局部晚期非小细胞肺癌治疗进展.ppt

Lung Cancer 2003;41:1–11. 作者 病人数 中位年龄 夹杂病 放疗时间剂量分割 局部控制 副反应 Zimmerman 68 76 未报告 24-40Gy/3-5F 88% at 3 3% III肺炎 Baumann 138 74 55%COPD, 30-48Gy/2-4F 88% at 3 3% III 肺炎 Timmerman 70 71 17%PS=2 20%严重心脏病 61%肺功能差 60-66Gy/3F 95% at 2 11% III-IV 6例死亡 Lagarwaard 206 73 65%COPD 60Gy/3-8F 88% at 2 3% III-IV 肺炎 Onoshi 257 74 17.5% PS=2 65% COPD Median BED=108 86% at 3 4.5%肋骨骨折 Senan 175 79 25%COPD 60Gy/3-8F 89% at 3 2% III-IV Nyman 45 74 69%费功能差 45Gy/3F 96% at 2 无III-IV Xia 43 71 均因夹杂病不能手术 50Gy/5F 95% at 3 3% III-IV 老年I期NSCLC SBRT的疗效 #： 3年生存率 Radiother Oncol. 2009 May 10. [Epub ahead of print] 目的：观察诱导化疗+加速分割放疗的疗效的临床II期试验 材料和方法：40例临床III期患者进入本研究。所有患者均接受三个疗程化疗后给予加速分割放疗（CHART）。放疗剂量为56Gy/36次，12天 结果：急性治疗副反应轻微，无明显后期损伤出现。 全组中位生存期15.7个月。2年生存率28% 结论：鉴于治疗副作用小，疗效与同步化放疗的接近， 因此建议有必要开展III期研究比较此治疗模式与标准同步化放疗疗效 A Phase II trial of induction chemotherapy followed by continous hyperfractionated accelerated radiotherapy in locally advanced non small cell lung cancer TKI药物在晚期NSCLC应用中积累了一定经验,也发现了一些对TKI药物的优势人群。 不适合于做化疗的局部晚期患者采用IRESSA和放疗联合应用 JCO 2006;24:(abstr 7046). 不适合于做化疗的局部晚期患者，erlotinib 与放疗联合应用（60Gy/30次），同步后erlotinib维持治疗6个月。 JCO 2008;26:(abstr 7563). 不适合于同步化放疗局部晚期NSCLC能否放疗TKI联用？ 『肿瘤治疗规范及放疗进展』2010上海学习班 2010年8月25-28日,上海 欢迎参加： * * * * * Since the the ras-raf-MAPK signal transduction pathway for stimulation of tumor cell division by EGF was described, it has become clear that the EGF receptor influences many aspects of tumor cell biology. For example, the EGF receptor stimulates AKT which inhibits tumor cell apoptosis. Similarly, EGFR stimulates tumor cell synthesis of vascular endothelial cell growth factor, a key mediator of tumor angiogenesis. Importantly for the future therapeutic use of Iressa, it is also clear that resistance to chemotherapy, radiotherapy and endocrine is often associated with upregulation of EGF receptor expression. Thus, combination treatments including Iressa may enhance antitumor activity and preclinical studies have