台北荣总肺癌诊疗共识v走2009.pptVIP

台 北 榮 總 肺 癌 診 療 共 識V.1.0 2009 台北榮總肺癌團隊 Revised on 2009/04/13 Released on 2009/05/04 台 北 榮 總 肺 癌 診 療 共 識 Multidisciplinary Team Taipei VGH Lung Cancer Panel Members TNM staging Taipei VGH supplement to TNM staging Table of stage grouping Evaluation and treatment Stage o (Tis) Stage I (T1-2,N0) and Stage II (T1-2, N1) Stage IIB (T3,N0) and stage IIIA (T3,N1) Stage IIIA (T1-3,N3) and stage IIIB (T4, N0-1) Stage IIIB (T1-3,N3) Stage IIIB (T4,N2-3) (T4: pleural effusion or pericardial effusion) Stage IV (M1: solitary site or disseminated) Surveillance Therapy for Recurrence and Metastases Occult (Tx,N0,M0),Evaluation and Treatment Second Lung Primary, Evaluation, and Treatment Principles of Surgical Resection Principles of Pathology Principles of Radiation Therapy - Recommended Radiation Doses - Dose Volume Data for Radiation Pneumonitis Principles of CCRT Principles of Chemotherapy - Non-Small Cell Lung Cancer - Small Cell Lung Cancer Adjuvant Chemotherapy Neoadjuvant Chemotherapy Clinical Trials for Advanced/ Metastatic NSCLC Tracheal cancer References 關於此臨床指引：肺癌的診療仍在發展階段，本指引主要在呈現目前肺癌診療的進展與共識，醫師應鼓勵病患參與臨床試驗 ，使其有機會得到最好的治療。在本指引中的化療用藥建議是基於現有的臨床證據，和目前的衛生署或健保局規定無關。 癌委會 Summary of Evaluation and Treatment PFT: Necessary for all operable stages PET (PET/CT) : recommend for all clinical stages, except Wet IIIB or stage IV with disseminate M1 Mediastinoscopy: recommend for all clinical stages, except Peripheral T1N0 Wet IIIB or stage IV with disseminate M1p.s. N2 or N3 disease can be confirmed by other methods including mediastinotomy, thoracoscopy, EBUS-FNA, EUS-FNA, CT-guided-FNA, supraclavicle LN biopsy Brain MRI: recommend for all clinical stages, except Stage I Wet IIIB or stage IV with disseminate M1 正子掃描（PET/CT SCAN）：肺癌clinical stage 的pre-treament workup，至於安排時間點是在胸腔電腦斷層（chest-CT）後。 除非Chest CT或PET SCAN都無縱膈腔異常發現且主要病灶在週邊(peripheral IA lesion)可以不做縱膈腔鏡外，否則縱膈腔鏡仍是評估縱膈腔淋巴結的gold standard Brain MRI取代brain CT建議在clinical stage I