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10 lung cancer
- 1. 肺 癌 LUNG CANCER 中山大学肿瘤医院 王 思 愚
- 5. lung cancer cases diagnosed in Cancer Center of Sun Yat-sen University
- 6. lung cancer cases diagnosed in Cancer Center of Sun Yat-sen University
- 8. The risk of lung cancer after stoping smoking Garfinkel L, Silverberg E. CA Cancer J Clin. 1991;41:137-145.
- 27. 2008 年 8 月 28 日
- 28. Bronchoscopy
- 29. Pathology NSCLC: squamous cell carcinoma
- 30. 2008 年 11 月 19 日
- 34. Stage grouping Mountain CF. Chest. 1997;111:1710-1717. IIIB IIIB IIIB IIIB N3 IIIB IIIA IIIA IIIA N2 IIIB IIIA IIB IIA N1 IIIB IIB IB IA N0 T4 T3 T2 T1
- 39. 5-years survival rate after surgery Mountain CF ， Chest 1997. TNM stage 5 YS （ clinical stage ） 5YS （ pathologic stage ） T1 N0 M0 n=687 61% n=511 67% T2 N0 M0 n=1189 38% n=549 57% T1 N1 M0 n=29 34% n=76 55% T2 N1 M0 n=250 24% n=288 39% T3 N0 M0 n=107 22% n=87 38% T3 N1 M0 n=40 9% n=55 25% T1-3 N2 M0 n=471 13% n=344 23% T4 N0-2 M0 n=458 7% NA Any T N3 M0 n=572 3% NA Any T any N M1 n=1427 1% NA
- 40. Radiation therapy Radiotherapy plays a major role in the treatment of lung cancer. It is divided into curative treatment and palliative treatment. It is of proven benefit in controlling bone pain, spinal cord compression, superior vena cava syndrome and bronchial obstruction.
- 42. The newest evidence for Adjuvant chemotherapy
- 44. 2007’s ASCO
- 45. LACE meta-analysis ： OS HR=0.89 95%CI=0.82-0.96 P=0.005 Pignon JP, et al. J Clin Oncol 2008; 26:3552-3559 100 80 60 40 20 0 1 2 3 4 5 ≥ 6 Time From Randomization (years) Chem. Control 总体生存 (%)
- 46. LACE meta-analysis ： DFS HR=0.84 95%CI=0.78-0.91 P<0.001 Pignon JP, et al. J Clin Oncol 2008; 26:3552-3559. Time From Randomization (years) 100 80 60 40 20 0 1 2 3 4 5 ≥ 6 Chem. Control 无病生存 (%)
- 49. IIIA-N2:Overall survival at 5 years with chemotherapy improved by 12% 31.1% vs 19.1% MS:33m vs 24m
- 52. Chemotherapy for advanced stage of lung cancer BMJ, 1995
- 54. First-line chemotherapy options in NSCLC (E1594): comparable efficacy with platinum doublets Schiller, et al. NEJM 2002 1.0 0.8 0.6 0.4 0.2 0 0 5 10 15 20 25 30 Time (months) Cisplatin/paclitaxel Cisplatin/gemcitabine Cisplatin/docetaxel Carboplatin/paclitaxel Probability of survival Therapeutic plateau: overall survival <12 months
- 55. Overall Survival by Histology Non-squamous (n=481) Squamous (n=182) HR=0.70 (95% CI: 0.56-0.88) P =0.002 HR=1.07 (95% CI: 0.49–0.73) P =0.678 Survival Probability Time (months) Time (months) 2009 ASCO Pemetrexed 15.5 mos Pemetrexed 9.9 mos Placebo 10.3 mos Placebo 10.8 mos
- 60. 晚期非小细胞肺癌 front-line 治疗策略 EGFR 突变者 30 ％ TKI MST ： 20 － 24 月 EGFR 野生者 70 ％ 腺癌 35 ％ 鳞癌 35 ％ 第三代＋铂类 10 月 维持治疗 13 月 培美曲塞＋铂类： 11.8 月 西妥昔单抗 或贝伐单抗 12 － 16 月 + ERCC1 BRCA1: 选择铂类药物 RRMI ：选择 Gemcitabine TS ：选择 Pemetrexed
- 62. 致谢胸科全体家人！
Notes de l'éditeur
- Garfinkel L, Silverberg E. Lung cancer and smoking trends in the United States over the past 25 years. CA Cancer J Clin. 1991;41:137-145.
- Squamous cell carcinoma: These tumours consist of layers of epithelial cells that secrete keratin, and therefore often present as obstructing tumours in the bronchi. They are the most common type of lung cancer representing 30-50% of all cases. The histological type of NSCLC may affect treatment outcome. Non-squamous cell carcinomas were twice as likely as squamous cell carcinomas to recur after surgery in one study (0.088 and 0.042 recurrences per patient per year, respectively), even though all the cancers were the same stage (T1 N0). 1 Bronchoalveolar carcinoma, a sub-type of adenocarcinoma, presents at an earlier stage than other adenocarcinomas, appears to be less aggressive, and is associated with better survival. Early diagnosis and surgical treatment are therefore particularly valuable in nodular bronchoalveolar carcinoma. 2 In contrast with other bronchial carcinomas, survival of patients with bronchoalveolar carcinoma is influenced more by the extent of lung involvement (eg presence of bilateral lesions, production of mucin by tumor cells) than by the extent of lymph node metastases. 3 1. Thomas P, Rubinstein L. Ann Thorac Surg 1990; 49: 242-247. 2. Grover FL, Piantadosi S. Ann Surg 1989; 209: 779-790. 3. Daly RC, et al. Ann Thorac Surg 1991; 51: 368-377.
- After obtaining the diagnosis of lung cancer through bronchoscopy, transbronchial needle aspiration, transthoracic needle aspiration, or mediastinoscopy, further diagnostic evaluations are directed at evaluating the extension of the disease. Diagnostic evaluation should include a chest X-ray and chest CT that encompasses the liver and adrenal glands.
- Clinical staging of lung cancer helps to determine the extent of disease and stratify patients into similar prognostic and therapeutic categories. An important goal is to separate patients with potentially resectable disease from those who have unresectable disease. The most recent staging system for lung cancer was published in 1997, replacing the 1986 classification. Mountain CF. Revisions in the International System for Staging Lung Cancer. Chest. 1997; 111:1710-1717.