Advanced technology in radiotherapy improved the treatment results
Normal tissue is properly protected
Definitive Radiotherapy for Early Stage NSCLC
the therapy provided a 98% rate of local control!
☆ ☆ ☆ ☆
Concurrent Chemo-Radiotherapy plays more important roles
Definitive Concurrent Chemo-Radiotherapy for Locally Advanced NSCLC
☆ ☆
RTOG 9410:
Concurrent vs Sequential Chemo-Radiotherapy for Stage III NSCLC
SBRT has been becoming standard treatment for inoperable stage I NSCLC
How about operable stage I NSCLC?
Randomized Studies are on the Way!
Definitive Radiotherapy for Early Stage NSCLC Question: Can we give a thorough staging in China ?
Overall Survival
1
0 .8
0 .6
0 .4
stage IA (n=47)
0 .2
stage IB (n=16)
p = 0.2
0
01234567
Time (years)
Comparison of 5-Yr Overall Survival Between Surgery & STI
Mountain * JCOG* JNCCH*
Outcomes After Stereotactic Lung Radiotherapy or Wedge Resection
for Stage I Non–Small-Cell Lung Cancer
Grills et al: JCO 2010 doi: 10.1200/JCO.2009.26.5157
Update in Radiotherapy for Non-Small Cell Lung Cancer
Radiotherapy for NSCLC
Definitive radiotherapy for early stage non-small cell lung cancer
Definitive radiotherapy for locally advanced stage non-small cell lung cancer
Outcomes After Stereotactic Lung Radiotherapy or Wedge Resection
for Stage I Non–Small-Cell Lung Cancer
Outcomes of Local Resection for Stage I Non–Small-Cell Lung Cancer
Can the clinical early stage Pts be given a thorough Staging?
PET/CT scanning, how many percent can it be used in your clinical early stage patients?
Outcomes After Stereotactic Lung Radiotherapy for Stage I Non–Small-Cell Lung Cancer
Summary of Japanese Studies
Survival curves of operable pts irradiated with BED of 100 Gy or more according to Stage
Survival
100 75
Dead/Total MST Seq 50 163/199 14.6 mo. Con 1 147/200 17.1 mo.
50
25
P-value (log-rank): 0.038
Mediastinoscopy, Is it accepted and widely used by our thoracic surgeon, AND our patients
EBUS, what does it mean, “ if appropriable”? Without appropriate staging, How do we treat our patients?
STI**
Stage IA 67% Stage IB 57%
80% 63%
74% 53%
90% 84%
* Surgery
** Stereotactic Irradiation
Onishi H, ASCO 2004
High-Tech Radiotherapy Machine
(A)
(B)
(C)
(D)
Image-guided radiation delivery
Outcomes After Stereotactic Lung Radiotherapy or Wedge Resection
for Stage I Non–Small-Cell Lung Cancer
Grills et al: JCO 2010 doi: 10.1200/JCO.2009.26.5157
So, before we get new evidence, surgery still is the standard care for operable early stative Concurrent Chemo-Radiotherapy for Locally Andvanced NSCLC