Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.

I trattamenti integrati nelle neoplasie testa collo

1,648 views

Published on

Relazione della Dott.ssa Nerina Denaro sul trattamento integrato delle neoplasie testa e collo. XIV Congresso AOICO, Roma.

Published in: Health & Medicine
  • DOWNLOAD THIS BOOKS INTO AVAILABLE FORMAT (Unlimited) ......................................................................................................................... ......................................................................................................................... Download Full PDF EBOOK here { https://tinyurl.com/yyxo9sk7 } ......................................................................................................................... Download Full EPUB Ebook here { https://tinyurl.com/yyxo9sk7 } ......................................................................................................................... ACCESS WEBSITE for All Ebooks ......................................................................................................................... Download Full PDF EBOOK here { https://tinyurl.com/yyxo9sk7 } ......................................................................................................................... Download EPUB Ebook here { https://tinyurl.com/yyxo9sk7 } ......................................................................................................................... Download doc Ebook here { https://tinyurl.com/yyxo9sk7 } ......................................................................................................................... ......................................................................................................................... ......................................................................................................................... .............. Browse by Genre Available eBooks ......................................................................................................................... Art, Biography, Business, Chick Lit, Children's, Christian, Classics, Comics, Contemporary, Cookbooks, Crime, Ebooks, Fantasy, Fiction, Graphic Novels, Historical Fiction, History, Horror, Humor And Comedy, Manga, Memoir, Music, Mystery, Non Fiction, Paranormal, Philosophy, Poetry, Psychology, Religion, Romance, Science, Science Fiction, Self Help, Suspense, Spirituality, Sports, Thriller, Travel, Young Adult,
       Reply 
    Are you sure you want to  Yes  No
    Your message goes here
  • DOWNLOAD THIS BOOKS INTO AVAILABLE FORMAT (Unlimited) ......................................................................................................................... ......................................................................................................................... Download Full PDF EBOOK here { https://tinyurl.com/y6a5rkg5 } ......................................................................................................................... Download Full EPUB Ebook here { https://tinyurl.com/y6a5rkg5 } ......................................................................................................................... ACCESS WEBSITE for All Ebooks ......................................................................................................................... Download Full PDF EBOOK here { https://tinyurl.com/y6a5rkg5 } ......................................................................................................................... Download EPUB Ebook here { https://tinyurl.com/y6a5rkg5 } ......................................................................................................................... Download doc Ebook here { https://tinyurl.com/y6a5rkg5 } ......................................................................................................................... ......................................................................................................................... ......................................................................................................................... .............. Browse by Genre Available eBooks ......................................................................................................................... Art, Biography, Business, Chick Lit, Children's, Christian, Classics, Comics, Contemporary, Cookbooks, Crime, Ebooks, Fantasy, Fiction, Graphic Novels, Historical Fiction, History, Horror, Humor And Comedy, Manga, Memoir, Music, Mystery, Non Fiction, Paranormal, Philosophy, Poetry, Psychology, Religion, Romance, Science, Science Fiction, Self Help, Suspense, Spirituality, Sports, Thriller, Travel, Young Adult,
       Reply 
    Are you sure you want to  Yes  No
    Your message goes here
  • DOWNLOAD THIS BOOKS INTO AVAILABLE FORMAT (Unlimited) ......................................................................................................................... ......................................................................................................................... Download Full PDF EBOOK here { https://tinyurl.com/y6a5rkg5 } ......................................................................................................................... Download Full EPUB Ebook here { https://tinyurl.com/y6a5rkg5 } ......................................................................................................................... ACCESS WEBSITE for All Ebooks ......................................................................................................................... Download Full PDF EBOOK here { https://tinyurl.com/y6a5rkg5 } ......................................................................................................................... Download EPUB Ebook here { https://tinyurl.com/y6a5rkg5 } ......................................................................................................................... Download doc Ebook here { https://tinyurl.com/y6a5rkg5 } ......................................................................................................................... ......................................................................................................................... ......................................................................................................................... .............. Browse by Genre Available eBooks ......................................................................................................................... Art, Biography, Business, Chick Lit, Children's, Christian, Classics, Comics, Contemporary, Cookbooks, Crime, Ebooks, Fantasy, Fiction, Graphic Novels, Historical Fiction, History, Horror, Humor And Comedy, Manga, Memoir, Music, Mystery, Non Fiction, Paranormal, Philosophy, Poetry, Psychology, Religion, Romance, Science, Science Fiction, Self Help, Suspense, Spirituality, Sports, Thriller, Travel, Young Adult,
       Reply 
    Are you sure you want to  Yes  No
    Your message goes here
  • Be the first to like this

I trattamenti integrati nelle neoplasie testa collo

  1. 1. I trattamenti integrati nelle neoplasietesta colloNerina DenaroOncologia MedicaA.O. Santa Croce e CarleRoma, 25-26 Gennaio 2013XIV Congresso AOICO"Lapproccio multidisciplinare alle neoplasie della testae del collo"
  2. 2. I trattamenti integrati nelle neoplasie testa collo
  3. 3. Rinofaringe (SCC – UCNT)Stadio I-IIStadio III-IV (LAHNC)OrofaringeStadio I-IIStadio III-IVIpofaringe (seno piriforme)Stadio I-IIStadio III-IVLaringeStadio I-IIStadio III-IVCavo oraleStadio I-IIStadio III-IVØRTØCRT(in casi selezionati terapia di induzione (ICT) )ØRT ( 2ascelta: CH)ØCRT (2ascelta BRT; in casi selezionati ICT or CH +RT o CRT)ØRT (2ascelta : CH)ØCRT (2ascelta : BRT; in casi selezionati CH + RT orCRT)ØCH O RTØStage III: CH/CRT o BRT/preservazione d’organoØStage IV: CRT (2ascelta : BRT; CH)ØCHØCH + RT or CRT (2ascelta: CRT or BRT)A chi?
  4. 4. III-IVCHIRURGIA CT/RTCT/RT FU Chir su N Chir su TRT-Trattamento esclusivo nella malattia localmenteavanzata-Dopo Chirurgia nei pazienti ad alto rischio di recidiva-Prima di un trattamento chirurgico o CRTQuando?
  5. 5. Adiuvante
  6. 6. Ø RT: Standard 1.8/2 cGy fino 66 – 75 GyØ CRT: P 100mg/m2x 3 + Standard RT (70 Gy)Esiste una Chemioradioterapia Standard?Settimane 1 2 3 4 5 6 7 (dose andscheduling)Cisplatin (17)   (100 mg/m2/day)Radiation ________________________________________ (200 cGy/day up to 70Gy)Ø BRT: Cetuximab + Standard RT (70 Gy)Ø CT di Induzione : T 75mg/m2 + P 75mg/m2 + F 750mg/m2 gg1-5 (Vermorken)Ø T 75 mg/m2 + P 100 mg/m2 + FU 1000 mg/m2/d gg1-4 (Posner)Come?
  7. 7. coventional RT + carbo/fu x 3 (arm A) 279 pts840 pts ------- Random accelerated RT + carbo/fu x 2 (arm B) 280 ptsvery accelerated RT (arm C) 281 pts
  8. 8. PFS3 cicli vs RT = p 0.0412 cicli vs RT = p 0.060OS3 cicli vs RT = p 0.0402 cicli vs RT = p 0.16LRC3 cicli vs RT = p 0.0452 cicli vs RT = p 0.033
  9. 9. Salama JK. Et al JCO 2007Chemoradiation
  10. 10. PosnerTAX 324VermorkenTAX 323Induzione
  11. 11. Induzione
  12. 12. Negli studi di Posner e Vermorken non c’è un confronto tra CRT e Induzioneseguita da RT o CRTGli studi che hanno fatto un confronto diretto Paradigm e Decide non hannoraggiunto un adeguato reclutamentoAggiungere la terapia di Induzione prima della CRT aggiunge tossicità eaumenta il numero di mortiInduzione
  13. 13. GSTTC – H&N07 (Italy)-- ICT **BRT *** BRT ICT > BRTCRT * CRT ICT > CRTFACTORIAL 2 X 2 STUDY* CF x 2 / RT** TPF*** CmabLA HNCGONO - INTERCEPTOR TRIAL (Italy)TCF x 3  C/mab + RTCisPt + RT(standard RTOG)Salvage surgeryFollow-upRStudi «Chiarificatori»
  14. 14. LA HNCGORTEC 2007-02 (France)TCF x 3  C/mab + RTCarbo/Fu + RTSalvage surgeryFollow-upRStudi «Chiarificatori»
  15. 15. RT ± CetuximabBonner et al Lancet Oncol 201010% di beneficio di sopravvivenza a lungo termine (5 anni OS 46% vs 36%)27% di riduzione del rischio di morte (HR=0.73)L’intensità del rash cutaneo correla con prolungata sopravvivenza>OS in tutte le localizzazioni: orofaringe, ipofaringe e laringeBioradioterapia Bonner TRIAL
  16. 16. Bioradioterapia il futuro?
  17. 17. I pazienti con tumore HPV+ hanno un significativo vantaggio disopravvivenza e di PFS (maggiormente orofaringe)Hpv
  18. 18. Hpv
  19. 19. Preservazione dell’organoAuthor (year) Site Treatment LP OSVA (1991) 332 LarynxStage III-IVPF  RTversusLTRT64% 68% at 2y68% at 2 yEORTC 24891 (1996) 202 Hypo pharynxT2-T4N0-N3PF  RTversusLTRT22% a 5 y 38% at 5 y33% at 5 yGETTEC (1998) 68 Larynx(only T3 fixed chord) N0-N2bPF  RTversusLTRT42% (median 8 y) 69% at 2y84% at 2 yP=0.006RTOG (2003) 547 LarynxStage III and IVPF  RTversusCT/RTversusRT70% a 5 yP =0,00384% a 5 yP=<0,00166% a 5 y59% at 5y55% at 5 y54% at 5 yGORTECC 2000-01(2009)213 LarynxHypo pharynxStage III and IVPFversus  RTTPF57% a 3 yP = .0370% a 3 y60% at 3y60% at 3 yEORTC 24954-22950(2009)450 Larynx T3-4Hypo pharynx T2-4N0-2PF  RTversusalternating PF – RTfor six weeks48% a 5 y52% a 5 y53% at 5y60% at 5 yPosner (2009) 166 LarynxHypo pharynxStage III/IV(74% resectable)PF versus  CT/RTTPF32% LFS a 3 y52% LPF a 3 y40% at 3y57% at 3 yTREMPLIN (2011) 153 LarynxHypo pharynxStage III-IVCT/RTTPF  versusCetuximab + RT93% a 3 months96% in 3 months85% at 1.5y86% at 1.5 y
  20. 20. The Intergroup trialThe Intergroup trial Standard radiotherapyStandard radiotherapyStandard radiotherapy +Standard radiotherapy +cisplatin 100mg/mcisplatin 100mg/m22q 3 wksq 3 wksAll grade III-VAll grade III-Vtoxicitiestoxicities 50%*50%* 90%*90%*Toxic deathsToxic deaths 2%2% 4.5%4.5%Adelstein DJ et al; J. Clin. Oncol. 2003;21:92-98Adelstein DJ et al; J. Clin. Oncol. 2003;21:92-98* = P<0.0001Tossicità
  21. 21. Tossicità051015202530doloredisfagiadisidratazioneUsodioppiaceiCaloponderaleQoLOspedalizzazioneNEA. Trotti, IJROBP 2003
  22. 22. Loco-regional failure 9,4%Distant failure 13,1%Second cancer 6,6%Treatment-related 7,8%Intercurrent mortality 11,8%Non cancer mortality 19,6%
  23. 23. • Circa 2/3 dei pazienti sviluppa mucosite severa che puòrichiedere il posizionamento di una PEGAng KK et al, J Clin Oncol 2005;23:3008-15Vokes EE et al, J Clin Oncol 2003;21:320-326• Scarsa Compliance al trattamento si verifica in circa 1/3 deipazientiLamont EB et al, Lancet Oncology 2001;2:261-269Browman GP et al, Head and Neck 2001;23:579-589• L’impatto della CRT sulla conservazione d’organo può esseresovrapponibile in alcune casistiche alla laringectomia totale intermini di QoL.Lo Tempio MM et al, Otolaryngol Head and Neck Surg 2005;132:948-53Hanna E et al, Otolaryngol Head and Neck Surg 2004;130:875-9Tossicità: CRT è efficace ma…
  24. 24. Lavoro multidisciplinare
  25. 25. • La Chemioradioterapia a base di Cisplatino (100 mg/m2 ) eRT convenzionale rimane lo standard sia in adiuvante chenel localmente avanzato• Nella preservazione d’organo CRT,CT alternata a RTe induzione si equivalgono• La bioradioterapia deve essereconsiderata nei pazienti che nonpossono ricevere CRTConclusioni: certezze
  26. 26. • Ct di induzione seguita da RT o CRT: Non ci sono datidefinitivi, deve essere valutata nei pz unfit per ricevere CRT• Non è stata definita la migliore terapia per I tumori HPVpositivi• Non si è concordi nel trattamento chirurgico di dissezionelinfonodale nei N2-3 post CRT• Rimane da stabilire la migliore combinazione, chirurgia,CRT, approccio trimodale per la preservazione dellaFUNZIONE D’ORGANOConclusioni: da definire
  27. 27. Grazie

×