安徽—肺癌脑转移的治疗.ppt

一石激起千重浪？ Mulvenna P,et al. Lancet.?2016 Oct 22;388(10055):2004-2014. WBRT for NSCLC：Yes No？ 本研究的一般描述 a non-inferiority, phase 3 randomised trial done at 69 UK and three Australian centres. NSCLC patients with brain metastases unsuitable for surgical resection or stereotactic radiotherapy optimal supportive care (OSC) including dexamethasone plus WBRT (20 Gy in five daily fractions) or OSC alone including dexamethasone The primary outcome measure：quality-adjusted life-years (QALYs). QALYs were generated from overall survival and patients’ weekly completion of the EQ-5D questionnaire. Between March 2, 2007, and Aug 29, 2014, 538 patients were recruited from 69 UK and three Australian centres, and were randomly assigned to receive either OSC plus WBRT (269) or OSC alone (269). Interpretation Although the primary outcome measure result includes the prespecified non-inferiority margin, the combination of the small difference in QALYs and the absence of a difference in survival and quality of life between the two groups suggests that WBRT provides little additional clinically significant benefit for this patient group. Overall Survival Average Quality of Life Average QALY Forest Plot of Survival In summary QUARTZ provides compelling information for clinicians and patients alike; for younger patients, WBRT might offer a survival advantage but for all other groups, omitting WBRT does not significantly affect QALY or overall survival. Nov. 2016：WBRT for NSCLC the end of an era? RTOG-RPA: Class 1-3 A three-class recursive partitioning (RPA) system by the RTOG to describe different prognostic groups of patients with brain metastases. RPA Class I: the most favorable prognostic group, KPS≥70, an age ≤65 years and controlled primary tumor without extracranial metastases. RPA Class III :the poorest prognosis patients, KPS 70. RPA Class II:The remainders of patients How to choose？ Quartz trial is groundbreaking in that it is the first prospective randomized study providing e