Nsclc - NSCLC New Advances in Treatment 2002-2005 STAGE-1...

Info iconThis preview shows pages 1–15. Sign up to view the full content.

View Full Document Right Arrow Icon
NSCLC New Advances in Treatment 2002-2005
Background image of page 1

Info iconThis preview has intentionally blurred sections. Sign up to view the full version.

View Full DocumentRight Arrow Icon
STAGE-1 NSCLC T 1 N 0 M 0 T 2 N 0 M 0 -S x i s T O C - Lobectomy > Segmentectomy/Wedge Resection - Ass with Locoregional recurrence However, no overall survival difference . - Inoperable disease but sufficient Pul. Reserve RT with curative intent - Adjuvant Therapy -Sx RT in St. I & II ass. survival CT
Background image of page 2
INT. ADJUVANT LUNG CANCER TRIAL [IALT] - 1867 Patients - St. I: 36.5% St. II: 24.2% St III: 39.3% - Cisplatin + Etoposide 56.5% Vinorelbine 26.8% Vinblastine 11% Vindesine 5.8% - Sx: Pneumonectomy- 34% Lobectomy: 64%
Background image of page 3

Info iconThis preview has intentionally blurred sections. Sign up to view the full version.

View Full DocumentRight Arrow Icon
1867 Patients 932 Patient (Adj. CT) Survival 44.5% 40% (p < 0.03) 5 years Disease free 39.4% 34.3% (p < 0.003) survival 5 years Conclusion: Cisplatin based adjuvant CT improves survival amongst completely resected NSCLC NEJM 2004; 350: 351-60 935 (Control) IALT
Background image of page 4
JAPAN LUNG CANCER RESEARCH GROUP - 979 Patients. - St I; 75% (adeno carcinoma) Patients Adj. UFT 2 yrs No Post-op T/T 5 yrs survival 88% 85% St. 1a: 716 pts. 5yrs survival 89% 90% (No Benefit) St. 1b: 263 pts. 5yrs Survival 85% 74%
Background image of page 5

Info iconThis preview has intentionally blurred sections. Sign up to view the full version.

View Full DocumentRight Arrow Icon
Conclusion : Adjuvant UFT improved survival among patients with St. I adeno carcinoma UFT : - uracil-tegafur - anti-angiogenic effect -orally NEJM 2004; 350: 1713-21
Background image of page 6
ADJUVANT LUNG PROJECT, ITALY 1209 Patients Mito/Vnd/Cis n = 606 (3 cycles) Control n = 603 I- 39% 38% II- 31% 34% IIIA- 29% 28% Sq. cell 51% 49% Adeno 36% 38% Pneumonectomy 24% 26% RT (Post CT) 43% 43% 50-54 6y/5-6 wks.
Background image of page 7

Info iconThis preview has intentionally blurred sections. Sign up to view the full version.

View Full DocumentRight Arrow Icon
Median OS 55.2 mths 48 mths Median 36.5 mths 28.9 mths Progression Free survival Differences not Statistically Significant Conclusion: Failed to confirm statistically significant role of adj. CT in completely resected NSCLC. J Natl. Cancer Inst. 2003; 95: 1453-61 Results from RCT: Adj. CT should be considered strongly in Ib or II NSCLC
Background image of page 8
RADIO THERAPY Conventional RT: - 10 weeks - may result in tumor repopulation if extended beyond six weeks - 1.6% loss of survival/day of treatment beyond six weeks Limiting overall t/t time Hypofractionation Large daily fraction Over shorter course Acceleration Hyperfractionated Acceleration short course multiple fractions/day
Background image of page 9

Info iconThis preview has intentionally blurred sections. Sign up to view the full version.

View Full DocumentRight Arrow Icon
Netherland Cancer Institute Dose/# : 2.25 Gy Time : 6 weeks (5 days/wk) # : 30 3D CRT : higher dose delivered to tumor, sparing (N) tissue 55 Patients (26 St. I & II, Rest locally advanced) rMLD = MLD/prescribed tumor dose [Measure for RR to develop Radiation Pneumonitis] ACCELERATION
Background image of page 10
Gr. I : St. I & II (13 patients) 87.8 Gy Gr. II/III : (29 patients) 81 Gy IV : (11 pts) 74 Gy Dose limiting toxicity : 3 pts (Gr III/IV Pneumonitis) Results : 6 CR 38 PR 6 stable/progressive disease Acceleration : No additional toxicity (Radiother Oncol 2003; 66: 119-26)
Background image of page 11

Info iconThis preview has intentionally blurred sections. Sign up to view the full version.

View Full DocumentRight Arrow Icon
HYPOFRACTIONATION Few, Large # over limited time period Radiological effects: 1. Risk of Accelerated Repopulation by Shortening overall t/t time 2. Late toxicity: High (Lung/Spinal cord) because of high # 3. Useful in small tumors 2 years OS: 46 – 81% Local control rates equivalent to conventional RT
Background image of page 12
25 Patients Medically Inoperable : St.I/I – 9 Patients : St. III – 16 Patients 11 Patients Induction CT Hypofractionated Accelerated RT 72 Gy/24 Daily # (i.e. 3 Gy/#) 22 Patients evaluable for Long term toxicity CR : 7 Patients PR : 8 Patients Stable Disease : 5 Patients Progression : 2 patients
Background image of page 13

Info iconThis preview has intentionally blurred sections. Sign up to view the full version.

View Full DocumentRight Arrow Icon
AC Toxicity: Gr. III Esophagitis - 2 Patients Gr. III Pnenuonitis - 1 Patient Gr. III Haemat toxicity
Background image of page 14
Image of page 15
This is the end of the preview. Sign up to access the rest of the document.

This note was uploaded on 12/03/2011 for the course MEDICINE 350 taught by Professor Dr.aslam during the Winter '07 term at Medical College.

Page1 / 60

Nsclc - NSCLC New Advances in Treatment 2002-2005 STAGE-1...

This preview shows document pages 1 - 15. Sign up to view the full document.

View Full Document Right Arrow Icon
Ask a homework question - tutors are online