肺癌治療與原理

LUNGCANCERMANAGEMENTMETHODSANDPHILOSOPHY

DR.D.R.JOSHIB.J.MEDICALCOLLEGE,PUNE

=SYMPTOMATIC&PHYSICALASSESSMENT,=RADIOLOGICALASSESSMENT,*PLAINCHESTFILMS,*C.T.SCANS*RADIONUCL.BONESCANS=Th’centesis,B’scopy,Med‘scopy=And….USGABDOMEN.

FORNEWPATIENTS---

HighindexofsuspicionTrytodefineanatomicextentFindcell-typeoflesionPatient'sGCforaggressiveRxPlanfortheRx.STAGING&5-YrsSURVIVAFORNSCLC(1986)

IT1_2nomo …… 60-80%II T1_2N1mo …… 25-50%IIIa T3N0-mo …… 25-40% T1-3N2mo …… 10-30%IIIb AnyT4/N3mo …...<5%IV AnyM1 ……<5%AJCC–RECOMMENDEDSTAGING…#Clinical–diagnostic#Post-surgical–pathologicstage#Re-treatmentstage#AutopsystagePERFORMANCEINDEX….***KARNOFSKYSCALE***ECOG(Zubrod)SCALE

RecordAtDiagnosisstageCorrelatewithapparentstage

oftheDisease.

PRE-OPEVALUATION-CARDIOPULMSTATUS

HIGHRISK:RecentMI,ArrhythmiasCongestiveCardiacFailure,SystemicHypertension…PulmonaryHypertension,FEV1<35%HighPCO2…INDICATIONSFORSURGERY..

NSCLC:1.TIS2.StageI,II3.StageIIIa4.AssocEffusiontransudateclear,nomalignantcell

SCLC:1.Solitarypulmonarynodule,2.StageI(T1NOMO)

SURGERYINUNDIAGNOSEDSPN

INDICATIONS…..H/OSMOKINGAGE>35YRSSIZE>3CMSLACKOFCALCIFICATIONH/OPREVIOUSORCURRENTMALIGNANCYGROWTHOFLESIONCHESTSYMPTOMSASSOCIATEDPNEUMONIA,COLLAPSE,

ADENOPATHY…..

EXTENTOFRESECTION…..

DEPENDSONEXTENTOFLESION

*Wedgeresection

*Segmentectomy

*Lobectomy

*Sleeveresection

*Pneumonectomy

#PALLIATIVERESECTION-NOROLE

NSCLC:CONTRAINDICATIONSFORCURATIVESURGERY…

STAGEIIIb-N3diseaseSTAGEIV

RecurrentLary

/PhrenicNpalsy

Venacava/LtAtriuminvolvement

SVCObstruction

T3Disease

Card.tamponade,MalignantEffusion.

CardiacarrythmiasMVV<40%,FEV1<1.5LSplitPFTbyV/Qscan<1Ltr.

CHEMOTHERAPYPATIENT…..*Fullyambulatory

*Evaluabletumormass

*Nopriorchemotherapy

*Nomedicalproblem

*PaO2atroomtemperature>50

*NoCO2retention

CHEMOTHERAPYINNSCLC…

…MAXIMUMBENEFITWHEN

*CHEMOTHaddedtoRADIOTH.

Locallyadvanced–IIIb&fewIIIa

*Neo-adjuvantChemoPre-operativeRx

forSTAGEIIIa–

somenewdrugs-

Docetaxel,Paclitaxel

Gemcitabine,Topotecan

Tirapazamine,etc…

CHEMOTHERAPYINSCLC…

WIDELYUSED:CISPL,ETOP.

Every3weeks

*oral/single/oldpt

ORpoorperformancept:ETOP.

*Singleagentchemo:ETOPOSIDE

TENOPOSIDE

*Salvage:ETOP+CISPL(EP)

Cycloph+Adria+Vincrist(CAV)

NOW:intensiveinitialORre-inductionRxwithautologousbonemarrowinfusion

NEO-ADJUVANTCHEMOTHERAPY

AssessdrugsensitivityofcellsRenderunresectableresectable

BettertoleratedbeforesurgerySlowsgrowthafterprimary

TumourisremovedPreservebloodsupply–

gooddrugdelivery

IncreasesurvivalinN2thansurgeryalone

RELATIVECONTRAINDICATIONS

FORRADIOTHERAPY…..

#PriorHIGH-DOS