?????????? IGRT

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??????????IGRT

KV?X????
40???MLC
KV??????
MV??????
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??????? ??NSCLC????

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Japanese StudiesI?NSCLC?????SRT??????????
Institute Dose/fx/OTT LC/Follow-up Uemats
u 50-60/5-10/5d 94 (47/50) 36M Kyoto
48Gy/4fr/12d 96 (49/51) 20M
Arimoto 60Gy/8fr/11d 92 (22/24)
24M Onimaru 60Gy/8fr/11d 88 (50/57)
18M Nagata Y, Kyoto Univ, IASLC, 2004
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Summary of Japanese Studies
Survival curves of operable pts irradiated with
BED of 100 Gy or more according to Stage
Comparison of 5-Yr Overall Survival Between
Surgery STI
Mountain
JCOG
JNCCH
STI
Stage IA Stage IB
80 63
90
67 57
74 53
84
Surgery
Stereotactic Irradiation
Onishi H, ASCO 2004
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the therapy provided a 98 rate of local control.
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INT0139 ???????!
100
??/??
CT/RT/S 145/202 CT/RT 155/194
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??FU 81 ??
???
50
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Logrank p0.24 ??? 0.87 (0.70, 1.10)
0
0
12
24
36
48
60
???????????
Albain et al. ASCO 2005. Abstract 7014.
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• Interpretation Chemotherapy plus radiotherapy
  with or without resection (preferably lobectomy)
  are options for patients with stage IIIA(N2)
  non-small-cell lung cancer.

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Can we undertake surgery in patients with stage
IIIA(N2) NSCLC after induction chemoradiotherapy
from now on? Yes, you can BUT only
selectively in patients with less extensive
resection (eg, lobectomy) than pneumonectomy.
Selection of patients for surgery in whom
complete resection is possible after induction
treatment with low morbidity and mortalityis
essential.
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??????ApN2?? ?????????????? ??????????????

• EORTC 08941
• ?AUnresectable pN2

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J Natl Cancer Inst 200799 442 50
Conclusion In selected patients with
pathologically proven stage IIIA-N2 NSCLC and a
response to induction chemotherapy, surgical
resection did not improve overall or
progression-free survival compared with
radiotherapy. In view of its low morbidity and
mortality, radiotherapy should be considered the
preferred locoregional treatment for these
patients.
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NSCLC??????
New data supports PORT in N2 cases
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PORT?N2????
N0
N0 N0 N1 N1 N2 N2
S SR S SR S SR
5yOS 41 31 34 30 20 27
DSS 53 39 44 38 27 36
P 0.0435 0.0435 0.0196 0.0196 0.0077 0.0077
N1
PORT?????OS?????DSS
SEER J Clin Oncol, 2006. 24 2998-3006
N2
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New Data from ANITA PORT in N2 Patients
1.00
CT RT is the best
0.75
0.50
0.25
RT is better than OBS
0.00
0
20
40
60
80
100
120
DURATION OF SURVIVAL (MONTHS)
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Retrospective results from Cancer Hospital
Institute of CAMS
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????????
?? ?? MST(?) 1?OS 3?OS 5?OS
SCR 61 48.3 96.7 63.9 38.2
SR 35 38.3 91.4 51.0 33.7
SC 100 33.1 82.0 46.7 31.9
S 25 21.6 61.5 38.5 23.1
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Plot of heart disease mortality free survival for
2 different time eras stratified by
postoperative radiotherapy (PORT) use
HR1.49(1.112.01 P0.009)
??????????????????????
HR1.08(0.791.48 P0.64)
Brian E Lally, et al. Cancer 2007 1109117
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3DCRT??NSCLC?????
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Int. J. Radiation Oncology Biol. Phys., Vol. 66,
No. 1, pp. 108116, 2006
3D vs. 2D in MEDICALLY INOPERABLE STAGE I
NONSMALL-CELL LUNG CANCER
(b) Disease-specific survival
(a) Overall survival
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Int. J. Radiation Oncology Biol. Phys., Vol. 66,
No. 1, pp. 108116, 2006
3D vs. 2D in MEDICALLY INOPERABLE STAGE I
NONSMALL-CELL LUNG CANCER
Local-regional control
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????NSCLC(?A/B)3DCRT vs ????
5?OS 6.4 MST 4.5?
?? ?? 1? 3? 5? MST
???? 275 61.0 13.8 8.0 15.6
3-DCRT 218 73.3 26.1 14.4 20.1
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????NSCLC(?A/B)3DCRT vs ????
?? ?? 1? 3? 5?
???? 275 65.1 16.7 11.2
3-DCRT 218 79.0 33.3 20.8
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• ???????????3DCRT ????NSCLC????
• 3DCRT????????????????

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Thanks??