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Lung Ca
Lung Ca
Lung Cancer
楊明維 醫師
Basis for Prescription of
Irradiation
Patient’s general condition
Treatment modalities
S/S Incidence
Cough 75%
Hemoptysis 50%
Dyspnea 40%
Chest pain 35%
Hoarseness 5%
SVC syndrome 5%
DIAGNOSTIC WORKUP
History: metastasis symptoms
Chest X-ray
NSCLC 85-88 % 80 %
SCLA 12-15 % 20 %
Treatment Algorithm
Non-small cell lung cancer
Stage grouping (AJCC 2002)
T1 T2 T3 T4
N0 IA IB IIB IIIB
N1 IIA IIB IIIA IIIB
N2 IIIA IIIA IIIA IIIB
N3 IIIB IIIB IIIB IIIB
5-years Survival Rate for NSCLC
Treatment Algorithm
Non-small cell lung cancer
Resectable Tumors of NSCLC
Stage I, II, resectable: 5-yrs S.V 50%
Postoperative irradiation:
1.positive or close surgical margins (T3)
2.positive hilar or mediastinal lymph
nodes
Technique of Radiation Therapy
LUL lobectomy
Squamous cell
carcinoma
IIIA (T3N2M0)
Margins: free
Post-OP C/T + R/T
488 P’t, LN(+), Completely removed
CCRT Vs R/T alone
C/T regimens: Cisplatin + Etoposide
LLL
IIIA (T3N1M0)
LN(+): Hilum
CCRT
Technique of R/T
Unresectable Tumors
Irradiation alone
Locally advanced NSCLC
(ASCO 1994;13:325)
Technique of Radiation Therapy
for locally advanced NSCLC
CHART (Continuous Hyperfractionated Accelerated Radiation Therapy)
2-Yrs S.V
CHART(54Gy) 30%
Conventional Tx (60Gy) 20%
Memorial Sloan-Kettering
照野方向設計
電腦最佳化運算
(JCO 1992)
Sequence of Irradiation and
Chemotherapy
Goto et al. Concurrent Sequentially
(ASCO 1999)
Cisplatin 80 D1 + q4w x 4 q3w x 4
VP 16 100 D1-3
1.5Gy bid C/T + TRT R/T follow C/T x IV
(45Gy/3wks)
Response 97.4% 90.4%
Median S.V (M) 27.2 19.5
Median S.V(M) 29 23
Limited stage
CCRT
Limited Disease
CCRT (EP x 4 + 45Gy) -> CR -> PCI
Extensive Disease
Role of R/T: Palliation
Palliative radiation therapy for
Lung Ca
More effectively palliated: hemoptysis or pain
More refractory: dyspnea
SVC syndrome
Adenocarcinoma
Palliative R/T
S + C/T S alone
5-yrs S.V 44.5% 40.4%
5-yrs DFS 39.4% 34.3%