管胃结合部腺癌新辅助治疗价值和靶区勾画探讨.ppt

* * * * * * * * * * * * * 化疗：FLP方案 放疗30Gy/15次 Stahl M, et al. Journal of Clinical Oncology 2009, 27(6):851-856. Phase III Comparison of Preoperative Chemotherapy Compared With Chemoradiotherapy in Patients With Locally Advanced Adenocarcinoma of the Esophagogastric Junction 该研究入组人群均为AEG患者，即去除了食管癌和胃体癌等其他部位肿瘤的混杂因素 拟计划入组354例AEG患者，进行困难仅有126例患者纳入研究，且放疗剂量偏低 P=0.07 Stahl M, et al. Journal of Clinical Oncology 2009, 27(6):851-856. 组别 pCR(%) 淋巴结阴性率(%) MST（m） 3y OS（%） CT 2 37 21 28 CRT 16 64 33 48 Phase III Comparison of Preoperative Chemotherapy Compared With Chemoradiotherapy in Patients With Locally Advanced Adenocarcinoma of the Esophagogastric Junction Burmeister BH, et al. European Journal of Cancer 2011, 47(3):354-360. 术前化疗组 DDP 80mg/m2 ； 5-Fu 1000mg/m2， d1，21 术前同步放化疗：30Gy/15次 DDP 80mg/m2 ； 5-Fu 800mg/m2， d1，21 Is concurrent radiation therapy required in patients receiving preoperative chemotherapy for adenocarcinoma of the oesophagus? A randomised phase II trial 术前放化疗较术前化疗生存无明显获益 组别 MST（月） mPFS（月） 5y OS（%） CT 29 14 36 CRT 32 26 45 Burmeister BH, et al. European Journal of Cancer 2011, 47(3):354-360. Kumagai K, et al..European Journal of Surgical Oncology (EJSO) 2015, 41(3):282-294. HR = 0.71 95% CI 0.45e1.12,P =0.146 Survival benefit and additional value of preoperative chemoradiotherapy in resectable gastric and gastro-oesophageal junction cancer: A direct and adjusted indirect comparison meta-analysis A randomized clinical trial of neoadjuvant chemotherapy versus neoadjuvant chemoradiotherapy for cancer of the oesophagus or gastro-oesophageal junction 术前化疗：FP方案，3周期（每21d） 术前放化疗：同方案化疗+ 40Gy/20f Klevebro?F, et al.Ann Oncol. 2016 Apr;27(4):660-7. 术前放化疗可提高病理缓解率、R0切除率，降低淋巴结转移率且未增加毒副作用、手术相关死亡率及术后并发症 Klevebro?F, et al.Ann Oncol. 2016 Apr;27(4):660-7. 49% vs 47% P=0.77 74% (TRG ?) vs 46% (TRG ?) P = 0.001 Klevebro?F, et al.Ann Oncol. 2016 Apr;27(4):660-7. 生存率与术前放化疗/术前化疗无关，但与TRG相关 A randomized clinical trial of neoadjuvant chemotherapy versus ne