Limits of Tumorectomy in clinical localized renal cell cancer：在临床局限性肾细胞癌的肿瘤切除术的限制课件.ppt

* * * * * * * * * * * * 20% 40% 60% 80% 100% 0 12 24 36 48 months D + E M + P no. at Risk 338 336 217 235 median survival (months) 18 16 HR: 0.80 (95% CI 0.67, 0.97), p = 0.01 med. F/U: 1 J docetaxel chemotherapy overall survival SWOG 9916 no (n) died Petrylak et al, N Engl J Med 2004 SWOG 99-16 Petrylak J NCI 2006 Survival in subgroupsdocetaxel 3 weekly vs mitoxantrone 0.2 0.4 0.6 0.8 1 1.2 1.4 Intent to Treat age 65 age ≥ 65 age ≥ 75 pain no pain yes KPS ≥ 80 KPS ≤ 70 hazard ratio in favour of docetaxel mitoxantrone Tannock et al, N Engl J Med 2004 Cochrane Reviewchemotherapy of HRPC n=6929 patients; 47 studies investigated substances: EMP docetaxel 5-FU cyclophosphamide doxorubicine mitoxantrone vinorelbine Shelley M, Harrison C et al. Cochrane Database Syst Rev 2006 Cochrane Review PSA response (50%): EMP 48% docetaxel 52% 5-FU 20% cyclophosphamide n.d. doxorubicine 50% (CAVE: only 1 study!) mitoxantrone 33% vinorelbine n.d. Shelley M, Harrison C et al. Cochrane Database Syst Rev 2006 only DOC = overall survival ↑ (2.5 months) pain ↓ DOC Mit + Pred quality of life ↑ DOC Mit + Pred results authors‘ conclusion: ?At the present time this* probably represents the best chemotherapeutic regime available for men with HRPC“ *- docetaxel q3w Shelley M, Harrison C et al. Cochrane Database Syst Rev 2006 secondary hormone manipulation or chemotherapy? secondary hormone manipulation chemotherapy CALGB9583 SWOG 9916 TAX-327 AAW + Ketokonazol EMP docetaxel vs MP DP q3w vs DP q1w vs MP n 260 770 1006 overall survival in better arm 16.7 months 17.5 months 18.9 months overall survival in worse arm 15.3 months 15.6 months 16.5 months Bellmunt, Eur Urol Suppl 2009 open questions when to start with chemotherapy? should asymptomatic M+ patients be treated? how long to continue treatment? secondary treatment? intermittent chemotherapy? re-exposition? Early vs late chemotherapy? for benefit esta