ς άθ ς α έ ς ι οθ α ής ο ό ος
ώ όι έ ιέ σ φέ ο ος.
SCLC Non SCLC α ί ο σα / ο ι ή
SCLC: Limited stage Stage I III (T any, N any, M0) α ι οθ α ύσι ο αι ού αι T3/4 ο α ά ο ί ια αι bulky φα ο άθ ια PET/CT αι MRI φά ο Extensive stage Stage IV (T any, N any, M1a,b) / ο α ά ο ί ια αι bulky φα ο άθ ια AJCC (7TH EDITION)
LS-SCLC: / VS. Pignon et al, NEJM 2002 N = 2573 pts 3y OS: 5.4%, p = 0.001 Warde et al, JCO 1992 N = 1911 3y OS: 5.4%, p < 0.001 οι ό α PIGNON, J. P. ET AL. A META-ANALYSIS OF THORACIC RADIOTHERAPY FOR SMALL-CELL LUNG CANCER. N. ENGL. J. MED. 327, 1618 1624 (1992).
LS-SCLC: α ό ο ς vs. ια ο ι ή α ό ο ώι vs. Ό ι DE RUYSSCHER, D. ET AL. TIME BETWEEN THE FIRST DAY OF CHEMOTHERAPY AND THE LAST DAY OF CHEST RADIATION IS THE MOST IMPORTANT PREDICTOR OF SURVIVAL IN LIMITED-DISEASE SMALL-CELL LUNG CANCER. J. CLIN. ONCOL. 24, 1057 1063 (2006).
LS-SCLC: ς ής ή αα ιβί σ αί α ασ α ο οί σ FRIED, D. B. ET AL. SYSTEMATIC REVIEW EVALUATING THE TIMING OF THORACIC RADIATION THERAPY IN COMBINED MODALITY THERAPY FOR LIMITED-STAGE SMALL-CELL LUNG CANCER. J. CLIN. ONCOL. 22, 4837 4845 (2004).
LS-SCLC: SER: START DATE TO THE END OF RT ς DE RUYSSCHER, D. ET AL. TIME BETWEEN THE FIRST DAY OF CHEMOTHERAPY AND THE LAST DAY OF CHEST RADIATION IS THE MOST IMPORTANT PREDICTOR OF SURVIVAL IN LIMITED-DISEASE SMALL-CELL LUNG CANCER. J. CLIN. ONCOL. 24, 1057 1063 (2006).
LS-SCLC: SER: START DATE TO THE END OF RT ώι α ό ο ς early concurrent) y OS α ά ~ % ια άθ οισοφα ί ι ας β ο ά α α ά ασ ο ιασ ή α ος SER SER DE RUYSSCHER, D. ET AL. TIME BETWEEN THE FIRST DAY OF CHEMOTHERAPY AND THE LAST DAY OF CHEST RADIATION IS THE MOST IMPORTANT PREDICTOR OF SURVIVAL IN LIMITED-DISEASE SMALL-CELL LUNG CANCER. J. CLIN. ONCOL. 24, 1057 1063 (2006).
LS-SCLC: ς
LS-SCLC: PCI N= pts, ή ς ύφ σ 5. % σ OS σ ία DFS, φα ι ές ασ άσ ις 59% vs. 33%). vs..
LS-SCLC: α ο ι ή έ (SEER database) N = 7995 pts 2y, 5y, 10 OS ο όφ ος σ ία PCI OS α α έ ι σ ο ί ι φά ισ BMs PATEL, S., MACDONALD, O. K. & SUNTHARALINGAM, M. EVALUATION OF THE USE OF PROPHYLACTIC CRANIAL IRRADIATION IN SMALL CELL LUNG CANCER. CANCER 115, 842 850 (2009).
ES-SCLC: THORACIC RT CREST Trial SLOTMAN, B. J. ET AL. USE OF THORACIC RADIOTHERAPY FOR EXTENSIVE STAGE SMALL-CELL LUNG CANCER: A PHASE 3 RANDOMISED CONTROLLED TRIAL. LANCET 385, 36 42 (2015).
ES-SCLC: THORACIC RT 1yr OS: 33 vs. 28%, p = 0.066 NS p = 0.004 2yr OS: 13 vs. 3%, p = 0.004 % σ ις θώ α α όφ ος σ ια ι ίσι ο ο ές σ ο ο ι ό οι ό όσο α SLOTMAN, B. J. ET AL. USE OF THORACIC RADIOTHERAPY FOR EXTENSIVE STAGE SMALL-CELL LUNG CANCER: A PHASE 3 RANDOMISED CONTROLLED TRIAL. LANCET 385, 36 42 (2015).
ES-SCLC: THORACIC RT SLOTMAN, B. J. & VAN TINTEREN, H. WHICH PATIENTS WITH EXTENSIVE STAGE SMALL-CELL LUNG CANCER SHOULD AND SHOULD NOT RECEIVE THORACIC RADIOTHERAPY? TRANSL LUNG CANCER RES 4, 292 294 (2015).
ES-SCLC: PCI
ES-SCLC: PCI BMs OS SLOTMAN, B. ET AL. PROPHYLACTIC CRANIAL IRRADIATION IN EXTENSIVE SMALL-CELL LUNG CANCER. N. ENGL. J. MED. 357, 664 672 (2007)
ES-SCLC: PCI
ES-SCLC: PCI
ES-SCLC: PCI
SCLC: Limited Stage α ό ο / ώι έ α PCI ος / 2ος ύ ος Extensive Stage ασθ ίς α α ό ισ σ ο θώ α α CREST trial) ί ςσ ί ο ς ο ι ό PCI; α α ο ούθ σ MRI φά ο όσο σ ο θώ α α
NSCLC: ι ι ή pn2 όσος ι ά ό ια ο ής ο ( αί ι Ό οι Pancoast IIIA N2 ι ή ιι ή I-IIIB α ο φισ ι ή (IV) σ ι ές. φα ι ές. ι οσ α ι ή
NSCLC: PORT metanalysis ( ί σ ± OS ια όσο N0-N1 (55 vs. 48%) Ό ι ια όσο N2 ι ι ή: 25% N0, α ιές έ ς,, Lancet 1998) Co60, unpublished data SEER database (Lally BE et al, JCO 2006) >7400 ασθ ίς, Stage II-III OS σ N2 όσο OS σ N0-N1 ANITA trial ( αιο οι έ % έ αβ postop RT αι ής N2 αι N1 ο έ αβα σ N1 ο έ αβα ια ιβί σ ή α ι ι ή
NSCLC: ANITA TRIAL pn2 pn1 CT CT + PORT DOUILLARD, J.-Y. ET AL. IMPACT OF POSTOPERATIVE RADIATION THERAPY ON SURVIVAL IN PATIENTS WITH COMPLETE RESECTION AND STAGE I, II, OR IIIA NON-SMALL-CELL LUNG CANCER TREATED WITH ADJUVANT CHEMOTHERAPY: THE ADJUVANT NAVELBINE INTERNATIONAL TRIALIST ASSOCIATION (ANITA) RANDOMIZED TRIAL. INT. J. RADIAT. ONCOL. BIOL. PHYS. 72, 695 701 (2008).
NSCLC: NCCN GUIDELINES 2017 N2 όσος ι ά ό ια σ ά ιο α ι ή 50-54 Gy ο ής I-III Boost (54-60 Gy) έ ασ
NSCLC: Ω T1 T2 T3 T4 N0 IA IB IIB IIIB N1 IIA IIB IIIA IIIB N2 IIIA IIIA IIIA IIIB N3 IIIB IIIB IIIB IIIB Patient should be offered surgery if adequate lung function and no medical contraindications Surgery may be suitable for some patients; decision based on clinical judgement Patients not suitable for surgery
NSCLC: PANCOAST pcr 56%, 2 ής ιβί σ - %, ής ιβί σ 40%
NSCLC: ί ις ά ιο ι ά ι ήσι ο Ό οι Pancoast οι ά IIIA & IIB* (T3-4 N0-1) * ό άσ ι ές α ές ο ι ι ής σ ασ ό όσ έ ι α ά α σθ ίς ο θα οβ θού σ ο ι ι ή / ι ι ι ή θ σι ό α -50 Gy ο ο ή θα έ ι α οβά ο αι σ
NSCLC: ό ος / έ βασ ς; INT/RTOG 0139 EP + Gy ί σ ή έ ι ιαφο ά σ έσ ιβί σ Albain et al, Lancet 2009) EORTC 08941 ύ οι σ ασ ό α ί ας ί σ ή ίς ιαφο ά σ ιβί σ Meerbeeck et al, JCNI 2007)
NSCLC:
NSCLC:
SBRT NSCLC: ο α ι ήα ι ο ι ο ι ή, 1950s, Lars Leksell Stereotactic Body Radiation Therapy, ά ιο I NSCLC ~15 έ ώ σ ι ι ή ά, α ία, ο α ι ά α ι οβιο ο ι ά α α αι ιαί ιαί ισ ι ά ι ές α α ήσ ις α ό ο ό ο ί ασ σ ο α οσο οι ι ό ς α έ ι ς BED (biological effective dose) >100 Gy SBRT: STEREOTACTIC BODY RADIATION THERAPY
No fly zone
NSCLC: Ω SBRT CORRADETTI, M. N., HAAS, A. R. & RENGAN, R. CENTRAL-AIRWAY NECROSIS AFTER STEREOTACTIC BODY-RADIATION THERAPY. N. ENGL. J. MED. 366, 2327 2329 (2012).
NSCLC: GRADE 4 Ω SBRT HOPPE, B. S. ET AL. ACUTE SKIN TOXICITY FOLLOWING STEREOTACTIC BODY RADIATION THERAPY FOR STAGE I NON-SMALL-CELL LUNG CANCER: WHO S AT RISK? INT. J. RADIAT. ONCOL. BIOL. PHYS. 72, 1283 1286 (2008).
NSCLC: VS. SBRT ROSEL Trial (Netherlands) closed (lack of accrual) Surgery vs. SABR, Any Risk, Stage IA 22 ασθ ίς STARS Trial (Industry Sponsored) closed (lack of accrual) 36 ασθ ίς ACOSOG Z4099 closed (lack of accrual) Sublobar resection vs. SABR, High Risk, Stage I έ α, ή ς accrual SIVA, S. & BALL, D. CURING OPERABLE STAGE I NON-SMALL CELL LUNG CANCER WITH STEREOTACTIC ABLATIVE BODY RADIOTHERAPY: THE FORCE AWAKENS. ONCOLOGIST 21, 393 398 (2016).
NSCLC: VS. SBRT CHANG, J. Y. ET AL. STEREOTACTIC ABLATIVE RADIOTHERAPY VERSUS LOBECTOMY FOR OPERABLE STAGE I NON-SMALL-CELL LUNG CANCER: A POOLED ANALYSIS OF TWO RANDOMISED TRIALS. LANCET ONCOL. 16, 630 637 (2015).
NSCLC: Ές Έ ς: Έ VS. SBRT
NSCLC: VS. 6 Trials, N = 1205 pts ιβί σ ς. % σ α έ ς οισοφα ί ι ας G3-4 α ό vs % AUPÉRIN, A. ET AL. META-ANALYSIS OF CONCOMITANT VERSUS SEQUENTIAL RADIOCHEMOTHERAPY IN LOCALLY ADVANCED NON-SMALL-CELL LUNG CANCER. J. CLIN. ONCOL. 28, 2181 2190 (2010).
NSCLC: VS. ECOG PS2 ή ά α ώ ια βά ο ς ια ο ι ή / > α ό ο οσο ή σ ι ο ή CALGB 30105 ισα ι ή Carbo/Gem Concurrent Gem + 16% Grade 4-5 ο ι ή οι ό α AUPÉRIN, A. ET AL. META-ANALYSIS OF CONCOMITANT VERSUS SEQUENTIAL RADIOCHEMOTHERAPY IN LOCALLY ADVANCED NON-SMALL-CELL LUNG CANCER. J. CLIN. ONCOL. 28, 2181 2190 (2010).
NSCLC: RTOG 0617 Ω BRADLEY, J. D. ET AL. STANDARD-DOSE VERSUS HIGH-DOSE CONFORMAL RADIOTHERAPY WITH CONCURRENT AND CONSOLIDATION CARBOPLATIN PLUS PACLITAXEL WITH OR WITHOUT CETUXIMAB FOR PATIENTS WITH STAGE IIIA OR IIIB NON-SMALL-CELL LUNG CANCER (RTOG 0617): A RANDOMISED, TWO-BYTWO FACTORIAL PHASE 3 STUDY. LANCET ONCOL. 16, 187 199 (2015).
NSCLC: RTOG 0617 Ω p=0.0042 BRADLEY, J. D. ET AL. STANDARD-DOSE VERSUS HIGH-DOSE CONFORMAL RADIOTHERAPY WITH CONCURRENT AND CONSOLIDATION CARBOPLATIN PLUS PACLITAXEL WITH OR WITHOUT CETUXIMAB FOR PATIENTS WITH STAGE IIIA OR IIIB NON-SMALL-CELL LUNG CANCER (RTOG 0617): A RANDOMISED, TWO-BYTWO FACTORIAL PHASE 3 STUDY. LANCET ONCOL. 16, 187 199 (2015).
NSCLC: 40 Ω Year Dose (Gy) RTOG study 2013 60 Individualized combined modality therapy 1306 2011 74-100 PET-based dose escalation concurrent with chemo 1106 2011 60 Targeted agents along with RT 60 Gy 0617 2006 60-74 Concurrent chemotherapy +/- Cetuximab 0617 2001 74 Involved Field RT with concurrent chemotherapy 0117 1994 63 Concurrent chemotherapy 9410 1993 64.5-83.8 Involved Field RT (3D) 9311 1988 60 Induction Chemotherapy 8808 1983 69.9 1.2 Gy BID 8311 1973 60 2 Gy per fraction 7301
NSCLC: 40 Ω Year Dose (Gy) RTOG study 2013 60 Individualized combined modality therapy 1306 2011 74-100 PET-based dose escalation concurrent with chemo 1106 2011 60 Targeted agents along with RT 60 Gy 0617 2006 60-74 Concurrent chemotherapy +/- Cetuximab 0617 2001 74 Involved Field RT with concurrent chemotherapy 0117 1994 63 Concurrent chemotherapy 9410 1993 64.5-83.8 Involved Field RT (3D) 9311 1988 60 Induction Chemotherapy 8808 1983 69.9 1.2 Gy BID 8311 1973 60 2 Gy per fraction 7301
ί σ ού ιαίο ύ οί ο οά ς φ έβας όφ α α α σ ι ής ο ού ι ο α ία
GRADING Ω YU, J. B., WILSON, L. D. & DETTERBECK, F. C. SUPERIOR VENA CAVA SYNDROME--A PROPOSED CLASSIFICATION SYSTEM AND ALGORITHM FOR MANAGEMENT. J. THORAC. ONCOL. 3, 811 814 (2008).
Ω ο α ε θό ά σ ή ε α φα ο ή α ι οθ α αο ί σ ι ι ή ι ό α ο σ ά ιο ς όσο αι βιο ο ία ο ό ο ίας βάσ αι ή α α ούφισ ιι ή α ι ώ ισ
Ύ Ά Ω Ί ς Έ ς - Ός Ό ς
ι ι ήα ι Ω ώ ισ 60 Gy ι ή ασ α ο οί σ (3-4) Gy x 3 αι σ σ έ ια ι ή ασ α ο οί σ α γο ι ή α ι 3 Gy x 10 4 Gy x 3 αι σ 4 Gy x 5 ή ώ ισ σ έ ια 3 Gy x (5-6) α ι ή α α ούφισ ςβ ί σ > % ός ός έ β ο ά, ROWELL, N. P. & GLEESON, F. V. STEROIDS, RADIOTHERAPY, CHEMOTHERAPY AND STENTS FOR SUPERIOR VENA CAVAL OBSTRUCTION IN CARCINOMA OF THE BRONCHUS: A SYSTEMATIC REVIEW. CLIN. ONCOL. 14, 338 351 (2002).
NSCLC: ι ο ι ι ή Όφ ος ό ο pn2, θ ι ά ό ια ι ή ό οσ σ ασ ό Pancoast tumors IIIA(N2); Ό ι σ ο ι ι ή ί ο σα / α α ο φισ ι ή ο ής, ECE;, όσ 45-50 Gy ο ή ά ιο α ί ο α ό ο > ια ο ι ή οσο ή σ α α ό ο α σ ή α α, όσ 60 Gy ί σ,α α ι ή, αι οσ α ι ή ο σ ήθ ς ί αι ί ο ι ι ή α ι ώ ισ
Ε Χ Ι Ω