肺癌的诊治指南幻灯片.pptVIP

NCI guideline:Treatment of ED SCLC (4) 3. Identification of effective new agents is difficult in patients who have previously been treated with standard chemotherapy because response rates to agents, even of known efficacy, are known to be lower than in previously untreated patients. This situation led to the suggestion that patients with extensive disease who are medically stable be treated with new agents under evaluation, with provisions for early change to standard combination therapy if there is no response.[35] Such a strategy has been shown to be feasible, with survival comparable to survival with initial standard therapy, as long as the patients with extensive disease are carefully chosen.[36-38] A variety of other strategies have been proposed, depending on the activity of the new agent in other tumors, in preclinical small cell lung cancer models, or the activity of drug analogs.[39] Active single agents undergoing further evaluation include paclitaxel and topotecan.[40,41] 非小细胞肺癌的治疗原则和方法（1） 非小细胞肺癌的治疗方法 S0：肺段肿瘤切除(仅限老人) S1：肺叶切除+纵隔淋巴结切除 S2：全肺切除+纵隔淋巴结切除 S3：袖状切除+纵隔淋巴结切除 S4：肺叶合并胸 膜切除 C1：术前辅助化疗 C2：术后辅助化疗 C3：姑息性化疗 BSC：最佳支持治疗 L： 激光治疗 BRM：生物反应修饰剂 CTM：中医药 TT: 靶向治疗 R0：根治性放疗 R1：术前辅助放疗 R2：术后辅助放疗 R3：姑息性放疗 非小细胞肺癌的治疗原则和方法（2） 非小细胞肺癌的治疗原则和疗效 注：+同时； 序贯； /选择其中之一 分期 综合治疗方法 5年生存率（%） 隐匿癌 观察或化学预防 0 S0/L 100 100 ⅠA T1 S1 75 65 ⅠB T2侵及脏层胸膜 S1 55 T2跨叶侵犯 S2 T2侵及主支气管 S3 T2不能承受手术 R0 非小细胞肺癌的治疗原则和方法（3） 非小细胞肺癌的治疗原则和疗效 注：+同时； 序贯； /选择其中之一 分期 综合治疗方法 5年生存率（%） ⅡA T1N1 S1 50 40 ⅡB T2N1 S1-3C2 35-50 T3 S4C2 35 T3 R1+C1S4C2；R1S4C2 最差 ⅢA T1-2N2 C1S1-3；C1+R1S1-3C2；S1-3C2R2 50 30 T3N1 R1+C1/R1S1-3C2；S4C2 35 T3N2 C1R1S1-3C2；S4C2 5 非小细胞肺癌的治疗原则和方法（4） 非小细胞肺癌的治疗原则和疗效 分期 综合治疗方法 5年生存率（%） ⅢB T4N0-2 S3C2；C1/R1S3C2 15 10 T4N3 C3+R3 5-10 Ⅳ M1单器官 C3+R3/C3R3；BSC 5 5 M1多器官 C3+R3/C3R3；BSC 注：+同时； 序贯； /选择其中之一 NCI Guideline of NSCLC Treatment of occult lung cancer (Tx,N0,M0) In occult lung cancer, a diagnostic evaluation often includes ches