朱国培下咽癌喉癌课件.ppt

* * * * * * * * * * Yet another trial, the phase III GORTEC trial, evaluated TPF vs PF in 220 treatment-naive patients with potentially resectable laryngeal and hypopharyngeal cancers. The doses of drugs used in this trial were identical to those administered in the EORTC trial for both treatment arms. Patients in each arm received induction treatment every 3 weeks for up to 3 cycles, and those who responded went on to receive radiation alone at 70 Gy. Nonresponders underwent total laryngectomy and then postoperative radiotherapy at a dose ranging from 54 to 66 Gy. The primary endpoint for this trial was the 3-year larynx preservation rate. * The preliminary results of this effort were presented by Dr. Calais. The larynx preservation rate was increased with induction TPF compared with standard PF. Larynx preservation was observed in 80% of those receiving TPF compared with only 58% of those on standard PF. The P value for this difference was .036. In addition, overall survival showed a trend toward improvement with TPF, although the difference was not statistically significant because the P value was only .096. Response rates were also significantly higher for the TPF arm vs the PF arm, with an overall response rate of nearly 83% with TPF vs 61% with PF. The P value for this comparison was .0013. * * * GORTEC 2000-01 保喉试验 0 10 20 30 40 50 60 70 80 90 100 中位随访39月 0 0.5 1 2 3 4 5 TPF arm PF arm 保喉率 (%) 年（随机分组后） p = 0.02 JNCI 2009, Yoann Pointreau, Gilles Calais M.D. in press 头颈肿瘤的诱导化疗 外科在上述保喉治疗中的作用 PD、SD，差的PR CR，好的PR: RT 退缩良好密切随访 无复发: :密切随访 诱导化疗 手术 手术 手术 诱导化疗 同期放化疗 退缩良好密切随访 无复发:密切随访 复发: CRT 手术 手术 复发: 任何残留 任何残留 头颈肿瘤的诱导化疗 治疗策略的灵活性好 √ 含紫杉醇的诱导化疗提高了可手术喉癌、下咽癌病例的保喉率 ? GORTEC 2000-01： TPF诱导化疗方案保喉率80%，相比PF组提高了15% 头颈肿瘤的诱导化疗 小 结 头颈肿瘤治疗的金标准----建立多学科综合治疗模式 治疗决定 病理科 放疗科 化疗科 头颈外科 放射诊断科 整形外科 病人 科学的临床试验+治疗指南 谢谢大家 * * * * * * * * * * * The updated 5-year results are shown here. Concurrent chemoradiotherapy significantly improved larynx preserv