Nonsmall cell lung cancer.ppt

1、, 3cm,Not in main bronchus,Surround by visceral pleura,T1, 3cm, 2cm,Involve main bronchus,Lobe atelectasis,Invade visceral pleura but not parietal pleura,T2,Invade parietal but not visceral pericardium,Invade diaphragm,Chest wall invasion,Invade mediastinum pleura,T3,Atelectasis of entire lung,Invol

2、ve main bronchus,2cm,T4,Invade following structure Mediastinum, heart, great vessel, trachea,esophagus, vertebra body, carina Separate tumor in the same lobe Malignant pleura effusion “wet” T4, pleura disease May regard as M1,N1,N2,Ipsilateral peribronchial,Ipsilateral hilum,intrapulmonary,Ipsilater

3、al mediastinum and/or subcarinal,N3,contralateral mediastinum,Ipsilateral supraclavicle,Contralateral supraclavicle,N2 subgroup,cN2 or pN2 cN2(bulky N2): by image study (CT scan, 1cm) pN2(micro N2): no N2 evidence at CT scan Single level or multiple level Number of lymph node levels involved,Andre F

4、 et al. J Clin Oncol 2000;18:2981-2989.,702 pts, N2 disease Resection with curative intent,Meanings of “unresectability”,Technically unresectable, regarding T stage T3: resectable, though morbidity existed T4: involve vital organ, impossible to resect Technically resectable, but of no use N2: multil

5、evel bulky N2 5yr OS 3%,Stage III NSCLC,Resectable stage III Part of IIIA, few IIIB(T4) Surgery as mainstay Neoadjuvant chemotherapy Unresectable stage III Almost all IIIB, some IIIA (depend on N2) Historically, RT as the alternative to surgery Incorporate chemotherapy to RT CRT,Neoadjuvant chemothe

6、rapy,MD Anderson and Spain, IIIA Positive Too small size, due to early closure NCI, IIIA Negative Small size French thoracic society group, I - IIIA Only benefit in N0/N1 patients,60 pts, NSCLC, IIIA,C/T x 3,Cyclophosphamide 500mg/m2, D1Cisplatin 100mg/m2, D1Etoposide 100mg/m2, D1-3 q4weeks,Surgery,

7、Roth JA et al. J Natl Cancer Inst 1994; 86: 673-680,MD Anderson,28 pts,32 pts,Surgery,C/T x 3,A,B,XRT for unresectable/incomplete resection,Both cN2 and pN2, single/multi-level N2,All patients,All resectable patients,Failure pattern in resected patients,A: 17 pts,4 distant failure0 local failure1 bo

8、th local and distant,8 distant failure2 local failure1 both local and distant,B: 21 pts,Roth JA et al. J Natl Cancer Inst 1994; 86: 673-680,MD Anderson,60 pts, NSCLC, IIIA,C/T x 3,Mitomycin-C 6mg/m2Ifosfamide 3g/m2Cisplatin 50mg/m2, q3w,Surgery,Rosell R et al. N Engl J Med 1994; 330: 153-158,Spain,3

9、0 pts,30 pts,Surgery,A,B,Mediasinum XRT,Mediasinum XRT,XRT: 50Gy,Both cN2 and pN2, single/multi-level N2,27 pts, NSCLC, IIIA(N2),C/T x 2,Cisplatin 100mg/m2, D1,Etoposide 50mg/m2, D1-3 q3w,Surgery,Pass HI et al. Ann Thorac Surg 1992; 53: 992-998,NCI,13 pts,14 pts,Surgery,A,B,Mediasinum XRT,XRT: 60Gy,

10、C/T x 4,Both cN2 and pN2, single/multi-level N2,355 pts, NSCLC, IB, II, IIIA,C/T x 2,Mitomycin-C 6mg/m2, D1Ifosfamide 1.5g/m2, D1-D3Cisplatin 30mg/m2, D1-D3 q3w,Surgery,Depierre A et al. J Clin Oncol 2002; 20:247-253,French Thoracic Society Group,179 pts,176 pts,Surgery,A,B,C/T x 2,N0/N1 dz: HR: 0.68, p=0.027 N2 dz, HR:1.04, p=0.85,NTUH practice,CXR + CT resectable, T1-T3, N0-N2 Brain CT + bone scan PET：ensure no distant mets Bulky N2：neoadj