医学课件肺癌.pptVIP

The graph shows 1- and 2-year survival in 563 patients with stage I-IIIB NSCLC randomized to receive either conventional radiotherapy (30 fractions of 2 Gray, reaching a total of 60 Gray in 6 weeks) or continuous hyperfractionated accelerated radiotherapy (CHART, 36 fractions of 1.5 Gray given three times daily, reaching a total of 54 Gray in 12 days).1 In this trial, CHART significantly improved survival compared with conventional radiotherapy.1 However, CHART was associated with a higher incidence of dysphagia1, and its value in routine practice has yet to be determined. 1. Saunders M, et al. Lancet 1997; 350: 161-165. A meta-analysis used data from 11 randomized clinical trials which compared radiotherapy with radiotherapy plus cisplatin-based chemotherapy in patients with locally advanced NSCLC.1 The graph shows the hazard ratio (relative risk of death) and confidence intervals for each of the 11 trials. The square represents the mean hazard ratio for each trial, and the outer and inner bars show the 95% and 99% confidence intervals. The size of the square represents the size of the trial. The center of the diamond represents the overall hazard ratio from all the trials combined, and its ends represent the 95% confidence interval. The majority of the trials reported a hazard ratio of 1 (to the left of the solid vertical line), indicating superior survival in the groups treated with radiotherapy plus chemotherapy. The overall hazard ratio was 0.87, indicating a 13% lower risk of death for the patients receiving combination treatment (p=0.005). Combined chemotherapy and radiotherapy is an appropriate treatment for patients with good performance status and weight loss of 5%. However, radiotherapy alone may be more appropriate for patients with stage III NSCLC with poor performance status or weight loss of 5% or more during the preceding 3-6 months.2 1. Non-small Cell Lung Cancer Collaborative Group. Br Med J 1995; 311: 899-909. 2. Juretic A, et al. An