临床医学04—培训课件.pptVIP

* A retrospective review investigated survival in 152 patients with stage I and II NSCLC, who were unable to undergo surgery for medical reasons and received radiotherapy instead.1 The graph shows 2-year disease-free survival by tumor stage (T1, T2 or T3) and radiation dose.1 T1 tumors treated with radiation doses of 65 Gray or more had the best disease-free survival rate, 73% at 2 years.1 This is comparable to the overall 2-year survival rates of approximately 75% (segmentectomy) and approximately 90% (lobectomy) reported separately for resected patients with stage I (T1 or T2, N0) NSCLC.2 1. Dosoretz DE, et al. Int J Radiation Oncology Biol Phys 1992; 24: 3-9. 2. Warren WH, Faber LP. J Thorac Cardiovasc Surg 1994; 107: 1087-1094. * Stage IIIA:1 surgery alone in highly selected cases chemotherapy combined with radiotherapy, chemotherapy plus radiotherapy followed by surgery, or chemotherapy after surgery (encouraging results for patients with good performance status) surgery and postoperative radiation therapy (can improve local control, but there is controversy over whether it improves survival) radiation therapy (long-term survival benefit in 5-10% of patients; patients with high performance status are most likely to benefit). Stage IIIB:1 radiation therapy alone (patients with advanced disease and high performance status are most likely to benefit) chemotherapy combined with radiation therapy (modest survival benefits compared with radiation therapy alone) chemotherapy and/or radiation therapy followed by surgery chemotherapy alone (for patients with malignant pleural effusion). 1. PDQ Treatment Guidelines. * * In order to replicate DNA, the two strands must be separated, which causes strain in adjacent areas of the helix. The strain is relieved by DNA topoisomerases, which make a transient break in the DNA backbone to permit unwinding. Topoisomerase inhibitors increase the frequency of these breaks, which eventually triggers programmed cell dea