化疗在非小细胞肺癌中的作用课件

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1、ChemotherapyofAdvancedNonSmallCellLungCancerRababGaafar,MDProfessorMedicalOncologyNationalCancerInstitute,CairoUniversityCairo,EgyptLungCancerResponsibleforaboutone-thirdofallcancerdeathsAccountsformoredeathsthanbreastcancer,prostatecancer,andcoloncancerCOMBI

2、NED80-90%ofpatientswhodeveloplungcancerwilldieofthediseaseSchillerASCO‘00LUNGCANCERIncidenceofmajorhistologictypes**Numbersdonotsumto100%becauseofdifferencesindiagnosticcriteria.GinsbergRJ,etal.Cancer:PrinciplesandPracticesofOncology.5thed.1997;858-911.Ginsbe

3、rgRJ,etal.Cancer:PrinciplesandPracticesofOncology.6thed.2001;925-983.18%40%SquamouscellcarcinomaSmall-cellcarcinoma30%Adenocarcinoma15%Large-cellcarcinomaASCOLungCancerAbstracts1980-2002FryWA,etal.Cancer.1996;77:1949-1995.31%StageIII38%StageIV24%StageI7%Sta

4、geIINON-SMALLCELLLUNGCANCERStagesatpresentationTNMstagingNSCLCstagesLymphnodesMainbronchusContralaterallymphnodeMetastasistodistantorgansInvasionofchestwallStageIVStage0StageIAStageIIBStageIIIB5-yearsurvivalbyTNMstatusinNSCLCStageIAIBIIAIIBIIIAIIIBIVTNMclassi

5、ficationT1N0M0T2N0M0T1N1M0T2N1M0orT3N0M0T1-3N2M0orT3N1M0T4NanyM0orTanyN3M0TanyNanyM1613834241351Mountain19975-yearsurvival(%)FryWA,etal.Cancer.1996;77:1953.YearsNON-SMALLCELLLUNGCANCERSurvivalbystageDiagnosticEvaluationofAdvancedLungCancer1-CXRItisprobablythe

6、mostvaluabletoolinthediagnosisoflungcancer.AperfectnormalCXRrulesoutthisdiagnosisinmostcases.2-CTchest-noninvasiveimprovestagingesp.spreadtomediastinum-candetectlocalinvasion-candetectlesionslessthan1cm-shouldextendinferiorlytoinvolveliver&adrenalglands.3-MRI-

7、noimprovementoverCTscanexceptinparavertebraltumors.-routineMRIisunnecessary.4-Bonescan:Indicatedinthepresenceof:Boneorchestpain.RaisedAlp.Elevatedserumcalcium.5-PETSCAN-higheraccuracythanCT&bonescaninidentifyingoccultmetastaticdiseaseinthemediastinumanddistant

8、sites.-negativePETscandoesnotprecludebiopsyofradiologicallyenlargedmediastinalLN.SystemicchemotherapyvsBestSupportiveCareAdvancedNSCLC:CurrentstatusPLATINUM-BASEDCTHRESULTSIN:Pro