Lung Cancer

advertisement
Taipei VGH Practice Guidelines:
Oncology Guidelines Index
Lung Cancer
台北榮總肺癌診療共識
V.1.0 2011
台北榮總肺癌團隊
Revised on 2011/05/30
Released on 2011/05/31
台北榮總肺癌團隊
Taipei VGH Practice Guidelines:
Oncology Guidelines Index
台北榮總肺癌團隊
Lung Cancer
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)
•
•
•
•
•
•
•
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
•
•
•
•
Surveillance
•
Therapy for Recurrence and Metastases
•
Occult (Tx,N0,M0),Evaluation and Treatment
Second Lung Primary, Evaluation, and
Treatment
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。
Taipei VGH Practice Guidelines:
Oncology Guidelines Index
台北榮總肺癌團隊
Lung Cancer
台北榮總肺癌委員會暨肺癌多專科團隊組織架構
癌委會
肺癌委員會暨肺癌多專科團隊
召集人:蔡俊明、許文虎
副召集人:賴信良、吳玉琮
個案管理師:宋易珍、洪秀瑩
非核心成員
核心成員
胸內
胸外
放射
病理
放療
核醫
藥劑部
骨科
營養
社工
Taipei VGH Practice Guidelines:
Oncology Guidelines Index
台北榮總肺癌團隊
Lung Cancer
台北榮總肺癌多專科團隊核心人員
李毓芹
蔡俊明
陳育民
邱昭華
胸外
許文虎
吳玉琮
放射
許明輝
吳美翰
陳俊谷
病理
周德盈
放療
顏上惠
陳一瑋
藍耿立
核醫
王世楨
林可瀚
胸腔
內科
賴信良
Taipei VGH Practice Guidelines:
Oncology Guidelines Index
Lung Cancer
台北榮總肺癌團隊
NSCLC
&SCLC
TNM
Staging
* MX has been removed by a general rule from UICC/AJCC.
Taipei VGH Practice Guidelines:
Oncology Guidelines Index
Lung Cancer
台北榮總肺癌團隊
Taipei VGH Practice Guidelines:
Oncology Guidelines Index
Lung Cancer
台北榮總肺癌團隊
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 M1
p.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
Taipei VGH Practice Guidelines:
Oncology Guidelines Index
Lung Cancer
台北榮總肺癌團隊
 正子掃描(PET/CT SCAN):肺癌clinical stage 的pretreament 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 II及stage III
以上的病人安排。
 術中病理檢查若有R1 (microscopic residual tumor) 或
R2(macroscopic residual tumor),應視實際情形考慮
reresection /(+chemotherapy)或是chemoradiation /
(+ chemotherapy)。
Taipei VGH Practice Guidelines:
Oncology Guidelines Index
NSCL-1
Lung Cancer
台北榮總肺癌團隊
From NCCN guideline, V.2.2009
Taipei VGH Practice Guidelines:
Oncology Guidelines Index
NSCL-2
Lung Cancer
台北榮總肺癌團隊
From NCCN guideline, V.2.2009
Taipei VGH Practice Guidelines:
Oncology Guidelines Index
NSCL-3
Lung Cancer
台北榮總肺癌團隊
From NCCN guideline, V.2.2009
Taipei VGH Practice Guidelines:
Oncology Guidelines Index
NSCL-4
Lung Cancer
台北榮總肺癌團隊
From NCCN guideline, V.2.2009
Taipei VGH Practice Guidelines:
Oncology Guidelines Index
NSCL-5
Lung Cancer
台北榮總肺癌團隊
From NCCN guideline, V.2.2009
Taipei VGH Practice Guidelines:
Oncology Guidelines Index
NSCL-6
Lung Cancer
台北榮總肺癌團隊
From NCCN guideline, V.2.2009
Taipei VGH Practice Guidelines:
Oncology Guidelines Index
NSCL-7
Lung Cancer
台北榮總肺癌團隊
From NCCN guideline, V.2.2009
Taipei VGH Practice Guidelines:
Oncology Guidelines Index
NSCL-8
Lung Cancer
台北榮總肺癌團隊
From NCCN guideline, V.2.2009
Taipei VGH Practice Guidelines:
Oncology Guidelines Index
NSCL-9
Lung Cancer
台北榮總肺癌團隊
From NCCN guideline, V.2.2009
Taipei VGH Practice Guidelines:
Oncology Guidelines Index
NSCL-10
Lung Cancer
台北榮總肺癌團隊
From NCCN guideline, V.2.2009
Taipei VGH Practice Guidelines:
Oncology Guidelines Index
台北榮總肺癌團隊
Lung Cancer
From NCCN guideline, V.2.2009
NSCL-11
Radiotherapy (2B)
or
or radiotherapy (2B)
such as with surgery or
radiotherapy
Taipei VGH Practice Guidelines:
Oncology Guidelines Index
NSCL-12
Lung Cancer
台北榮總肺癌團隊
From NCCN guideline, V.2.2009
Taipei VGH Practice Guidelines:
Oncology Guidelines Index
台北榮總肺癌團隊
Lung Cancer
NSCL-13
EGFR-TKI regardless of PSb (category 2B)
Therapy for recurrence
and metastasis
EGFR-TKI
sensitive
mutation (+)a
EGFR mutation
status known
EGFR-TKI
sensitive
mutation (-)
Stage IV
PS= 0-1
Chemotherapy (category 1)
or
Bevacizumab + chemotherapy
(if criteria met)
PS= 2
Chemotherapy
PS= 3-4
Best supportive care only
(see NCCN palliative care
guidelines)
East Asian, never
smoker &
adnocarcinoma
EGFR-TKI regardless of PSb (category 2B)
EGFR mutation
status unknown
Others
Switch to another EGFR-TKI (category 2B or 3)
Progression after EGFR-TKI treatment
a
Tumors with EGFR gene deletion at exon 19 (747-750), mutation at L858R, L861Q and G719X are those usually sensitive to EGFR-TKI.
is the preferred choice, but chemotherapy can be used if TKI is not available.
b EGFR-TKI
See
NSCL-14
Taipei VGH Practice Guidelines:
Oncology Guidelines Index
NSCL-14
Lung Cancer
台北榮總肺癌團隊
From NCCN guideline, V.2.2009
Taipei VGH Practice Guidelines:
Oncology Guidelines Index
Lung Cancer
台北榮總肺癌團隊
From NCCN guideline, V.2.2009
NSCL-15
Or
Gefitinib
Or
Gefitinib
Gefitinib and Erlotinib in 2nd-line therapy : adenocarcinoma
Gefitnib in 3rd-line therapy: adenocarcinoma; Erlotinib in 3rd-line therapy: NSCLC
Taipei VGH Practice Guidelines:
Oncology Guidelines Index
Lung Cancer
台北榮總肺癌團隊
PRINCIPLES OF SURGICAL RESECTION
•
•
•
•
•
非緊急狀況下,術前所需影像學檢查應完備。
是否可切除(resectablility)之決定建議應由有經驗之胸腔外
科醫師來決定。
如生理狀況許可(physiologically feasible) ,應採取
lobectomy或pneumonectomy。
如生理狀況受限制(physiologically compromised) ,應採
局部切除(Limited resection-segmentectomy or wedge
resection) 。
在不違背標準腫瘤手術原則下,可採用VATS (Videoassisted thoracic surgery) 。
Taipei VGH Practice Guidelines:
Oncology Guidelines Index
Lung Cancer
台北榮總肺癌團隊
PRINCIPLES OF SURGICAL RESECTION
•
N1&N2 node resection and mapping (minimum of three
N2 stations sampled or complete lymph node dissection)
•
如內科狀況無法開刀(medically inoperable) ,clinical
stage I& II病人應接受potential curative radiotherapy。
•
假如解剖位置適當與邊緣可切除乾淨(anatomically
appropriate and margin-negative resection) ,採取肺葉
保存術式比全肺切除好( lung sparing anatomic resectionsleeve lobectomy preferred over pneumonectomy) 。
Taipei VGH Practice Guidelines:
Oncology Guidelines Index
Lung Cancer
台北榮總肺癌團隊
PRINCIPLES OF PATHOLOGICAL REVIEW
•
•
•
•
病理評估的目的包括:
classify the lung cancer; determine the extent of invasion; establish
the status of cancer involvement of surgical margins; determine
the molecular abnormalities to predict for response to EGFR- TKI 。
手術病理報告應該有WHO肺癌組織分類。
Pure bronchioloalveolar carcinoma (BAC)應無stroma、pleura與
lymphatic spaces之侵犯。免疫染色: Non-mucinous BAC = TTF-1
(+) / CK7 (+) / CK20 (-); Mucinous BAC = TTF-1 (-) / CK7 (+) /
CK20 (+) 。
免疫染色可幫助鑑別原發或轉移肺腺癌,區別腺癌及惡性間皮細胞
癌,決定腫瘤之神經內分泌分化。
EGFR: Epidermal Growth Factor Receptor
TKI: Tyrosine Kinase Inhibitor
TTF-1: Thyroid transcription factor-1
Taipei VGH Practice Guidelines:
Oncology Guidelines Index
Lung Cancer
台北榮總肺癌團隊
PRINCIPLES OF PATHOLOGICAL REVIEW
•
•
•
•
•
TTF-1對區分原發或轉移肺腺癌很重要。大部分原發肺腺癌TTF-1為陽
性,轉移腺癌(甲狀腺癌除外)為陰性反應。
Primary lung adenocarcinoma:
TTF-1(+) / CK7(+) / CK20(-) / CDX-2 (-)
Metastatic colorectal carcinoma:
TTF-1(-) / CK7(-) / CK20(+) / CDX-2 (+)
EGFR mutation之有無與TKI治療之反應相關;如TKI 對exon21
mutation 與exon19 deletion之腫瘤治療效果良好。
K-ras與吸煙相關;K-ras與EGFR mutation為mutually exclusive;有Kras mutation對TKI治療效果不佳。
小細胞癌多數(95%)原發自肺,少數則來自肺外器官,二者有類似之臨
床和生物特性,極易廣泛轉移。小細胞癌細胞通常Keratin 及至少一種
之neuroendocrine differentiation markers (CD56, synaptophysin或
chromogranin A)呈陽性免疫染色。
Taipei VGH Practice Guidelines:
Oncology Guidelines Index
Lung Cancer
3D conformal technique
台北榮總肺癌團隊
Taipei VGH Practice Guidelines:
Oncology Guidelines Index
Lung Cancer
台北榮總肺癌團隊
 按2009年NCCN guideline的精神,其所建議的
放射治療已非傳統二次元定位的方式,而是因
應放射治療技術的進步,以電腦斷層評估腫瘤
的位置、體積和淋巴結引流的三次元定位方式,
來決定照射的角度、劑量和範圍。
 美國NCCN所建議的放射照射劑量並不完全適用
於國人,本共識以依國內病人狀況要做適度的
調整 。
Taipei VGH Practice Guidelines:
Oncology Guidelines Index
Lung Cancer
台北榮總肺癌團隊
Recommended Radiation Doses for NSCLC
(Modified doses for domestic patients)
Treatment Plan
Preoperative
Total Dose
Fraction Size
45-50 Gy
1.8 - 2 Gy
50 Gy
54-60 Gy
60-66 Gy
Up to 70 Gy
1.8 - 2 Gy
1.8 - 2 Gy
1.8 - 2 Gy
1.8 - 2 Gy
Postoperative
1.
2.
Negative margin
Extracapsular nodal extension
or microscopic positive margin
3. Gross residual tumor
Definitive
1. Without concurrent
chemotherapy
2.
Up to 70 Gy for volume< 25%
Up to 60-66 Gy for volume
between 25-36%
With concurrent chemotherapy Up to 60-66 Gy
(Mainly paclitaxel + carboplatin)
Palliative (for primary lung lesion;
SVC syndrome, obstructive
pneumonitis, etc.)
30-50Gy
1.8 - 2 Gy
1.8 - 2 Gy
1.8 - 2 Gy
2-2.5 Gy
Taipei VGH Practice Guidelines:
Oncology Guidelines Index
台北榮總肺癌團隊
Lung Cancer
Dose Volume Data for Radiation Pneumonitis (Modified for domestic patients)
RT +/Induction Chemotherapy
Parameter
MLD
Concurrent Chemotherapy
Range
Pneumonitis
(%)
Range
Pneumonitis
(%)
< 10 (Gy)
10-20
21-30
> 30
0-10
9-16
24-27
24-44
< 16.5 (Gy)
≧16.5
11-13
36-45
≦ 42 (%)
> 42
3
38
< 20 (%)
21-25
26-30
>31
9
18
51
85
LP(5)
LP(20)
< 20 (%)
20-31
≧ 32
0-2 (%)
7-15
13-48
LP(30)
≦ 8 (%)
>8
6 (%)
24
MLD-Mean Lung Dose, LP: percentage of lung that received radiation (Gy)
Taipei VGH Practice Guidelines:
Oncology Guidelines Index
Lung Cancer
台北榮總肺癌團隊
同步化學併放射治療(CCRT)原則
◎ NSCLC Dose: up to 60-66Gy/1.8-2Gy/day
◎ Limited SCLC
1.年齡小於等於70歲,PS:0~1,接受CCRT DOSE:50~60 Gy/1.8Gy/day
排程:放療自開始持續做至50~60 Gy,而化學治療自開始先做三個療程後休
息,須重新評估病患治療反應,之後再依實際情形安排接續的治療。
如有CR 加做预防性全腦放射治療 (prophylactic cranial irradiation, PCI)
DOSE: 30Gy/ 2Gy/ day x15 fractions(一天一次共十五次)
如有PR 持續化學治療,但不做PCI
2.年齡大於70歲,PS:0~1,採用接續性化放療(sequential chemoradiotherapy)
DOSE:50~60 Gy/1.8Gy/day
排程:連續的三個療程的化學治療後休息,在二週內重新評估
如有CR 加做PCI, DOSE: 30Gy/ 2Gy/ day x15 fractions(一天一次共十五次)
如有PR 加做胸腔的放療及三個療程的化學治療,但不做PCI
3.如有PD 接受第二線化療。
Taipei VGH Practice Guidelines:
Oncology Guidelines Index
台北榮總肺癌團隊
Lung Cancer
肺癌化學治療用藥準則 – 非小細胞肺癌
◎ 第一線
- Gemcitabine (GC-G)
G (1000-1250mg/m2) + Cisplatin (60-75mg/m2), Q3-4W.
- Vinorelbine (NC-N)
Vinorelbine (25-30 mg/m2 i.v. or 60-80 mg/m2 p.o.) +
Cisplatin (60-75 mg/m2), Q3-4W.
◎ 第二線
- Docetaxel
1. Docetaxel (60 - 75mg/m2)-D1, Q3W.
2. Docetaxel (30 - 35mg/m2)-D1,8, Q3W.
- Pemetrexed (500mg/m2)-D1,Q3W.
- Paclitaxel (TaC or TaC-Ta-Ta)
1. Paclitaxel (160-175 mg/m2) + Cisplatin (60- 75 mg/m2), Q3W.
2. Paclitaxel (60-80 mg/m2)-D1,8,15 + Cisplatin (60-75 mg/m2) -D1, Q4W.
- Docetaxel (TC or TC-T)
1. Docetaxel (60-75 mg/m2)-D1 + Cisplatin (60-75 mg/m2)-D1, Q3W.
2. Docetaxel (30-35 mg/m2)-D1,8 + Cisplatin (60-75 mg/m2)- D1,Q3W.
- Pemetrexed (AC)
Pemetrexed (500mg/m2) + Cisplatin (60-75mg/m2), Q3W.
-Gefitinib 250 mg, QD. (if Adeno , EGFR sensitizing mutation(+) )
- Gefitinib 250 mg, QD. (if Adeno)
- Erlotinib 150 mg, QD. (if Adeno)
◎ 第三線
- Erlotinib 150 mg, QD. (if NSCLC)
※ 備註:
1. Elderly or poor performance status:cisplatin omited
2. Cisplatin 若改成 Carboplatin, 劑量為 (CCr+25) x AUC, AUC = 4-6
3. Bevacizumab 7.5 mg/kg 可與 chemotherapy 並用於第一線治療,
但限於non-squamous cell carcinoma, no hemoptysis, no untreated
CNS mets
4. EGFR-TKI 可用於第一線治療, if EGFR-TKI sensitizing mutation(+)
5. Pemetrexate/cisplatin用於第一線治療以及 pemetrexate用於第二線
治療都僅限於non-squamous cell carcinoma
* 病患若參加本院 IRB 同意
之臨床試驗,則依該臨床試驗
之治療計畫進行
Taipei VGH Practice Guidelines:
Oncology Guidelines Index
台北榮總肺癌團隊
Lung Cancer
肺癌化學治療用藥準則 – 小細胞肺癌
( 臨床試驗病例除外 )
◎ Standard regimens (PVP):
1. Cisplatin (60-75 mg/m2) + VP-16 (60-80 mg/m2) D1,2,3/ Q3W
2. Carboplatin (AUC=5)D1 + VP-16 (60-80 mg/m2) D1,2,3/ Q3W
◎ Relapsed regimens:
1. Ifosfamide 1000 mg/m2 D1-3 + oral VP16 50 mg D1-10/ Q3W
2. Topotecan 1.5 mg/m2 D1-3 + epirubicin 30 mg/m2 D1/ Q3W
Taipei VGH Practice Guidelines:
Oncology Guidelines Index
台北榮總肺癌團隊
Lung Cancer
Chemotherapy Regimens for Adjuvant Therapy-platintinum based
Published Chemotherapy Regimens
Schedules
Vinorelbine (25-30 mg/m2 i.v. or 60-80 mg/m2 p.o.)-D1,8 + Cisplatin (6075 mg/m2)-D1
Q3W for 4 cycles
Other Acceptable Chemotherapy Regimens
Schedules
GC-G
G (1000-1250mg/m2)-D1,8 + Cisplatin (60-75mg/m2)-D1
Q3W for 4 cycles
TC
Docetaxel (60-75 mg/m2)-D1 + Cisplatin (60-75 mg/m2)-D1
Q3W for 4 cycles
TaC*
Paclitaxel (160-175 mg/m2)-D1 + Cisplatin (60- 75 mg/m2)-D1
Q3W for 4 cycles
NC-N
Chemotherapy Regimens for Adjuvant Therapy-non platintinum based
UFUR
300~400mg-QD (3 capsule QD) or 200mg BID (2 capsules BID)
2 years
Chemotherapy Regimens for Adjuvant Therapy- Alternative
Cisplatin 若改成 Carboplatin, 劑量為 (CCr+25) x AUC, AUC = 4-6
*Palitaxel+carboplatin regimen showed no survival benefit in stage IB patients
Taipei VGH Practice Guidelines:
Oncology Guidelines Index
Lung
Cancer Cancer
Primary
Tracheal
台北榮總肺癌團隊
Staging
Proposed TNM classification and staging for primary tracheal carcinoma*
*Ref: Paolo Macchiarini, Lancet Oncol 2006; 7: 83–91
Taipei VGH Practice Guidelines:
Oncology Guidelines Index
WORKUP
CLINICAL
STAGE
ADDITIONAL EVALUATION
(as clinically indicated)
•Multidisciplinary
evaluation is encouraged
•PET/CT scan
•
•
•
H&P
CBC, platelet
Chemistry
profile
Smoking
cessation
counseling
PFT
Chest CT scan
Bronchoscopy
Brain MRI
•
•
•
•
•
Stage I-III,
IVA
Stage IVB
Metastatic
cancer
a
台北榮總肺癌團隊
Cancer
PrimaryLung
Tracheal
Cancer
•Consider 3D-CT
reconstruction (multi-planar
reconstruction, volume
rendering technique,
minimal intensity projector)
Medical fit for
a
surgery,
resectable
Medical unfit for
surgery,
or
b
unresectable,
or
surgery not
elected and
patient medically
able to tolerate
chemotherapy
Medical unfit for
surgery and
patient unable to
tolerate
chemotherapy
See Primary
Treatment
(TRACH-1 )
See Primary
Treatment
(TRACH-2 )
See Primary
Treatment
(TRACH-2 )
See Primary
Treatment
(TRACH-3)
Medically able to tolerate major thoracic surgery
Unresctable tumor: greater than 50% of tracheal length involved by tumor, “frozen”mediastinum, poor
general condition of patient, distant metastases in squamous cell carcinoma; Oncologist 1997;2;245-253
b
Taipei VGH Practice Guidelines:
Oncology Guidelines Index
Lung
Cancer Cancer
Primary
Tracheal
PRIMARY
TREATMENT
Medically fit for
surgery, a
resectable
a
c
Surgery
台北榮總肺癌團隊
ADJUNCTIVE/ADJUVANT
TREATMENT
Radiation
c
•Complete resection (R0):
50Gy over tumor bed and adjacent mediastinum
c
•Incomplete resection with residual margin
R1:
R2:
>60Gy over tumor bed and 50Gy over adjacent
mediastinum
Medically able to tolerate major thoracic surgery
R0=No cancer at resection margins, R1=Microscopic residual cancer, R2=Macroscopic residual cancer
TRACH-1
Taipei VGH Practice Guidelines:
Oncology Guidelines Index
Lung
Cancer Cancer
Primary
Tracheal
台北榮總肺癌團隊
PRIMARY TREATMENT
Medical unfit for
surgery,
or
b
unresectable,
or
surgery not elected
and patient
medically able to
tolerate
chemotherapy
Medical unfit
for surgery
and patient
unable to
tolerate
chemotherapy
RT, 60Gy + concurrent
chemotherapy (Cisplatinbased) (preferred)
or
Best supportive care
Best Supportive Care
•Obstruction: stent, laser,
photodynamic therapy, RT
(external 30-50Gy or brachytherapy)
•Pain control: RT and/or medications
•Nutrition
RT 60-66Gy
or
Best supportive care
b Unresctable
tumor: greater than 50% of tracheal length involved by tumor, “frozen”mediastinum, poor
general condition of patient, distant metastases in squamous cell carcinoma; Oncologist 1997;2;245-253
TRACH-2
Taipei VGH Practice Guidelines:
Oncology Guidelines Index
Lung
Cancer Cancer
Primary
Tracheal
台北榮總肺癌團隊
SALVAGE THERPAY
Karnofsky
performance
score > 60
or
ECOG
performance
score≦2
RT, 60Gy + concurrent
chemotherapy (Cisplatinbased) (preferred)
or
Chemotherapy
or
Best supportive care
Stage IVB
Metastatic cancer
Best Supportive Care
Karnofsky
performance
score ≦ 60
or
ECOG
performance
score≧3
Best supportive care
•Obstruction: stent, laser,
photodynamic therapy, RT
(external 30-50Gy or brachytherapy)
•Pain control: RT and/or medications
•Nutrition
TRACH-3
Taipei VGH Practice Guidelines:
Oncology Guidelines Index
Lung Cancer
台北榮總肺癌診療共識
主要依據- 1.NCCN v3 2011
- 2.健保局最新給付標準
台北榮總肺癌團隊
Taipei VGH Practice Guidelines:
Oncology Guidelines Index
Lung Cancer
本治療指引將每年檢討修訂一次
預定下次修訂日期: 2012年05月
台北榮總肺癌團隊
Download
Related flashcards

Tumor markers

15 cards

American oncologists

54 cards

Cancer researchers

69 cards

Create Flashcards