不可切除Ⅲ期非小细胞肺癌的治疗的基本原则和相关的问题.pptVIP

* Spigel DR, Hainsworth JD, Yardley DA, et al. Tracheoesophageal fistula formation in patients with lung cancer treated with chemoradiation and bevacizumab. J Clin Oncol 2010; 28:43–48. 入选患者：不可手术切除的III期NSCLC 非鳞癌 无心包及肋膜转移 年龄18 有可评价病灶 未接受治疗（生物，化疗，放疗） ECOG0-1分 The non–small-cell lung cancer trial included patients with unresectable stage III nonsquamous non–small-cell histology without pleural or pericardial effusions. Other inclusion criteria were identical for both trials and included age 18 years or older; measurable disease per Response Evaluation Criteria in Solid Tumors(RECIST)11;noprior chemotherapy, radiation, or biologic treatment; Eastern Cooperative OncologyGroupperformance status 0 to 1 (ranging from normal to ambulatory, but restricted in strenuous activity); and adequate renal, hepatic, and hematologic function * * Spigel DR, Hainsworth JD, Yardley DA, et al. Tracheoesophageal fistula formation in patients with lung cancer treated with chemoradiation and bevacizumab. J Clin Oncol 2010; 28:43–48. Spigel DR, et al.J Clin Oncol 2010; 28:43–48. 5人2007年2月入驻，2007年11月即关闭 几乎每人有3-4级的毒性反应 贝伐单抗加重放疗引起的食管炎从而促使食管瘘的形成，可威胁生命 This trial opened with enrollment limited to five patients in Nashville beginning in February 2007 (Appendix).Thetrial was closed early for safety December 2007. All five patients completed induction and consolidation therapy, and received limited maintenance therapy before trial closure. TTP, response rate, and survival end points could not be assessed due to early trial closure. Grade 3 and 4 toxicity observed in any phase of the trial included anemia (two of five patients), neutropenia (three of five patients), leukopenia (three patients), and thrombocytopenia (two patients). Excluding TEF, anorexia, dyspnea, and fatigue (two patients each), grade 3 and 4 toxicity was otherwise limited to one patient each. A 65-year-old patient developed bilateral