肺癌的化療夏黎明課件

LungCancerChemotherapy

LimingxiathefirstaffiliatedhospitalofAnhuiCollegeofTraditionalChineseMedicine

Alsocalled:Bronchogeniccarcinoma

Lungcancerisoneofthemostcommoncancersintheworld.Itisaleadingcauseofcancerdeathinmenandwomenintheworld.Cigarettesmokingcausesmostlungcancers.Riskfactors:cigarettes,highlevelsofpollution,radiationandasbestosexposure,etc.Yourlungsaretwospongyorgansinyourchestthataredividedintosections(lobes).Everytimeyouinhale,airiscarriedthroughthewindpipetoyourlungsintwomajorairways(bronchi).Insideyourlungs,thebronchisubdivideintoamillionsmallerairways(bronchioles),whichfinallyendinclustersoftinyairsacs(alveoli).Withintheairsacs,oxygenisabsorbedintoyourbloodstreamandcarbondioxideisreleased.HowIsLungCancerDiagnosed?SymptomsandsyndromesPulmonarysymptoms

Symptomsinotherorgans

Symptomslinkedtotumormetabolism

Blood(hematologic)syndromes

Veinandartery(vascular)syndromes

Skin(cutaneous)syndromes

Musculoskeletalsyndromes

Nervoussystem(neurologic)syndromes

Hormonal(endocrine)syndromes

Miscellaneoussyndromes

Testsanddiagnosis

ScreeningDiagnosis

ImagingtestsSputumcytologyTissuesamples(biopsy)

bronchoscopy

mediastinoscopy

needlebiopsy

(Left)ConventionalCTscanwithoutcontrastshowingpossibletumorintheliver.(Right)ConventionalCTscanofthesamepatientusingcontrast.ImagescourtesyofDr.PeterChoyke,DepartmentofRadiology,ClinicalCenter,NationalInstitutesofHealth.SmallCellLungCarcinoma(above)accountsforabout15percentofalllungcancercases.Normallungcells(above).StageI.Canceratthisstagehasinvadedtheunderlyinglungtissuebuthasn'tspreadtothelymphnodes.StageII.Thisstagecancerhasspreadtoneighboringlymphnodesorinvadedthechestwall.StageIIIA.Atthisstage,cancerhasspreadfromthelungtolymphnodesinthecenterofthechest.StageIIIB.Thecancerhasspreadlocallytoareassuchastheheart,bloodvessels,tracheaandesophagus—allwithinthechest—ortolymphnodesintheareaofthecollarboneortothetissuethatsurroundsthelungswithintheribcage(pleura).StageIV.Thecancerhasspreadtootherpartsofthebody,suchastheliver,bonesorbrain.Stagesofnon-smallcelllungcancer

Staging

Limited.Cancerisconfinedtoonelungandtoitsneighboringlymphnodes.Extensive.Cancerhasspreadbeyondonelungandnearbylymphnodes,andmayhaveinvadedbothlungs,moreremotelymphnodesorotherorgans.Stagesofsmallcelllungcancer

LungcancersurgeryStage

Commonoptions

Treatmentoptionsfornon-smallcelllungcancers

ISurgeryIISurgery,chemotherapy,radiationIIIACombinedchemotherapyandradiation,sometimessurgerybasedonresultsoftreatmentIIIBChemotherapy,sometimesradiationIVChemotherapy,targeteddrugtherapy,clinicaltrials,supportivecareStage

Commonoptions

TreatmentoptionsforsmallcelllungcancersLimitedCombinedchemotherapyandradiation,sometimessurgeryExtensiveChemotherapy,clinicaltrials,supportivecareChemotherapyisusuallythemaintreatmentforSCLC

ChemotherapyforSCLCgenerallyusesacombinationof2drugs.ThedrugcombinationsmostoftenusedforinitialchemotherapyforSCLCare:

cisplatinandetoposidecarboplatinandetoposidecisplatinandirinotecancarboplatinandirinotecancyclophosphamide,doxorubicin(Adriamycin),andvincristineIfthecancerprogressesduringtreatmentorreturnsaftertreatmentisfinished,differentchemotherapydrugsmaybetried.Thechoiceofdrugsdependstosomeextentonhowsoonthecancerbeginstogrowagain.(Thelongerittakesforthecancertoreturn,themorelikelyitistorespondtofurthertreatment.)ChemotherapyforSCLC

Ifthecancerprogressesduringtreatmentorrelapseswithin2to3monthsoffinishingtreatment,drugssuchastopotecan,ifosfamide,paclitaxel,docetaxel,irinotecan,orgemcitabinemaybetried.Iftherelapseoccursfrom2to3monthsto6monthsaftertreatment,topotecanisoftenthedrugofchoice.Otherdrugsthatmaybetriedincludeirinotecan,cyclophosphamide/doxorubicin/vincristine(knownastheCAVregimen),gemcitabine,paclitaxel,docetaxel,oraletoposide,orvinorelbine.Forrelapses6ormoremonthsaftertreatment,theoriginalchemotherapyregimenmaystillbeeffectiveandcanoftenbetriedagain.ChemotherapyforSCLC

Chemotherapyistreatmentwithanti-cancerdrugsinjectedintoaveinortakenbymouth.Thesedrugsenterthebloodstreamandgothroughoutthebody,makingthistreatmentusefulforcancerthathasspread(metastasized)todistantorgans.Dependingonthetypeandstageoflungcancer,chemotherapymaybegivenasthemain(primary)treatmentorasanaddition(adjuvant)tosurgeryorradiationtherapy.Doctorsgivechemotherapyincycles,witheachperiodoftreatmentfollowedbyarestperiodtoallowthebodytimetorecover.Chemotherapycyclesgenerallylastabout3to4weeks,andinitialtreatmenttypicallyinvolves4to6cycles.Chemotherapyisoftennotrecommendedforpatientsinpoorhealth,butadvancedagebyitselfisnotabarriertogettingchemotherapy.NSCLCChemotherapyMostoften,initialtreatmentforadvancedlungcancerusesacombinationof2chemotherapydrugs.Studieshaveshownthataddingathirdchemotherapydrugdoesn'taddmuchbenefitandislikelytocausemoresideeffects.ThedrugsmostfrequentlyusedforinitialchemotherapyforNSCLCare:cisplatincarboplatinpaclitaxeldocetaxelgemcitabinevinorelbineirinotecanetoposidevinblastinepemetrexedNSCLCChemotherapyThemostcommoncombinationsincludeeithercisplatinorcarboplatinplusoneotherdrug,althoughsomestudieshavefoundthatusingcombinationswithlessseveresideeffects,suchasgemcitabinewithvinorelbineorpaclitaxel,maybejustaseffectiveformanypatients.Forpeoplewhosecancersmeetcertaincriteria,targetedthe