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1、胸腔外科 副教授 高 英 隆 ( Chest Surgery Associated Professor Kao Eing-Long ) Tel: 3121101 ext: 6306E mail: kaeilcc.kmu.edu.tw,呼吸系統疾病 ( Respiratory Disease ),非小細胞肺癌 ( Non Small Cell Lung Cancer ),學習目標 ( Learning Object ),Classification of Lung Cancer : SCLC vs NSCLC.Diagnosis / Tumor Markers.Grading / Extent
2、/ Staging.TMN Classification / Performance Status Scales.Therapeutic Decisions.Pre-op Pulmonary / Cardiovascular Evaluation. Surgery Risks / Chemotherapy / Radiation Therapy.New Diagnostic Tolls & Treatment Strategies.,New Diagnostic Tools & Treatment Strategies TOPICS - New Diagnostic Tools Molecul
3、ar Biology / Biomarkers,Early detection. Prediction of sensitivity to CT/RT Detection of minimal residual disease / relapse Results of low dose spiral CT scan screening programs New diagnostic tools PET, LIFE Bronchoscopy, ( Lung Imaging Fluorescence Endoscope ) Virtual CT bronchoscopy,TOPICS - Trea
4、tment StrategiesRole of SurgeryMinimally invasive thoracic approaches. Surgical staging. Nodal sampling / radical dissection. Sentinel node. Limited resection for very early disease. Management of spiral CT scan lesions below 1 cm,Role of Radiotherapy3D Conformal Radiotherapy, Intensity Modulated Ra
5、diation Therapy ( IMRT ).Images Guided Radiation Therapy ( IGRT ). DIBH. Stereotactic Precision Radiotherapy. Proton Therapy,Chemopreventive agentsCOX-2 inhibitors, Glucorticoids. Retinoid resistance and new retinoids, Gene strategies, Bioadjuvant therapies, Systemic vs. Pulmonary delivery,New treat
6、ment approachesPharmacogenomic.New cytotoxic agents, ( Paclitaxel - Taxol )Targeted ( EGFR ) biologic therapies. Apoptotic agents, ( p53-cs17, Rb-cs13, )Hybrid cytotoxic-cytostatic approach, Modulators ( Interferon, Cytokin ) and revertants of drug resistance, Vaccines,Laboratory Tests Special bioch
7、emical studies Blood survey Calcium LDHHormone ACTH, AVP, ADH (SIADH), PTHTumor marker CEA TPA CYFRA21 SCC NSEp34 Biology, Genetic Changes p35 Oncogens, Tumor Suppressor Genes, p36 Growth Factors, p37 & p38 遺傳, 突變, 不活化腫瘤抑制基因, 活化Oncogenes & GH不正常分泌.,Pre-op Pulmonary / Cardiovascular Evaluation Evalua
8、tion Of The Respiratory SystemClinical Evaluation, Exercise Capacity, Spirometry, Arterial Blood Gas Analysis, Regional Pulmonary Studies ( Including LPT ), Pulmonary Circulation (TUPAO)Evaluation Of Cardiovascular System Other Perioperative Therapeutic Considerations Prevention Of CV Complications
9、Prevention Of Respiratory Complications,Risk Factors Age, Respiratory Diseases, Abnormal Pulmonary Function, CV Disease ( Cardiac Function Test ) Extent of Resection, General Risk Factors ( Nutrition, Alcohol & Smoking, Obesity )Common Physiologic Disturbance Increased Pulmonary Arterial Venous Shun
10、ting Atelectasis Uneven Disturbance of Ventilation & Perfusion Increased Lung Water Diffusion Block Increased Pulmonary Dead Space Increased Work of Breathing Decrased oxygen Transport in The Blood Decreased Resistance to Infection,PREOPERATIVE ASSESSMENT OF PATIENTS UNDERGOING LUNG RESECTION FOR CA
11、NCER SURGERY FOR NSCLCSURGICAL ADJUVANT THERAPY OF NSCLC NSCLC: DEFINITIVE RADIOTHRAPY & COMBINED MODALITY THERAPYTHE ROLE OF CHEMOTHERAPY IN THE MANAGEMENT OF DISSEMINATED NSCLC TREATMENT OF SCLCSUPERIOR SULCUS TUMORS SVC SYNDROME: AN ONCOLOGIC EMERGENCY,The Surgery Procedure vs. Risk FactorsDepend
12、ent On The Nature, Conduct, And Extent Of OperationNormal Lung Function After OperationLung Volumes And Ventilatory Patterns Gas Exchange Pulmonary Defense MechanismsDependent On The Conduct Of The ProcedureWill Suffer Respiratory Complications.Airway Defense Abolish / Reduce; 需Airway MonitorARDS (
13、Fluid Overload / Blood Massive Transfuse )Dependent On The Extent Of The OperationLung Function After PneumonectomyRisk Of Concomitant Cardiac & Pulmonary Operations,CANCER PATIENT MANAGEMENT,The diagnosis of cancer requires a histological proof of malignancy The treatment is mostly based on the ext
14、ension of the disease and on the histology. Performance status, age and history are also critical factors for establishing the treatment strategy.,TUMOR EXTENT STAGING,The extent of the disease is one of the key parameters for treatment orientation. In case of localized disease the resectability of
15、the tumor and the operability of the patient are also pivotal.,TNM CLASSIFICATION,The U.I.C.C (Union Internationale Contre le Cancer) has set up on international classification based on tumor size (T), lymph node involvement (N) and the presence (or not) of distant metastasis (M). The prognosis is b
16、etter if the tumor id small and if there is no lymph node involvement and no distant metastasis.,TUMOR MARKERS/EXAMPLES,In some tumors, the evolution of tumor markers over time should allow the assessment of treatment efficacy and the early detection of relapse.,PERFORMANCE STATUS SCALES,There are several performance status scales. The Karnofsky goes from 100 (normal) to 0 (dead). The E.C.O.G. from 0 (normal) to 5 (dead). These scales evaluate the degree of autonomy for current activities.,
