食管癌放化疗面临的挑战与对策PPT参考课件.pptVIP

* 同步放化疗后达PET-CR者手术和非手术预后相似 * Annals of Oncology 24: 1262–1266, 2013 Association between clinical complete response and pathological complete response after preoperative chemoradiation in patients with gastroesophageal cancer: analysis in a large cohort M. D. Anderson Cancer Center, Houston, USA Background: clinCR 定义为术前同步放化疗后手术前内镜阴性+PET阴性 pathCR 术后病理阴性 Results: 284 patients, 218 (77%) achieved clinCR. 67 (31%) of the 218 achieved pathCR. The sensitivity of clinCR for pathCR was 97.1% (67/69), The specificity was low (29.8%; 64/215). Of the 66 patients who had less than a clinCR, only 2 (3%) had a pathCR. Thus, the rate of pathCR was significantly different in patients with clinCR than in those with less than a clinCR (P 0.001). * 术前同步放化疗后达PCR患者治疗前分子特征是什么 基础研究能否找到标记 * 二、放疗最佳剂量？ RTOG8501 50.4GY 日本 60GY 中国 教科书 60GY或更高（同步） 60-70GY（根治性放疗） 2011卫生部规范 50-50.4GY （同步） * Phase II Study of Concurrent Chemoradiotherapy at the Dose of 50.4 Gy with Elective Nodal Irradiation for Stage II–III Esophageal Carcinoma 60GY Jpn J Clin Oncol 2013;43(6)608–615 9906 本实验 CR 62.2% 70.6% 3YOS 44.7% 63.8% 5YOS 36.8% 治疗相关死亡 5.3% 0 50.4GY * 科学合理的个体化剂量应根据肿瘤放疗敏感性 * 三、靶区如何勾画？ * * 1. 局部失败和远处转移是食管癌治疗失败的主要原因 2. 转移淋巴结诊断准确性提高：PET-CT、腔内超声、CT 3. 8501试验确立了同步放化疗的地位，淋巴结预防性照射3级以上毒副作用增加，患者依从性降低 4. 化疗药物对隐匿病灶的作用 5. Grills等推测区域淋巴结存在低剂量的放射剂量效应，累及野照射区域淋巴结接受照射剂量曲线为处方剂量的40%-70% 累及野照射产生背景 * * * * Cancer Letters 357 (2015) 69–74 * * 淋巴结转移能力是最重要考量因素 局部中晚期 N- N+ 术后T3 N- N+ * RTOG PF 同步2周期，辅助2周期 日本9906 PF 同步2周期，如缓解+2周期，无效改挽救性手术 国内食管癌诊治规范对于鳞癌不