肺癌腦轉(zhuǎn)移的治療進(jìn)展江浩腫瘤放療中心蚌埠醫(yī)學(xué)院第一附屬醫(yī)院蚌埠醫(yī)學(xué)院附屬腫瘤醫(yī)院一石激起千重浪？MulvennaP,etal.Lancet.

2016Oct22;388(10055):2004-2014.WBRTforNSCLC：Yes&No？MulvennaP,etal.Lancet.

2016Oct22;388(10055):2004-2014.本研究的一般描述anon-inferiority,phase3randomisedtrialdoneat69UKandthreeAustraliancentres.NSCLCpatientswithbrainmetastasesunsuitableforsurgicalresectionorstereotacticradiotherapyoptimalsupportivecare(OSC)includingdexamethasoneplusWBRT(20Gyinfivedailyfractions)orOSCaloneincludingdexamethasoneTheprimaryoutcomemeasure：quality-adjustedlife-years(QALYs).QALYsweregeneratedfromoverallsurvivalandpatients’weeklycompletionoftheEQ-5Dquestionnaire.BetweenMarch2,2007,andAug29,2014,538patientswererecruitedfrom69UKandthreeAustraliancentres,andwererandomlyassignedtoreceiveeitherOSCplusWBRT(269)orOSCalone(269).InterpretationAlthoughtheprimaryoutcomemeasureresultincludestheprespecifiednon-inferioritymargin,thecombinationofthesmalldifferenceinQALYsandtheabsenceofadifferenceinsurvivalandqualityoflifebetweenthetwogroupssuggeststhatWBRTprovideslittleadditionalclinicallysignificantbenefitforthispatientgroup.OverallSurvivalAverageQualityofLifeAverageQALYForestPlotofSurvivalInsummaryQUARTZprovidescompellinginformationforcliniciansandpatientsalike;foryoungerpatients,WBRTmightofferasurvivaladvantagebutforallothergroups,omittingWBRTdoesnotsignificantlyaffectQALYoroverallsurvival.Nov.2016：WBRTforNSCLC

theendofanera?AnnaM.E.B,etal.JThorac.Dis.2016;8(11):E1525-E1527RTOG-RPA:Class1-3Athree-classrecursivepartitioning(RPA)systembytheRTOGtodescribedifferentprognosticgroupsofpatientswithbrainmetastases.RPAClassI:themostfavorableprognosticgroup,KPS≥70,anage≤65yearsandcontrolledprimarytumorwithoutextracranialmetastases.RPAClassIII:thepoorestprognosispatients,KPS<70.RPAClassII:TheremaindersofpatientsGasparLE,etal.IntJRadiat

Oncol

BiolPhys.2000;47:1001-6.Howtochoose？QuartztrialisgroundbreakinginthatitisthefirstprospectiverandomizedstudyprovidingevidencethatpoorprognosispatientswithbrainmetastasesfromNSCLCdonotbenefitfromWBRT,andBSCshouldberegardedstandardofcareinthesepatients.Asexplained,thisdoesnotholdtrueforyoungerpatients,withlimitedorabsentextracranialdisease,inwhominadditiontothepossibilityofWBRTothertreatmentapproachesincludingradiosurgeryaloneorsystemictreatmentmaybeindicatedasanalternativetoWBRT.RTOG-GPA:GradedPrognostic

AssessmentsSperdutoPW,etal.IntJRadiat

Oncol

BiolPhys2010;77:655–61.RTOG-GPA:GradedPrognostic

AssessmentsSperdutoPW,etal.IntJRadiat

Oncol

BiolPhys2010;77:655–61.JCO：Jan.2017SRS/WBRT/EGFR-TKIGPA:2-3.5&0-1.5?結(jié)論與爭議結(jié)論：對于不適合行手術(shù)/SRS放療的非小細(xì)胞肺癌患者可以選擇一激素