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1、Update in Radiotherapy for Non-Small Cell Lung CancerCancer Institute Percentage patients eligible for concurrent therapyData from Cancer Hospital of CAMS Comparison of comorbidity per age (1)VariablesGroups70岁70岁P value No.（%）No.（%） ComorbidityYes78(24.5)76(43.7)0.000 No241(75.5)98(56.3）493 of 527
2、with documented information of comorbiditiy, 2000-2006Charlson comorbidity index（CCI)Definition of comorbidity：1、Chronic Obstructive Pulmonary Disease （COPD）2、 Cardiovascular Diseases：Myocardial Ischemia、 Myocardial Infarction、Angina Pectoris、Coronary Artery Bypass Graft Surgery 3、Peripheral Artery
3、Disease：Intermittent Claudication（Raynauds disease）、Abdominal Aortic Aneurysm、Surgical Intervention 4、Cerebral Vascular Diseases： Hemiplegia according to Cerebral Vascular Accidents 5、Other Diseases：severe Rheumatoid Arthritis、Renal Diseases：Glomerulonephritis，Pyelonephritis；Gastrointestinal Disease
4、s： Gastric Ulcer，Gastrectomy，Colitis；Hepatic Diseases：Cirrhosis，Heptitis；Confusion；Chronic InfectionExclusion Criteria：other malignant tumors，Hypertension，Diabetes，and some Autoimmune Diseases（Sarcoidosis，Wegener granulomatosis，Systemic Lupus Erythematosus ）are not considered as comorbiditiesData fr
5、om Cancer Hospital of CAMSComparison of comorbidity per age (2)Age GroupNo comorbidityComorbidityTotalNo.（%）No.（%）0-59146（84.4）27（15.6）173（35.1 ）60-6995（65.1）51（34.9）146（29.6 ）70-7470（63.6）40（36.4）110（22.3 ）75+28（43.7）36（56.3）64（13.0 ）Total339（68.8）154（31.2）493（100 ）Percentage of Pts eligible for co
6、ncurrent chemoradiotherapynDefine criteria of eligibilityAge75 Follow CCI criteria：pt with severe comorbidity 0%10%20%30%40%50%60%70%80%90%100%0-5960-6970-7475+ Age DistributioneligibleineligibleTreatment FeaturesVariables分组7070P valueNo.（%）No.（%） Total Dose(Gy)5060 Gy849(24.3) 35(21.9)0.340 60 Gy18
7、6(50.7)92(57.5) 60Gy92(25.1)33(20.6) ModalityRT alone121(33.0)120(75.0)0.000 Concurrent CRT113(30.8)8(5)Sequential CRT133(36.2)32(20)TechniquesRegular RT191(52.0)83(51.9)1.000 3 DCRT176(48.0)77(48.1)Interaction of age and systemic treatment (chemotherapy) Without chemotherapyWith chemotherapyP=0.625
8、P=0.0137070important implicationsTo clinical guidelines：adequate supportive care and efficacious combination treatmentless toxic curative treatments: Sequential chemotherapy or Radiotherapy aloneradiation with targeted agentsNew radiation techniquesNew radiation techniques improved treatment results
9、Image-Guided Radiation Delivery IGRT40 pairs of leaves MLCKV-level X -ray tubeKV-level Array Detector MV-level Array Detector Better location for patient positionBetter location for tumorAccurate irradiation to target volumeControl tumor moving in breath4-Direction CT imaging techniqueinspirationSpi
10、ral initiationPhaseFrom inspiraion to exhalationEnd of exhalationexhalationBreath curveBed positionFrom exhalation to inspiraionFrom inspiraion to exhalationUse of advanced radiation technologies have translated into improvement of survivalInt. J. Radiation Oncology Biol. Phys., Vol. 66, No. 1, pp.
11、108116, 20063D vs 2D in MEDICALLY INOPERABLE STAGE I NONSMALL-CELL LUNG CANCER(a) Overall survival(b) Disease-specific survivalInt. J. Radiation Oncology Biol. Phys., Vol. 66, No. 1, pp. 108116, 20063D vs 2D in MEDICALLY INOPERABLE STAGE I NONSMALL-CELL LUNG CANCERLocal-regional controlInfluence of
12、Technologic Advances on Outcomes in Patients With Unresectable, Locally Advanced NonSmall-Cell Lung Cancer Receiving Concomitant Chemoradiotherapy Zhongxing X. Liao M.D.*, , , Ritsuko R. Komaki M.D.*, et al. International Journal of Radiation Oncology*Biology*Physics Volume 76, Issue 3, 1 March 2010
13、, Pages 775-781 Conclusions1、Treatment with 4DCT/IMRT was at least as good as that with 3DCRT in terms of the rates of freedom from LRP and DM. 2、There was a significant reduction in toxicity and a significant improvement in OS.3 DCRT vs 2D in NSCLCCancer Hospital & Institute of CAMS 2001-2006StageN
14、SCLC 3D vs 2DTime (month)SurvivalConformal RTRegular RT中华放射肿瘤学杂志，2008Locally Advanced NSCLC（A/B） 3DCRT vs 2DNo.Pts1yr3yr5yrMST2D27561.013.88.015.63-DCRT21873.326.114.420.15yr OS 6.4%MST 4.5 MPoster Presented in WCLC, 2009Locally Advanced NSCLC（A/B） 3DCRT vs 2DNo.Pts1yr3yr5yr2D27565.116.711.23-DCRT21
15、879.033.320.8Normal Tissue can be properly ProtectedDoses can be accurately calculated ProspectnAll the radiation Oncologists can use the new radiotherapy techniques adequitelynAll the thoracic surgeons and medical oncologists have some level of knowledge on the advances of radiotherapynSelect optimized modality for our patients in multidisciplinary treatment groupThank you for your attention!
