局部晚期NSCLC2014熱點問腫瘤放療系、腫瘤醫醫師、教授、博士生導如何治療Ⅲ期如何治療Ⅲ期MediansurvivaltimecomparisonbetweenInd.+CCRTvsCCRT±cons.alongpLAMP2005(2007SenanGoudaToxicitycomparisonbetweenInd.+CCRTvsCCRTalongpG3/4ANC:G3/4Peum.4G3/4esoph.G3/4ANC:G3/4Peum.G3/4esop.G3/4ANC:G3/4Peum.G3/4esop.G3esoG3/4ANC:G3/4esoLAMP(ACR427):RandomizedPhaseIITrialof3ChemoradiationArm1 2cycles axel/CarboXRT63StageArm2Arm2 2cyclesXRT63GyandweeklyWtloss<Arm3Arm3 XRT63Gyandweekly2cyclesBelani,JCO

RTOGreferenceMST=14.5LAMP(267cases):≥Gr3 MedianInduction→ 12.5 11.0 16.1Thisearlysurvival ysisofArm2utilizinginductionchemotherapyfollowedbyconcurrentchemo-radiationdoesnotdemonstrateasurvivalimprovementwhencomparedwithsequentialchemo-radiationhistoricaldata.Accrualtothisarmhasbeenterminated.（CurranWJ,ProcAmSocClinOncol2001abstrNote:RTOGreferenceMST=14.5

NEJM,366:23,火力交放療患者的保護傘：全自動多葉調強放療照射野內劑量任意FFFFFFDoseatcentralrayis4x適應 ECOG0-小于70無胃潰瘍 、高血以往腫瘤史者需已無病生存超過3白細胞絕對計數：大于或等于血小板：大于或等于10肺功能：FEV1大于或1.2升/肝功能：AST、ALT均<2.5倍正常膽紅腎功： ：短徑≥1cm或SUV〉 +0.5-PTV:ITV頭腳方ITV橫斷方擺位誤初治患者同步放化療：中高劑（PDD60mg/m2 1、同步放化療中卡鉑不如順ChoyH,etal.2012 研究設N-

R培美曲塞+64-68Gy2Gy/d,5d/wd1-

ChoyH,etal.2012 2年OS(%)(主要 )點)ChoyH,etal.2012

研究結果：4級毒卡鉑組順鉑組0中性粒細胞減少血小板減少食管炎0OTPChoyH,etal.2012 2、PE方案優于TP方PHASEIISTUDYOFCISPLATIN/ETOPOSIDEVS.WEEKLY AXOL/CARBOPLATINWITHLOCALLYADVANCEDNON-SMALLCELLLUNGCANCER(LA-NSCLC)OuGuangfei,Wushixiu,Caojianzhong,LiangJun,ZhangHongxin,ChenDongfu,XiaoZefeng,FengQingfu,ZhouZhongmei,LvJima,WangLuhCancerhospital,chinsesacademyofmedicalscience(CAMS) China,100021；Thefirstaffiliatedhospitalofwenzhoumedicalcollege,Wenzhou,China,325000PE (50mg/m2)ondays1,8,and29,etoposide(50mg/m2)onday1to5and29toPC axol(45Concurrentthoracicradiotherapy:60Gy/30fractionsday1to (2Gy/fractionand5fractionsGrade

725

1617 Grade2729(87.9Grade54(12.1RadiationpGrade2417Grade2-816ThisstudyshowedafavorableoverallsurvivalandadifferenttoxicityprofileinthePE-basedChRTgroupcomparingwiththoseintheweeklyPC-basedChRTgroup. AphaseIIImulti-centricrandomizedtrialtofurthervalidatethisresultisKiura2011ASCOAnnual4、西妥昔單抗提高同步放化療作研究：CALGB30407indanR,etal.JClinOncol2011,29:3120-3125.研究設 N-=109（101可評價

培美曲塞W1，250mg/m2W1-6）;indanR,etal.JClinOncol2011,29:3120-研究結論：提示胸部放療聯合培美曲卡鉑西妥昔單抗或培美曲卡鉑治局部晚期非小細肺癌效相似，者推薦進一步研究非鱗癌，期G0617 。

Z

RT60-66Gy/30f/6-7wsTaxol（15mg/m2,RT60-66Gy/30f/6-7wsTaxol（45mg/m2,EnrollmentHistologicallyorcytologicallyconfirmedunresectablestageIIIAorstageAge:18-70yearsnomorethan5%weightlosswithinpast3ECOG0-AppropriatemainorganLeucocyte>=4000/μL，neutrophilcount>=1500/μL,CR<=1.5upperlimitofnormal，TB<=1.5upperlimitofnormal，ASTandALT<=2.5upperlimitofnormal,AKP<=5upperlimitofFEV1>=1.5Land>50%upperlimitofreceivedinductionchemotherapy<=4understandandsigntheInformedExclusiveCarcinoidtumorsandsmallcelllungreceivedinductionchemotherapy>4pregnantandlactatingwithasecondprimarytumorotherthannon-melanomaskincancerorinsitucervicalcarcinoma.Activeinfection,uncontrolleddiabetes,priorallergicreactiontopa axel.-InadequentliverandrenalOtherseriousdisease,forexamplemyocardialinfarction.Uncontrolablepsychopath.Investigatorconsiderinappropriatepatientsforthe60 offollow-17.7mo.（1.3mo.－48Table1.Thebaselinecharacteristicsofpatie rolledCharacteristics Numberofpatients p-valueGroup Age（yearsMedia 5 60Rang 22-7 45-75SeRac

Mal 2 2 .705Femal Ha 3 2 0.64Othe Performancestatu 2 1 0.30 1Weightlos≤5 2 2 0.51>5 StagⅢ750.57ⅢHistolog22Squamou110.14Adenocarcinom19Adenosquamou20 -12 34 4 12 23412341234123456-- -2-- -- 44-- ------432411--32-411----6313-- 1234123412341234A6--92--1--31--B661584---33-- 31311 31311Overallsurvivalcomparisonbetweentwoarms,15mg/m2 ofpa axelconcurrentwithradiotherapyiseffectiveandsafeforpatientwithLANSCLCafter2-4cyclesinductionchemotherapyaccordingtoourpreliminarystudy.PhaseⅢtrialiswarrantedtoevaluatetheoverallsurvivalratesofthetwoAA、HOGLUN01-24/USO02-Cisplatin50mg/m2IVdEtoposide50mg/m2IVd1-5&29-ConcurrentRT59.4Gy(1.8203PS0-1vs2IIIAvsIIIBCRvsnon-Taxotere75mg/m2q3Taxotere75mg/m2q3 147ECOGPS0-1atstudy(+PS2atFEV-1>1literatstudyPrimaryendpoint:OS;secondaryendpoints:PFS,Hannaetal.ASCO PatientPatientAgeStagePSFEV-1>2Current*TaxoterevsObservationCategoricaldata:Fisher’sexactContinuousdata:Kruskal-WallisHannaetal.ASCO OverallSurvival(ITT)RandomizedPatients(n=147) Observation:Median:24.1months(18.0-3yearsurvivalrate:Percentofpatients Median:Percentofpatients

3yearsurvivalrate: MonthsSinceHannaetal.ASCO OverallOverallSurvivalbyForonlythe143randomizedpatientswithstageandsurvival

ConsolidationTaxotereStagelllAConsolidationTaxotereStageObservationStagelllAObservationStage

WeeksSince

Hannaetal.ASCO Grade3/4Non-Hematological---------------------------- -------------Hannaetal.ASCO2007: OS:HOG-LUN01OS:HOG-LUN01and

SWOGHOGArmCDStage

WeeksSince

BAmultinationalphaseIIIrandomizedtrialwithorwithoutAmultinationalphaseIIIrandomizedtrialwithorwithoutConsolidationChemotherapyusingdocetaxelandcisplatinafterconcurrentchemoradiationinInoperablestageIIINon-smallcelllungcancer(CCheIN).ParkK,etal.2014 研究背同期放化療（concurrnetchemoradiotherapy,CCRT）是不可手術期NSCLC的推薦治療方NCLC（-NCLC）期臨床研WG54期依泊鉑療鞏 模，果有景；但是III期臨床研究HOGLUN01-24未能證實根治性CCRT后鞏 療組vs觀察組：中位OS21.2因此，CCRT后 療的地位尚未確定，需要進一步隨機對照研ParkK,etal.2014 研究設計：、III期隨機對照研局部晚期、不可手術的III期PD→退出研 期

療機放機化

4-8療 觀周

同期放化 ↑ ↑ 標志物探索：ERCC1、III型β-

ParkK,etal.2014 統計學假假定兩個治療組的中位PFS分別為10個月和14個月雙側α=0.05，90%的效2年入組時間，18個月的隨→4年入組時間（2007年5月修訂→5年入組時間（2008年8月修訂→6年入組時間（2010年9月修訂事件發生數目要兩組共379預期脫落共計需要入組患者：434例（每組217例中期分析：完成50%入組（2009ASCO）ParkK,etal.2014 患者特征 男女012*有些數據缺 ParkK,etal.2014 患者特征單單純 療國家/陸33*有些數據缺 ParkK,etal.2014

單獨療單獨療時間（月nmPFS(95%CI單純8.05(7.56,CCRT鞏9.10(7.92,ParkK,etal.2014 中位隨訪50.7個單獨單獨療時間（月nmOS(95%CI單純20.63(17.58,21.78(17.71,CCRT療ParkK,etal.2014 同期放化療的緩解PP

ParkK,etal.2014 血液毒血液毒CCRT階段 觀察鞏固治療234234234貧中性粒下血小板下ParkK,etal.2014 非血液毒 所有級