肺癌治疗与原理PPT.pptVIP

LUNG CANCER MANAGEMENT METHODS AND PHILOSOPHY DR. D. R. JOSHI B. J. MEDICAL COLLEGE, PUNE;; ;STAGING 5-Yrs SURVIVAFOR NSCLC (1986) I T1_2 no mo …… 60-80 % II T1_2 N1 mo …… 25-50 % IIIa T3 N0- mo …… 25-40 % T1-3 N2 mo …… 10-30 % IIIb Any T4/N3 mo …... 5 % IV Any M1 …… 5 %;AJCC –RECOMMENDED STAGING … # Clinical –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, II 3. Stage III a 4. Assoc Effusion transudate clear, no malignant cell SCLC : 1. Solitary pulmonary nodule, 2. Stage I (T1NOMO) ; SURGERY IN UNDIAGNOSED SPN INDICATIONS ….. H/O SMOKING AGE 35 YRS SIZE 3 CMS LACK OF CALCIFICATION H/O PREVIOUS OR CURRENT MALIGNANCY GROWTH OF LESION CHEST SYMPTOMS ASSOCIATED PNEUMONIA, COLLAPSE,  ADENOPATHY …..; EXTENT OF RESECTION ….. DEPENDS ON EXTENT OF LESION  * Wedge resection * Segmentectomy * Lobectomy * Sleeve resection * Pneumonectomy # PALLIATIVE RESECTION - NO ROLE ; NSCLC : CONTRAINDICATIONS FOR CURATIVE SURGERY … STAGE IIIb - N3 disease STAGE IV Recurrent Lary / Phrenic N palsy Vena cava / Lt Atrium involvement SVC Obstruction T3 Dis