肺癌课件-（精） - 副本.ppt

* Surgery and postoperative radiotherapy for patients with a solitary brain metastasis and no evidence of other tumors.1 Stereotactic radiosurgery may be useful in highly selected patients with good performance status and with metastases confined to the brain.1 Palliative external beam radiotherapy.1 Chemotherapy for symptom palliation in patients with good performance status. 1 Some chemotherapy regimens may prolong time to progression and survival. Docetaxel 100 mg/m2 every 3 weeks significantly (p=0.044) prolonged time to progression compared with vinorelbine and ifosfamide (p0.001) in 373 patients with recurrent NSCLC after platinum-based chemotherapy.2 Taxotere 75 mg/m2 significantly (p0.05) prolonged survival compared with best supportive care in patients with NSCLC previously treated with platinum-based chemotherapy.3 Endobronchial laser therapy or interstitial radiotherapy for endobronchial lesions.1 1. PDQ Treatment Guidelines. 2. Fossella FV, et al. ASCO 1999, abs. 1776. 3. Shepherd E, et al. ECCO 1999, abs. 979. * Resistance to platinum drugs develops in many NSCLC tumors. The mechanism of drug resistance is multifactorial, but important mechanisms include1: reduced uptake of the drug into tumor cells deactivation by intracellular thiols increased DNA repair increased DNA damage tolerance. 1. Perez RP. Eur J Cancer 1998; 34: 1535-1542. * * Current treatment for NSCLC is not satisfactory, except possibly for the small subset of patients with surgically curable T1 N0 M0 stage I disease.1 Prevention would reduce the overall burden of disease (most lung cancer is caused by environmental factors, which could be avoided). Earlier diagnosis could increase the percentage of patients treated at stage I, where the outcome of treatment is often good. Improved treatment of regional and advanced disease. Patients with NSCLC should be considered for clinical trials.1 1. PDQ Treatment Guidelines. * Up to 90% of cases of lung cancer can be attributed to th