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优质参赛课件参赛选手：***LUNGCANCERMANAGEMENTMETHODSANDPHILOSOPHYDR.D.R.JOSHIB.J.MEDICALCOLLEGE,PUNE=SYMPTOMATIC&PHYSICALASSESSMENT,=RADIOLOGICALAS

SESSMENT,*PLAINCHESTFILMS,*C.T.SCANS*RADIONUCL.BONESCANS=Th’centesis,B’scopy,Med‘scopy=And….USGABDOMEN.FORNEWPATIENTS---➢Hig

hindexofsuspicion➢Trytodefineanatomicextent➢Findcell-typeoflesion➢Patient'sGCforaggressiveRx➢PlanfortheRx.STAGING&5-YrsSURVIVAF

ORNSCLC(1986)IT1_2nomo……60-80%IIT1_2N1mo……25-50%IIIaT3N0-mo……25-40%T1-3N2mo……10-30%IIIbAnyT4/N3mo…...<5%IVAnyM1……<5%AJCC–RECOMMENDEDSTAGING…#Cli

nical–diagnostic#Post-surgical–pathologicstage#Re-treatmentstage#AutopsystagePERFORMANCEINDEX….***KARNOFSKYSCALE***ECOG(Zubrod)SCALE❖RecordAt

Diagnosisstage❖CorrelatewithapparentstageoftheDisease.PRE-OPEVALUATION-CARDIOPULMSTATUSHIGHRISK:RecentMI,ArrhythmiasCongestiveCardiacFailure,Sy

stemicHypertension…PulmonaryHypertension,FEV1<35%HighPCO2…INDICATIONSFORSURGERY..NSCLC:1.TIS2.StageI,II3.Stag

eIIIa4.AssocEffusiontransudateclear,nomalignantcellSCLC:1.Solitarypulmonarynodule,2.StageI(T1NOMO)SURGERYINUN

DIAGNOSEDSPNINDICATIONS…..•H/OSMOKING•AGE>35YRS•SIZE>3CMS•LACKOFCALCIFICATION•H/OPREVIOUSORCURRENTMALIGNANCY•GROWTHOFLESION•CHESTSYMPTOMS•ASSOCIA

TEDPNEUMONIA,COLLAPSE,ADENOPATHY…..EXTENTOFRESECTION…..DEPENDSONEXTENTOFLESION*Wedgeresection*Segmentectomy*Lobectomy*Sleeveresection

*Pneumonectomy#PALLIATIVERESECTION-NOROLE➢NSCLC:CONTRAINDICATIONSFORCURATIVESURGERY…STAGEIIIb-N3diseaseSTAGEIVRecurrentLary/PhrenicNpals

yVenacava/LtAtriuminvolvementSVCObstructionT3DiseaseCard.tamponade,MalignantEffusion.CardiacarrythmiasMVV<40%,FEV1<1.5LS

plitPFTbyV/Qscan<1Ltr.CHEMOTHERAPYPATIENT…..*Fullyambulatory*Evaluabletumormass*Nopriorchemotherapy*Nomedic

alproblem*PaO2atroomtemperature>50*NoCO2retentionCHEMOTHERAPYINNSCLC……MAXIMUMBENEFITWHEN*CHEMOTHaddedtoRADIOTH.Locallyadvanced–IIIb&fewIIIa*Neo-ad

juvantChemoPre-operativeRxforSTAGEIIIa–somenewdrugs-Docetaxel,PaclitaxelGemcitabine,TopotecanTirapaza

mine,etc…CHEMOTHERAPYINSCLC…WIDELYUSED:CISPL,ETOP.Every3weeks*oral/single/oldptORpoorperformancept:ETOP

.*Singleagentchemo:ETOPOSIDETENOPOSIDE*Salvage:ETOP+CISPL(EP)Cycloph+Adria+Vincrist(CAV)NOW:intensiveinitialORre-inductionRxwith

autologousbonemarrowinfusionNEO-ADJUVANTCHEMOTHERAPYAssessdrugsensitivityofcellsRenderunresectable→resecta

bleBettertoleratedbeforesurgerySlowsgrowthafterprimaryTumourisremovedPreservebloodsupply–gooddrugdeliveryIncreasesurvivalinN2thansur

geryaloneRELATIVECONTRAINDICATIONSFORRADIOTHERAPY…..#PriorHIGH-DOSERADIATION#ConnectiveTissueDisorders#FEV1<800cc#Tracheo–EsophagealFistula#Projected

RadiationTherapyfieldtoinclude>40%NormalLungand>50%Heartvol.RADIATION-THERAPYI.NeoadjuvantPancoast*N24500II.AdjuvantN+T3Inco

m.resection5000III.PalliativeStageIIIStageIV2-5000(localsymptoms)IV.DefinitiveT1-2N0-1No/refuseSurg6000V.SCLC(+chemo)Ltdstage5000ADVANCESINRA

DIOTHERAPY..#BIOLOGIC*Hyper-fractionation*AcceleratedTherapy#TECHNICAL*3-DimensionalConf.RadiationTherapy❖RESPONSETOPALLIATIVERADIATION…..Haemopt

ysis……….75-85%SVCobstruction…60-80%Pain…………………50-75%Cough……………….35-65%Dyspnoea…………..35-50%Wt.loss/anorexia..30-50%Atelecta

sis…………20%V.Cordpalsy……….5%OVERALLRELIEF=60-70%SUPPORTIVECARE…#EncouragetoSTOPSMOKING#DuringCHEMOTHERAPY--*ANTI–EMETICS,*BLOODCOUNTS&CHEMISTRY*MONITO

RFORINFECTIONANDBLEEDING*ROUTINEBOLUS/FLUIDSWITHCISPLATINPSYCHOLOGICALSUPPORT..#FEAR,ANXIETY,DEPRESSION#COMPROMISEDSELFIMAGE#CANCE

RSURVIVORS#PHYSICALHANDICAPS--REAL--PERCEIVED❖FEAROFRELAPSEDEALINGWITHDEATH…..#THREEPHASESOFUNSUCCESSFULCANCERRx_-OPTIMISMATHOPEOFC

URE-ACKNOWLEDGEMETOFINCURABLEDISEASEATRECURRENCE-DENIAL,ISOLATION,ANGER,DEPRESSION,BARGAINING,ATDISCLOSUREOFIMMINENTDEATH………….contd..

#SPEAKFRANKLYREGARDINGLIKELYCOURSEOFDISEASE#RE-ASSUREPATIENT&FAMILY#SURROGATEDECISION#LEGALDOCUMENTS#DNRORDERSAnysuggestions/feedbackiswelcom

eAndmaypleasebecommunicatedto<drjaydr@pn3.vsnl.net.in>再见！！