胸部肿瘤内科治疗策略.ppt

* * 本页要点：EGFR-TKI药物用于二线治疗，对于EGFR突变阴性的疗效要远远差于突变阳性的患者，有的有效率只有2.6。因此，在TKI药物应用于二线治疗时也要进行EGFR突变的检测，才能保证患者的获益 * Metastatic (extensive-stage) disease is present at diagnosis in most patients with SCLC. Thus, survival is usually not affected by small changes in the amount of locoregional tumour involvement, as it is for NSCLC. Thus, although relevant, the detailed TNM staging previously described (which is more appropriate when surgery is being considered) is not commonly employed for staging SCLC. Instead, a simplified staging system of ‘limited’ versus ‘extensive’ disease is used.1 Approximately one-third of patients with SCLC present with limited-stage disease.2 In limited-stage disease, the tumour is confined to the hemithorax of origin, the mediastinum and the supraclavicular nodes, which can be encompassed within a ‘tolerable radiation’ therapy port.3 The extensive stage of SCLC encompasses any tumour too widespread to be included within the definition of limited stage and any patients with distant metastasis.3 Patients with limited disease have a median survival of 3 months without drug therapy, compared with 1.5 months for patients with extensive disease.2 References PDQ Treatment Guidelines 2000. Kelly K. Chest 2000; 117 (4 Suppl 1): 156S-162S. Zelen M. Cancer Chemother Rep 3 1973; 4: 31-42. SCLC预后 广泛性肿瘤平均存活时间不超过12~15周， 局限性肿瘤只有大约6个月。 化疗显著的提高平均生存期： 局限性肿瘤为12个月 广泛性肿瘤为9~10个月。 SCLC治疗原则 广泛性：化疗 局限性：多种模式的治疗 化疗 放疗 手术 局限期小细胞肺癌的治疗策略 SCLC 一线化疗 SCLC一线化疗最常用的方案为： EP方案 CAV方案 对于局限期的患者， EP方案疗效优于CAV方案。 共识与争议 放疗和EP方案联合是目前局限期小细胞肺癌患者的标准治疗。 放疗早期参与治疗优于晚参与。 与放射治疗联合时选用EP方案 序贯还是同步 脑预防放疗的时间 放疗的范围、剂量， 时间剂量分割方法、 共识 争议 治疗选择 同步化放疗和放疗早期参与有一定的生存受益。 放疗早期参与在放疗总疗程时间小于 30 天，化疗方案为 EP 或含有 DDP 组更显示出提高患者长期生存。 任何治疗开始到放疗结束的时间（SER）短显