survival in Randomized Patients EORTC 08941 trial:subset analysis of patients in the surgery arm The Oncologist 2006; 11: 39-50. No. of patients Median survival (months) 5-year survival (%) p value (Bi)-lobectomy 58 25.4 27 0.009 P