肺癌治疗与原理课件

1、LUNG CANCER MANAGEMENTMETHODS AND PHILOSOPHY DR. D. R. JOSHIB. J. MEDICAL COLLEGE, PUNE = SYMPTOMATIC & PHYSICAL ASSESSMENT, = RADIOLOGICAL ASSESSMENT, * PLAIN CHEST FILMS, * C.T.SCANS * RADIONUCL.BONE SCANS = Thcentesis, Bscopy, Medscopy = And . U S G ABDOMEN. FOR NEW PATIENTS - High index of suspi

2、cion Try to define anatomic extent Find cell-type of lesion Patients GC for aggressive Rx Plan for the Rx.STAGING & 5-Yrs SURVIVAFOR NSCLC (1986) I T1_2 no mo 60-80 % IIT1_2 N1 mo 25-50 % IIIaT3 N0- mo 25-40 % T1-3 N2 mo 10-30 % IIIbAny T4/N3 mo . 5 % IVAny M1 5 %AJCC RECOMMENDED STAGING # Clinical

3、diagnostic # Post-surgical pathologic stage # Re-treatment stage # Autopsy stage PRE-OP EVALUATION - CARDIOPULM STATUS HIGH RISK : Recent MI, Arrhythmias Congestive Cardiac Failure, Systemic Hypertension Pulmonary Hypertension, FEV1 35 % High PCO2 INDICATIONS FOR SURGERY . NSCLC : 1. TIS 2. Stage I,

4、 II 3. Stage III a 4. Assoc Effusion transudate clear, no malignant cell SCLC : 1. Solitary pulmonary nodule, 2. Stage I (T1NOMO) EXTENT OF RESECTION . DEPENDS ON EXTENT OF LESION * Wedge resection * Segmentectomy * Lobectomy * Sleeve resection * Pneumonectomy # PALLIATIVE RESECTION - NO ROLE NSCLC

5、: CONTRAINDICATIONS FOR CURATIVE SURGERY STAGE IIIb - N3 disease STAGE IV Recurrent Lary / Phrenic N palsy Vena cava / Lt Atrium involvement SVC Obstruction T3 Disease Card. tamponade, Malignant Effusion. Cardiac arrythmias MVV 40%, FEV11.5L Split PFT by V / Q scan 50 * No CO2 retention CHEMOTHERAPY

6、 IN SCLC WIDELY USED : CISPL, ETOP. Every 3 weeks* oral / single / old pt OR poor performance pt : ETOP.* Single agent chemo : ETOPOSIDE TENOPOSIDE* Salvage : ETOP + CISPL ( EP ) Cycloph+Adria+Vincrist (CAV) NOW : intensive initial OR re-induction Rx with autologous bone marrow infusion NEO-ADJUVANT

7、 CHEMOTHERAPY Assess drug sensitivity of cells Render unresectable resectable Better tolerated before surgery Slows growth after primary Tumour is removed Preserve blood supply good drug delivery Increase survival in N2 than surgery alone RADIATION - THERAPY I. Neoadjuvant Pancoast * N2 4500 II. Adj

8、uvant N+ T3 Incom.resection 5000 III. Palliative Stage III Stage IV 2-5000 (local symptoms) IV. Definitive T1-2N0-1 No/refuse Surg 6000 V. SCLC (+chemo) Ltd stage 5000 ADVANCES IN RADIOTHERAPY. # BIOLOGIC * Hyper - fractionation * Accelerated Therapy # TECHNICAL * 3- Dimensional Conf. Radiation Ther

9、apy RESPONSE TO PALLIATIVE RADIATION . Haemoptysis . 75-85 % SVC obstruction 60-80 % Pain 50-75 % Cough . 35-65 % Dyspnoea . 35-50 % Wt.loss / anorexia . 30-50 % Atelectasis 20 % V.Cord palsy . 5 % OVERALL RELIEF = 60-70 % SUPPORTIVE CARE # Encourage to STOP SMOKING # During CHEMOTHERAPY - * ANTI EM

10、ETICS, * BLOOD COUNTS & CHEMISTRY * MONITOR FOR INFECTION AND BLEEDING * ROUTINE BOLUS / FLUIDS WITH CISPLATINPSYCHOLOGICAL SUPPORT. # FEAR, ANXIETY, DEPRESSION # COMPROMISED SELF IMAGE # CANCER SURVIVORS # PHYSICAL HANDICAPS - REAL - PERCEIVED FEAR OF RELAPSEDEALING WITH DEATH . # THREE PHASES OF UNSUCCESSFUL CANCER Rx _ - OPTIMISM AT HOPE OF CURE - ACKNOWLEDGEMET OF INCURABLE DISEASE AT RECUR