Aug
25
The lung cancer is one of common malignant tumors, near ten year lung cancer's disease incidence rate and the mortality rate have the obvious markup tendency. The clinical lung cancer common symptom includes: West BUr Anwar luck Oncology institute ??First, west lung cancer lungs symptom BUr Anwar luck Oncology institute ??1st, cough: Is the most common symptom, approximately some 2/3 patients have this symptom. May be coughs mildly, may also be the serious cough, sputamentum how many different. But in has in the chronic long-term cough patient, once the cough nature change, either the frequency conversion or appears coughs at night, must be vigilant the lung cancer. The incessancy, controls with difficulty the cough is one of lung cancer most painful symptoms. West BUr Anwar luck Oncology institute ??2nd, hemoptysis: Has half lung cancer patient to have this symptom. once 40 year-old above smoking man presents in the phlegm the belt blood, the capillary or the small blood clot, the lung cancer possibility is quite big, this is also one of lung cancer incipient symptoms. West BUr Anwar luck Oncology institute ??3rd, chest pain: 30%~40% patients present the lung chest pain, generally for the intermittent not fierce chest in ache. The performance or drills the pain for the dull pain, from sustainable several minutes to several hours. If cancer invades and the pleural membrane ache is fierce, continues fixedly with. If early lung cancer reappearance chest pain, later will again present the ache expression bad prognosis. West BUr Anwar luck Oncology institute ??4th, gives off heat: Because the lung cancer gives off heat majority is cancer causes the inflammation which bronchial tube cavity blocking, the drainage impeded send to cause. The early time with the antibiotic treatment, the body temperature may restore normally, but easy to recur. Tumor volume big, the inflammatory center presents necrosis, because often the toxin absorption causes the high body temperature. Is sometimes daily remittent fever, reaches long time of the several month, the anti-SARS treatment is repeatedly invalid, once the lump body excision, the body temperature restores normally immediately. The lung cancer patient inspects in vivo not obvious inflammation, but actually has gives off heat obviously, often is the tumor itself causes, namely so-called “cancerous heat”, body temperature often below 38 degrees. above 45 years old the masculine smoker long-term lungs inflammation gives off heat, treatment result not good You Yao vigilant lung cancer possibility. West BUr Anwar luck Oncology institute ??5th, the chest stuffy, pants: Besides the tumor blocking bronchial tube causes the lung not to open and the lungs inflammation may cause the chest to pant stuffily, generally many are quite obvious in the lung cancer later period, particularly presents when the abundant hydrothorax is more prominent. West BUr Anwar luck Oncology institute ??Second, outside the lung cancer lung in the chest displays: As a result of tumor infringement pleural membrane: The thoracic wall and in the mediastinum organ and the chest the nerve and so on, may cause a series of chest performance. The tumor infringement pleural membrane may cause the breath ache and the chest cavity accumulates the fluid (i.e. hydrothorax), the hydrothorax is not good for the courage and uprightness expression prognosis. In the hydrothorax looks up malignant tumor cell to lose the surgery opportunity. Because the tumor implicates the mediastinum many are the mediastinum lymph node shift causes, minority is the direct infringement. Because some 5% patient in the tumor oppression the venae cavae causes above the upper limb and the shoulder the edema, vein anger opens, the headache, the scant of breath, expressed already is the later period. The tumor oppression esophagus may cause swallows the difficulty, encroaches upon the throat to return to the nerve to be possible to cause the sound hoarse. West BUr Anwar luck Oncology institute ??Third, outside the lung cancer chest shifts the performance: The lung cancer often shifts along the lymph vessel and the blood vessel, by the pate lymph node, the liver, the adrenal gland, the bone, the kidney and the brain shifts common. The nearly 15% patients are take shift the stove as to display most early, a blood line of shift is most common in the adenocarcinoma and the cellule lung cancer. West BUr Anwar luck Oncology institute ??Fourth, outside chest non-shift performance: Outside the chest the non-shift performance only then 2% patients may appear, but the symptom is complex, implicates the system to be many, the cause of disease mechanism is unclear. Has the skeleton performance common, like clubbed finger (foot) and osteoarthropathy and so on; Nerve muscle performance, like myopathy, periphery mental illness, cerebellum denatured and so on; Endocrine performance, like Ke Xingshi syndrome, in vivo hormone secretion exceptionally, carcinoid syndrome, Gao Gaixue sickness and so on; Blood vessel performance, like phlebitis, endocardium inflammation and so on; Blood performance, like anemia, purpura, kind of leukemia response and so on; Skin performance, like black acanthosis, skleriasis and so on. West BUr Anwar luck Oncology institute ??Fifth, whole body performance: The lung cancer whole body performance and other malignant tumor may appear equally loss of appetite, become emaciated, the asthenia, finally may present the wicked liquid and so on. West BUr Anwar luck Oncology institute
Aug
25
The lung cancer - - lung's malignant epidermis tumor, it stems from the bronchial tube epidermis, the bronchial tube pituitary gland, the bronchiole epidermis and the alveolar epithelium and so on, calls the bronchial tube lung cancer, the abbreviation lung cancer. west v8Y Anwar luck Oncology institute The lung cancer clinical common symptom for the cough, chest pain, the hemoptysis, gives off heat and so on, but does not have the specificities, therefore does not favor the early discovery. Generally occurs in central committee's lung cancer has the symptom to occur in periphery and early obvious. west v8Y Anwar luck Oncology institute The lung cancer common symptom minute states under: west v8Y Anwar luck Oncology institute ??First, lung cancer primary cancer causes west symptom v8Y Anwar luck Oncology institute ??1st, cough: For the most common symptom, often displays for the irritating quality coughs, controls not easily for the medicine. Following when sends the infection, then coughs is accompanied by the mucilage sputum puriforme. west v8Y Anwar luck Oncology institute ??2nd, hemoptysis: Approximately half lung cancer patient has this symptom, displays for the endurance either in the discontinual repeatedly few hemoptysis or the phlegm the belt blood. After cancer corrodes the trunk, then causes the massive hemoptysis. west v8Y Anwar luck Oncology institute ??3rd, breathes heavily presses, the chest to be stuffy, short of breath: This many are because cancer grows in the atmospheric orifice, jamming gas channel result. The lung cancer concurrent lungs infect, the later period to produce the massive hydrothorax oppression chest cavity, double lung proliferating cancer to send the lung function drop and so on to be possible to cause to breathe heavily suppress the symptom. west v8Y Anwar luck Oncology institute ??4th, general symptom: Gives off heat, becomes emaciated, cachexia and so on. west v8Y Anwar luck Oncology institute ??Second, the lung cancer tumor partial proliferation causes west symptom v8Y Anwar luck Oncology institute ??1st, chest pain: When directly cancer encroaches upon the pleural membrane, the rib, the thoracic wall, has chest pain. Goitre located at pleural membrane nearby when many for anomalous dull pain or one's secret worries; The rib encroaches upon time, then the ache spot is been more fixed, could find the tender area; When has severe pain which controls with difficulty, nearly has the widespread pleural membrane or partial thoracic wall infringement, the prognosis is bad. west v8Y Anwar luck Oncology institute ??2nd, swallows the difficulty: Cancer infringement or oppresses the esophagus to be possible to cause swallows the difficulty, even corrodes the penetration pipe wall, forms the bronchial tube - esophagus fistula, causes the feed to choke coughs and the lungs infects. west v8Y Anwar luck Oncology institute ??3rd, sound hoarse: Cancer shifts sends the mediastinum lymph node to be tumescent, oppresses the throat to return to the nerve (left side to be common), may present the sound hoarse. west v8Y Anwar luck Oncology institute ??4th, vena cava superior oppression syndrome: Cancer oppresses the venae cavae, sends the blood backflow to be blocked, produces a face, the pate, upper limb dropsy, first chest vein anger opens, causes the headache, dizziness. west v8Y Anwar luck Oncology institute ??Third, the lung cancer cancer distant place shift appears west symptom v8Y Anwar luck Oncology institute ??The lung cancer patient most is easy the distant place shift which appears is the brain, the liver, the bone. The brain shifts when sickness sees the headache, disgusting, the vomit, the body activity disadvantageous and so on; The liver shifts when may appear losses of appetite, the jaundice, the liver area ache, the ascites and so on, the hospital looks up the liver function to be unusual; When shift to skeleton, heavy may have the partial fierce ache, even has the bone fracture, the common bone shifts the spot for the spine, the rib, the skull and the skeleton. west v8Y Anwar luck Oncology institute ?Fourth, outside the lung cancer lung displays west v8Y the Anwar luck Oncology institute ??The minority patient as a result of cancer's dystopia internal secretion function, will produce outside group of lungs to display, will be called “the vice-cancer syndrome”. If the joints largely with the clubbed finger, the black acanthosis, the low natremia, the adrenal cortex function hyperfunction, the mamma masculina growth, the critically ill myasthenia, the spinal cord cerebellum denaturate, peripheral nerve denaturation and so on. Outside the above lung the symptom sees much largely in our country by the joint with the clubbed finger. west v8Y Anwar luck Oncology institute
Aug
23
(1) the prohibition and control of smoking: smoking prohibition and control of the first to focus on the reduction of smokers in the population the proportion of the need for certain laws or regulations limit the restrictions on people, especially young people from smoking
(2) control of air pollution: do a good job in environmental protection work to control air pollution effectively so as to achieve the purpose of the prevention of lung cancer
(3) occupational protection: on the exploitation of the mining of radioactive ores should take effective protective measures to reduce staff by as much as possible the amount of radiation exposure to carcinogenic compounds of the workers must take all effective measures for labor protection and to avoid or reduce cancer contact factor
(4) prevention and treatment of chronic bronchitis: chronic bronchitis due to the incidence of lung cancer in patients with chronic bronchitis were higher than those without an active control is why the prevention of chronic bronchitis, lung cancer have a certain significance, especially suffering from chronic bronchitis to persuade smokers to quit the suffering from chronic bronchitis due to cigarette smoke and the crowd a higher incidence of lung cancer
(5) early detection of early diagnosis and early treatment: the early lung cancer screening is not yet satisfactory means of population census in the cost of lung cancer is very expensive and to reduce the possibility of lung cancer mortality in a small
Explore the use of chemicals to prevent the use of cyclooxygenase (COX) inhibitors, fat-oxygenase inhibitors, such as trying to block the cancer-causing factors in the development of a number of carotenoid-rich vitamin E selenium, such as retinal foods have preventive effects of lung cancer
(2) control of air pollution: do a good job in environmental protection work to control air pollution effectively so as to achieve the purpose of the prevention of lung cancer
(3) occupational protection: on the exploitation of the mining of radioactive ores should take effective protective measures to reduce staff by as much as possible the amount of radiation exposure to carcinogenic compounds of the workers must take all effective measures for labor protection and to avoid or reduce cancer contact factor
(4) prevention and treatment of chronic bronchitis: chronic bronchitis due to the incidence of lung cancer in patients with chronic bronchitis were higher than those without an active control is why the prevention of chronic bronchitis, lung cancer have a certain significance, especially suffering from chronic bronchitis to persuade smokers to quit the suffering from chronic bronchitis due to cigarette smoke and the crowd a higher incidence of lung cancer
(5) early detection of early diagnosis and early treatment: the early lung cancer screening is not yet satisfactory means of population census in the cost of lung cancer is very expensive and to reduce the possibility of lung cancer mortality in a small
Explore the use of chemicals to prevent the use of cyclooxygenase (COX) inhibitors, fat-oxygenase inhibitors, such as trying to block the cancer-causing factors in the development of a number of carotenoid-rich vitamin E selenium, such as retinal foods have preventive effects of lung cancer
Aug
23
?Treatment?
A lung cancer treatment options
Phase ? Phase ? Phase ? a period in stage ? ? b
Non-small cell lung cancer after surgical treatment is advisable to chemotherapy have not been biased in favor of reunification with the adenocarcinoma of the middle level recommended chemotherapy after surgery can be considered a conditional ? postoperative radiotherapy after chemotherapy for radiotherapy or surgery
? Radiation Therapy for Surgical + chemotherapy ? in line with the expansion of surgical indications / or radiotherapy surgery + radiotherapy + chemotherapy and radiotherapy-based selective chemotherapy and general medical treatment
Small cell lung cancer chemotherapy surgery + chemotherapy + surgery + chemotherapy based on the efficacy of radiotherapy chemotherapy can increase significantly with surgery and postoperative chemotherapy and radiotherapy-based selective chemotherapy and general medical treatment
Second, surgical treatment
Treatment of lung cancer, in addition to stage ? ? b and outside the surgical treatment should be based on or for surgical treatment-oriented according to different types of pathological stage??chemotherapy, radiation therapy and immunotherapy of a comprehensive treatment of small cell lung cancer indication for treatment program to be constantly improving the clinical practice
On survival after lung cancer surgery has been reported three-year period of national survival rate was 40% ~ 60%; the five-year survival rate was 22.9% ~ 44.3% operative mortality was 3% in
(A) the selection of cases are generally the following conditions can be used as surgical treatment of choice for
1, no distant metastasis (M0) will include the substance of the brain adrenal organs such as liver lymph nodes outside the chest, such as bone
2. Cancerous tissues adjacent to the thoracic organs or tissue, such as violations of the proliferation of aorta and superior vena cava in esophageal cancer, such as pleural effusion
3. No recurrent laryngeal nerve phrenic nerve paralysis
4. No serious cardiopulmonary dysfunction or angina made the near future the author
5. Without severe liver disease and severe diabetes
Have the following conditions should be cautious in general surgery or the need for further examination and treatment:
(1) elderly and ailing poor cardiopulmonary function
(2) small-cell lung cancer I view things in addition to chemotherapy or radiotherapy should be first and then determine whether the surgical treatment
(3) x-ray can see in addition to the primary tumor outside the mediastinum is also the transfer of several suspicious persons
(B) exploratory thoracotomy patients without surgical contraindications indications where a clear diagnosis of lung cancer symptoms or highly suspected to be lung cancer can be combined according to specific conditions set out in section I of this chapter to choose surgery if the disease has been found in patients with resectable beyond the scope of the original cancer can be removed from the primary tumor should be removed This is called a reduction operation in principle, but for pneumonectomy to other forms of treatment of postoperative adjuvant
(C) surgical resection of lung cancer and the meaning of the name
1. Palliative resection (P): Where a surgical resection of the chest cavity when there is still residual carcinoma (Histopathology confirmed) or complete surgical resection when the that the naked eye, such as normal bronchial stump but there is residual cancer cells under the microscope are referred to as palliative excision
Where there are suspicious residual thoracic cancer surgery in the Department organizations with a metal tag to be supplemented with postoperative radiation therapy
2. Radical resection (R): radical mastectomy refers to the original cancer and its metastatic lymph nodes removed completely clean
Radical resection of lung cancer patients who require not only the naked eye is more important to achieve cure is to remove lymph nodes and bronchial stump under the microscope and no residual cancer cells in order to achieve this end I would radical surgery of lung cancer is divided into four grades as follows
Root 1 (R1): the primary cancer and lymph node dissection from a station
Root 2 (R2): the primary cancer and lymph node dissection were 12 points
Root 3 (R3): the primary cancer and lymph node dissection were l23 Station
Gen-4 (B4): primary carcinoma and lymph node resection l234 Station
It should be noted that these four levels of radical surgery to remove lymph nodes means that the scope does not mean that the effect of radical surgery
(D) the choice of lung cancer surgery in 1985 in accordance with the international staging of lung cancer on 0 ? ? and ? of lung cancer cases where no surgery can be a taboo sign both surgical treatment of the principles of surgical resection: complete resection of primary tumor and the chest, there are lymph node metastasis and may be retained as far as possible the normal lung the whole lung tissue resection should be carefully
1. Local excision:??refers to wedge resection or segmental resection and lung volume for a small primary carcinoma of the lung function of frail elderly cancer worse or better grade differentiation, such as the lower lung may be considered for local excision
2. Lobectomy: For the isolation of peripheral lung cancer confined to one lobe with no obvious lymphadenopathy lobectomy feasible if cancer involving both lobes or the middle or the middle of the bronchial feasible under the middle of both lobes of lung resection
3. Sleeve lobectomy and wedge-shaped sleeve lobectomy: This procedure applies to more than the middle of the right lung on the lung such as bronchial carcinoid tumor is located in leaves and leaf bronchial openings were involved sleeve lobectomy feasible; not affect leaf bronchial openings possible wedge sleeve lobectomy
4. Pneumonectomy (normally try not to make the right pneumonectomy): Where the lesion can not widely used method of removal of these lesions can be carefully considered when the line pneumonectomy
5. Carinal resection and reconstruction surgery: lung tumor involved more than the main bronchial or tracheal wall protuberans but not more than 2cm at: ? carinal resection and reconstruction can be used for surgery or sleeve pneumonectomy; ? If retained leaf when arguing for the retention of lung surgery can be determined in accordance with the circumstances
Anesthesia: general anesthesia endotracheal intubation is appropriate if the higher number of bleeding and secretions should be held in double-lumen intubation to ensure airway patency
(E) of recurrence or relapse of the surgical treatment of lung cancer
1. More than the treatment of primary lung cancer: The diagnosis of multiple primary lung cancer were in accordance with the principles of the second primary processing
2. To deal with recurrent lung cancer: Lung cancer is the so-called recurrent scar refers to the original operation took place within the bounds of the original cancer or tumor-related recurrence of breast cancer with recurrent lung cancer as its principles should be based on the patient's cardiopulmonary function and whether the surgical removal of the scope of the decision
Three Radiation Therapy
(A) the principles of radiotherapy treatment of small cell carcinoma followed by squamous cell carcinoma of the best adenocarcinoma small cell carcinoma of the worst but it is prone to transfer the use of large-area radiation exposure asymmetric field area should include both primary mediastinal supraclavicular and even liver and other parts of the brain to be supplemented by drug therapy for squamous cell carcinoma-ray moderate degree of sensitivity to local violations of diseases mainly steamed bread so the transfer of relatively more radical treatment of adenocarcinoma of the sensitivity of poor-ray metastasis and easy it is less blood the use of radiation therapy alone to radiation sensitivity of tumor in addition to suffering from the effects of pathological types of tumors is still subject to the size of tumor cell differentiation of tumor cells constitute a proportion of the tumor bed, etc. So many factors before the development of radiation therapy should be carefully Analysis of the full balance is not easy to conclude
(B) adaptation of radiotherapy treatment for the purpose of levy in accordance with the treatment of palliative care is divided into radical radiotherapy after preoperative radiotherapy and intraluminal brachytherapy, such as
1. The scope of application of radical treatment
(1) there are contraindications or refuse surgery for early surgery cases or lesions confined to the scope of the dish a case 150cm2
(2) cardio-pulmonary function of normal liver and kidney blood white blood cell count greater than 3 × 109 / 1 hemoglobin greater than 100g / 1 person
(3) KS ? 60 hours prior to the formulation of detailed plans to strictly implement the treatment plan will not change even if there is radiation to cure the tumor response should be the objective of
2. Palliative care: a very great difference between the purpose of close to radical treatment of patients with palliative care in order to alleviate the suffering of the extension of life to improve quality of life; have only terminally ill people to alleviate symptoms and even caused by the role of comfort such as pain treatment paralysis coma and bleeding dyspnea palliative the number of radiation treatment can be from several to dozens of specific conditions should be based on conditions and equipment may be, but it must be the aim of not increasing the suffering of patients in the event of the principle of treatment of radiation reaction or greater decline in scores KS may modify, as appropriate, treatment programs by the Department of irradiation treatment of the site have symptoms usually less available high-dose radiotherapy
3. Radiotherapy before surgery: surgical resection aimed at increasing the rate of reduction surgery in the risk of causing disseminated tumor surgical resection of the estimated patients have no difficulty in high-dose preoperative radiotherapy less; such as a huge tumor or surgical resection of foreign invasion is estimated that there are difficulties Conventional radiotherapy can be separated from radiotherapy to surgery generally about 50 days longer than three months is appropriate
4. Radiotherapy after surgery: preoperative underestimation for surgery to remove the tumor cases did not complete the focus should be placed in the local residual silver tag folder in order to accurately position when radiotherapy
5. Intraluminal short-distance radiotherapy: the limitations applicable to the foci in the bronchial technology can be installed after the bronchoscopy the bronchial lesions Department catheter placed with Iridium (192Ir) brachytherapy for in vitro irradiation and treatment with improved
Table 17-2 monotherapy different pathological types of lung cancer on the efficient
Drug-small-cell squamous cell carcinoma% carcinoma%%% large cell carcinoma
Cyclophosphamide 38 20 20 23
Ifosfamide 63 27 23 36
CCNU 15 30 20 17
ACNU 38 16 17 --
Vincristine 4,210,200
Vindesine 24 13 29 20
Etoposide 40 25 12 0
Adriamycin 30 20 15 25
Epirubicin 57 7 7 --
Methotrexate 30 25 30 12
Methyl benzyl hydrazine 63 27 23 36
Cisplatin 17 19 19 19
Carbon-platinum 41,777
IV chemotherapy
Chemotherapy over the past two decades the rapid development of widely used information from at home and abroad to see the small cell lung cancer, whether early or late than the sure cure for even a small number of reports of non-small cell lung cancer also have a certain effect but has yet to be only palliative role chemotherapy in recent years to improve the industry's role in lung cancer is no longer limited to the advanced inoperable lung cancer as a systemic treatment and often included in the comprehensive treatment of lung cancer
(B) chemotherapy for small cell lung cancer small cell lung cancer as a result of the biological characteristics of the present with the exception of a few recognized that without sufficient evidence of intrathoracic lymph node metastasis who should be the preferred chemical treatment outside
1 to adapt to levy
(1) confirmed by pathology or cytology in patients with small cell lung cancer
(2) KS points in the 50 to 60 hours or more
(3) expected survival time in a month or more
(4) age ? 70 years of age
2. Contraindication
(1) aging and ailing persons or cachexia
(2) heart, liver function disorder
(3) leukocytes of poor bone marrow function in the 3 × 109 / L platelets in the following 80 × 109 / l (direct count) below
(4) fever and infection complications, such as bleeding tendency
3. Commonly used programs: except in special circumstances not generally a single-drug treatment of international and national clinical cooperative group recommended a more effective program include:
(1) CAO (Shanghai Chest Hospital)
Intravenous cyclophosphamide in the first day of 1000mg/m2
Adriamycin 50-60mg/m2 the first day of intravenous
Intravenous vincristine 1mg/m2 the first day of
One cycle every three weeks for each course of treatment for 2-3 weeks
(2) COMVP (National Institute of collaborative programs chemotherapy)
Lactam ring 500-700mg/m2 scales the first 18 days of intravenous
Article 1mg/m2 intravenous vincristine l8 days
Methotrexate intravenous or intramuscular injection 7-14mg/m2 No. 351012 days
Etoposide 100mg/m2 intravenous drip No. 3 ~ 7 days
Repeat every three weeks for 2 ~ 3 cycles for a course
3.ECHO (MDAuderson Hospital and Tumor Institute)
Etoposide 100mg intravenous infusion (3 hours) the first 3-5 days
Central scales 1000g/m2 amide infusion (1 hour) days of the first l
Adriamycin 60mg/m2 infusion (15-30 minutes) the first day l
Lmg/m2 vincristine infusion (15-30 minutes) the first 18 days
Every 3 weeks for a 3-cycle is a cycle of treatment
4.CMC (NCI / VA Shanghai Chest Hospital)
Lactam ring scales 500mg/m2 weekly intravenous x3 or 1000 ~ 1500mg/m2 intravenous injection of the second day of fasting CCNU 50 ~ 70mg/m2 oral first night
Methotrexate 10mg/m2 intravenous injection 2 times per week x6 or 30mg/m2 day 2
One cycle every three weeks for 2 to 3 cycles for a course of treatment
5.CV (IE Smith1987)
Carbon-platinum (carboplatin) 300mg/m2 intravenous infusion of the first l-day
Etoposide 100mg/m2 infusion 1 to 3 days
Four weeks per cycle for a 4-cycle course of treatment
Before and after surgery to surgery or chemotherapy for the tumor by chemotherapy after surgery to reduce the conditions of patients should, as far as possible to remove the original tumor resection of the possibility of local recurrence of preoperative chemotherapy in the general course of 2 to 3 inadequate appropriate treatment to prevent disease and long course of treatment caused by excessive fibrosis difficulties caused by the operation of any pre-operative chemotherapy has made it clear there were intrathoracic lymph node metastasis should be used for the I period without intrathoracic lymph node metastasis whether preoperative chemotherapy is still needed to be exploration of post-operative chemotherapy a greater impact after long-term survival is important to stress the application of the general in favor of chemotherapy more than 4 to 6 cycles of chemotherapy may be effective if it is estimated that surgical resection can not be clean and disease can not be found during all of the net should also be given to all regional radiation therapy
(C) non-small cell lung cancer chemotherapy for non-small cell lung cancer drugs may be effective but the efficiency of a number of low and very few can achieve complete remission
1. To adapt to sign:
(1) by pathology or cytology confirmed adenocarcinoma or squamous cell carcinoma but not in stage ? surgery and postoperative recurrence and metastasis, or other reasons should not I ? period of surgery patients
(2) surgical exploration by pathological examination were the following circumstances: ? residual foci; ? intrathoracic lymph node metastasis; ? lymphatic or blood clots in the tumor thrombus; ? poorly differentiated cancer
(3) chest or pericardial effusion required the use of local chemotherapy
2. Taboos imposed: with small cell carcinoma
3. Commonly used programs: single-drug treatment for non-small cell lung cancer is very low and should be an efficient use of combined chemotherapy (1) CAP:
Intravenous cyclophosphamide 400mg/m2 days of the first l
Adriamycin 40 ~ 50mg/m2 intravenous injection of the first l-day
40 ~ 80mg/m2 cisplatin intravenous day 1
One cycle every three weeks for a treatment period of 2-3
Injection of cisplatin to patients prior to transfusion 500ml glucose 5% 10 5% glucose saline and then cisplatin 500m1 in l ~ 2 hours, half an hour after the instillation of oral furosemide 20mg continues to drip 500mI Ringer's solution and 10% chloride 10m1 K vomiting to prevent and reduce the infusion of dexamethasone at the same time 5 ~ 10mg intramuscular injection or intravenous infusion of metoclopramide (total amount of 40 ~ 90mg)
(2) MFP:
Intravenous instillation of mitomycin 5-6mg/m2 No. 11529 days
Fluorouracil 500mg intravenous infusion of the first day 101217193l333840
Intravenous infusion of cisplatin 30mg the first 3 to 5 days 24 ~ 26 days
6 weeks per cycle every 2 ~ 3 cycles for a course
(3) CAMB
Cyclophosphamide 500 ~ 700mg/m2 intravenous injection of the first day l815222936
Adriamycin 40mg/m2 intravenous instillation first l22 days
Methotrexate 7 ~ 14mg/m2 intravenous drip No. 1012171931333840 days
Pingyangmycin 10mg intramuscular injection the first day 35ll131719242631333840
Every six weeks for a cycle period of 2 ~ 3 - treatment
(4) PE:
Etoposide 100mg intravenous No. l-5 days
Cisplatin (DDP) 80mg/m2 intravenous hydration the first four weeks of each l-day course of treatment for a
Adriamycin 50mg/m2 still shared the first two days of intravenous
Pleural and pericardial injection fluid should be done as far as possible, and then pumped into the drug
However, in order to prevent mediastinal swing to each extract to be no more than 1000m1 usually 5 ~ 7 days of each extract more than 3 times a change of drug-free medium for more than effect effusion drainage should be closed or silicone insert small drainage water-sealed bottle to be useful After the injection of liquid drugs do Pai folder and then pipe 24 ~ 48 hours after extubation of the drugs can be selected:
(1) Immunomodulator: Corynebacterium short (CP) 7mg saline soluble in 40 ~ 60ml in about 80% of patients can be effective after the first injection
(2) chemotherapy drugs:
? MBP: mitomycin C 5 ~ 6mg/m2 capacity in 20 ~ 40ml of normal saline
Pingyangmycin: 10 ~ 20mg dissolved in saline in 20 ~ 40ml
Cisplatin: 50 ~ 80mg dissolved in saline in 20 ~ 40ml
? CP:
Dissolved in saline CTX 500mg/m2 in 20 ~ 40ml
DDP 50mg/m2 dissolved in saline in 20 ~ 40ml
Above drugs can be injected into a joint or single-drug medicine chest with a single dose may be increased when the l / 3 into the patient should be advised bed rest and every 5 to 10 minutes to change position so that uniform distribution of drug exposure and pleural cavity pericardial injection drugs should be appropriate reduce the l / 3 dose or choice of local reactions less common drug thiotepa to send 40 ~ 60mg / or DDP50mg / times, many patients in the injection l ~ 3 times is expected to control pleural effusion of pericardial effusion may have a certain effect
(D) attention to matters of lung cancer chemotherapy
1. At present, chemotherapy for lung cancer in general it can not achieve radical chemotherapy may be of a certain stage with surgery or radiation therapy to strengthen the local or regional tumor control at the same time as far as possible, chemotherapy should be based on the patient's tolerance to give higher doses for lung cancer chemotherapy for a certain degree of gastrointestinal reaction and bone marrow suppression is difficult to avoid the number of treatment should be based on patient's response and efficacy of an appropriate increase to achieve complete remission, as far as possible
2. The interval treatment of drug toxicity as a result of existing in the drug often can be after the extension of several weeks during each week intervals from the date of the beginning of chemotherapy every 4 to 6 weeks of drug toxicity must be followed by the disappearance of the response a course
3. Chemotherapy drug or in the process of dressing change indications
(1) treatment of 1 or 2 is still the progress of disease or treatment has become stable but deteriorated again in the rest period
(2) toxicity of 3 to 4 pairs of a certain threat to patient health
(3) there are complications such as fever> 38 degrees or have bleeding tendencies
(4) patients with rapid deterioration of the general situation there cachexia
Five complications of lung cancer chemotherapy
(A) of the superior vena cava syndrome caused by chemotherapy for lung cancer with superior vena cava syndrome surgery if possible every effort should be made on surgery for repair or replacement of inferior vena cava is regrettable that the majority of the patients had surgery in late opportunity lost if patients with acute upper superior vena cava should be immediately given to the role of the rapid and effective anti-cancer drug therapy feasible, such as the impact of high-dose cyclophosphamide adriamycin nitrogen mustard can be alone to radiotherapy combined with chemotherapy in succession should be noted that the acute phase of chemotherapy and then radiation therapy can not be Radiotherapy may be a result of edema caused by superior vena cava or even give rise to increase the symptoms of asphyxiation caused by chronic obstructive best if used before radiation therapy in the acute stage can be properly co-ordinated with the application of corticosteroids such as hydrocortisone to give the song 100 ~ 200mg intravenous infusion or strong and Song 5 ~ 10mg oral diuretics at the same time given to most patients can be alleviated in a number of survival but only 2 to 5 months
(B) of the chemotherapy of brain metastases from lung cancer with brain metastasis is the best treatment for localized radiation therapy but if the body that there is no other Department of intracranial metastasis transfer for a single lesion can craniotomy and radiotherapy combined with chemotherapy in our hospital have case of lung cancer patients with brain metastases occurred in line surgical resection of brain metastases after radiotherapy combined with chemotherapy survived for 18 years now
For brain metastases to systemic medication may be the basis of cell types depending on whether the drug through the blood-brain barrier, such as ethyl nitrosourea sodium cyclohexyl nitrosourea and other fat-soluble substances on the brain through the blood-brain barrier transfers corticosteroid treatment can be used to alleviate symptoms of cerebral edema but continuous use may affect the patient's survival time if the transfer is for the unilateral internal carotid artery (carotid artery or by the superior thyroid artery) the role of the rapid infusion of anti - cancer drug
(C) pleural effusion caused by lung cancer chemotherapy in the diagnosis of lung cancer are 1% of patients with pleural effusion have been no indications at this time surgery to receive chemotherapy only a temporary effect of the drugs commonly used are as follows:
1 mustard: In operation under sterile pleural effusion within the pump as much as possible to do (there are small catheter placed) 200m1 by 0.4mg/kg diluted with normal saline injected into the chest once again the largest amount of not more than 20mg immediately after injection so that patients position to transform the direction of continued about 15 minutes to ensure uniform liquid distribution of all the inner surface of the chest once a week for 55% efficient ~ 87% a week before and after the drug should pay attention to the situation of bone marrow function and whole body
2. Ah Ping: The response rate of about 64% ~ 88% of the drug will enable the emergence of inflammatory adhesion pleural space can be used to start the disappearance of 50 ~ 100mg dissolved in saline injected in the chest lomI if the patient does not respond to every 2 to re-re-injected on the 5th 100 ~ 200mg until the liquid can also be used to reduce up to 600 ~ 800mg single injection of the main reactions of local pain fever patients are still some low blood pressure
3. Tetracyclines: tetracycline as a sclerosing agent for cancer treatment of pleural effusion are generally placed in a closed chest catheter to 500mg of tetracycline dissolved in 30ml normal saline injected into the thoracic cavity with normal saline and then 10m1 clamp pipe cleaning catheter closure of six hours and change of position while at the same time and then drainage tube? a href = "http://jbk.39.net/keshi/pifu/pifubing/490b3.html" target = "_blank" class = blue> carbuncle procyonoides broom ? ? scratch? about four hours to determine the liquid and then pulled out without drainage patients was reported for other drugs (nitrogen mustard, etc.) this method fails to successfully control the growth of liquid 3 to 19 months Satoshi Kitamura also reported using 500mg2 weeks doxycycline intrapleural injection 2 or 3 times the liquid can completely disappear
4. Other: self-adriamycin for adenocarcinoma pleural effusion caused by intrathoracic better of the first 6 ~ 12mg addition Xiaoliu mustard can also be used 30 ~ 40mg / times 5 - fluorouracil 750 ~ 1000mg / times yet to gel Gold (198Au) colloidal phosphorus (32P) and the polio vaccine type ? ? vaccinia vaccine
Prognosis ??
Although in the treatment of lung cancer has made great progress such as: surgery radiotherapy chemotherapy combination therapy as well as new anti-cancer drugs available but still very poor prognosis of lung cancer treatment in patients with lung cancer 5-year survival rate was 14% and 30 years ago 11% of lung cancer is a high mortality rate was mainly due to the lack of early diagnosis and effective treatment in most patients, even early in the first visit for systemic diseases
The impact of prognostic factors of lung cancer include: age of site types and stages of cancer surgery and chemotherapy are man-made factors that control center or violations pleural dirty poor prognosis of early lung cancer are of the view that most often due to lung cancer after 2 ~ 3-year recurrence in this period should increase the number of follow-up after the first two years on average should be 3 to 4 times to review and X-ray taken after 2 to 3 years and reviewed 2 times usually taken X-ray examination of blood CEA Bronchoscopy CT and bone scan only when there are clinical indications for the use of
A lung cancer treatment options
Phase ? Phase ? Phase ? a period in stage ? ? b
Non-small cell lung cancer after surgical treatment is advisable to chemotherapy have not been biased in favor of reunification with the adenocarcinoma of the middle level recommended chemotherapy after surgery can be considered a conditional ? postoperative radiotherapy after chemotherapy for radiotherapy or surgery
? Radiation Therapy for Surgical + chemotherapy ? in line with the expansion of surgical indications / or radiotherapy surgery + radiotherapy + chemotherapy and radiotherapy-based selective chemotherapy and general medical treatment
Small cell lung cancer chemotherapy surgery + chemotherapy + surgery + chemotherapy based on the efficacy of radiotherapy chemotherapy can increase significantly with surgery and postoperative chemotherapy and radiotherapy-based selective chemotherapy and general medical treatment
Second, surgical treatment
Treatment of lung cancer, in addition to stage ? ? b and outside the surgical treatment should be based on or for surgical treatment-oriented according to different types of pathological stage??chemotherapy, radiation therapy and immunotherapy of a comprehensive treatment of small cell lung cancer indication for treatment program to be constantly improving the clinical practice
On survival after lung cancer surgery has been reported three-year period of national survival rate was 40% ~ 60%; the five-year survival rate was 22.9% ~ 44.3% operative mortality was 3% in
(A) the selection of cases are generally the following conditions can be used as surgical treatment of choice for
1, no distant metastasis (M0) will include the substance of the brain adrenal organs such as liver lymph nodes outside the chest, such as bone
2. Cancerous tissues adjacent to the thoracic organs or tissue, such as violations of the proliferation of aorta and superior vena cava in esophageal cancer, such as pleural effusion
3. No recurrent laryngeal nerve phrenic nerve paralysis
4. No serious cardiopulmonary dysfunction or angina made the near future the author
5. Without severe liver disease and severe diabetes
Have the following conditions should be cautious in general surgery or the need for further examination and treatment:
(1) elderly and ailing poor cardiopulmonary function
(2) small-cell lung cancer I view things in addition to chemotherapy or radiotherapy should be first and then determine whether the surgical treatment
(3) x-ray can see in addition to the primary tumor outside the mediastinum is also the transfer of several suspicious persons
(B) exploratory thoracotomy patients without surgical contraindications indications where a clear diagnosis of lung cancer symptoms or highly suspected to be lung cancer can be combined according to specific conditions set out in section I of this chapter to choose surgery if the disease has been found in patients with resectable beyond the scope of the original cancer can be removed from the primary tumor should be removed This is called a reduction operation in principle, but for pneumonectomy to other forms of treatment of postoperative adjuvant
(C) surgical resection of lung cancer and the meaning of the name
1. Palliative resection (P): Where a surgical resection of the chest cavity when there is still residual carcinoma (Histopathology confirmed) or complete surgical resection when the that the naked eye, such as normal bronchial stump but there is residual cancer cells under the microscope are referred to as palliative excision
Where there are suspicious residual thoracic cancer surgery in the Department organizations with a metal tag to be supplemented with postoperative radiation therapy
2. Radical resection (R): radical mastectomy refers to the original cancer and its metastatic lymph nodes removed completely clean
Radical resection of lung cancer patients who require not only the naked eye is more important to achieve cure is to remove lymph nodes and bronchial stump under the microscope and no residual cancer cells in order to achieve this end I would radical surgery of lung cancer is divided into four grades as follows
Root 1 (R1): the primary cancer and lymph node dissection from a station
Root 2 (R2): the primary cancer and lymph node dissection were 12 points
Root 3 (R3): the primary cancer and lymph node dissection were l23 Station
Gen-4 (B4): primary carcinoma and lymph node resection l234 Station
It should be noted that these four levels of radical surgery to remove lymph nodes means that the scope does not mean that the effect of radical surgery
(D) the choice of lung cancer surgery in 1985 in accordance with the international staging of lung cancer on 0 ? ? and ? of lung cancer cases where no surgery can be a taboo sign both surgical treatment of the principles of surgical resection: complete resection of primary tumor and the chest, there are lymph node metastasis and may be retained as far as possible the normal lung the whole lung tissue resection should be carefully
1. Local excision:??refers to wedge resection or segmental resection and lung volume for a small primary carcinoma of the lung function of frail elderly cancer worse or better grade differentiation, such as the lower lung may be considered for local excision
2. Lobectomy: For the isolation of peripheral lung cancer confined to one lobe with no obvious lymphadenopathy lobectomy feasible if cancer involving both lobes or the middle or the middle of the bronchial feasible under the middle of both lobes of lung resection
3. Sleeve lobectomy and wedge-shaped sleeve lobectomy: This procedure applies to more than the middle of the right lung on the lung such as bronchial carcinoid tumor is located in leaves and leaf bronchial openings were involved sleeve lobectomy feasible; not affect leaf bronchial openings possible wedge sleeve lobectomy
4. Pneumonectomy (normally try not to make the right pneumonectomy): Where the lesion can not widely used method of removal of these lesions can be carefully considered when the line pneumonectomy
5. Carinal resection and reconstruction surgery: lung tumor involved more than the main bronchial or tracheal wall protuberans but not more than 2cm at: ? carinal resection and reconstruction can be used for surgery or sleeve pneumonectomy; ? If retained leaf when arguing for the retention of lung surgery can be determined in accordance with the circumstances
Anesthesia: general anesthesia endotracheal intubation is appropriate if the higher number of bleeding and secretions should be held in double-lumen intubation to ensure airway patency
(E) of recurrence or relapse of the surgical treatment of lung cancer
1. More than the treatment of primary lung cancer: The diagnosis of multiple primary lung cancer were in accordance with the principles of the second primary processing
2. To deal with recurrent lung cancer: Lung cancer is the so-called recurrent scar refers to the original operation took place within the bounds of the original cancer or tumor-related recurrence of breast cancer with recurrent lung cancer as its principles should be based on the patient's cardiopulmonary function and whether the surgical removal of the scope of the decision
Three Radiation Therapy
(A) the principles of radiotherapy treatment of small cell carcinoma followed by squamous cell carcinoma of the best adenocarcinoma small cell carcinoma of the worst but it is prone to transfer the use of large-area radiation exposure asymmetric field area should include both primary mediastinal supraclavicular and even liver and other parts of the brain to be supplemented by drug therapy for squamous cell carcinoma-ray moderate degree of sensitivity to local violations of diseases mainly steamed bread so the transfer of relatively more radical treatment of adenocarcinoma of the sensitivity of poor-ray metastasis and easy it is less blood the use of radiation therapy alone to radiation sensitivity of tumor in addition to suffering from the effects of pathological types of tumors is still subject to the size of tumor cell differentiation of tumor cells constitute a proportion of the tumor bed, etc. So many factors before the development of radiation therapy should be carefully Analysis of the full balance is not easy to conclude
(B) adaptation of radiotherapy treatment for the purpose of levy in accordance with the treatment of palliative care is divided into radical radiotherapy after preoperative radiotherapy and intraluminal brachytherapy, such as
1. The scope of application of radical treatment
(1) there are contraindications or refuse surgery for early surgery cases or lesions confined to the scope of the dish a case 150cm2
(2) cardio-pulmonary function of normal liver and kidney blood white blood cell count greater than 3 × 109 / 1 hemoglobin greater than 100g / 1 person
(3) KS ? 60 hours prior to the formulation of detailed plans to strictly implement the treatment plan will not change even if there is radiation to cure the tumor response should be the objective of
2. Palliative care: a very great difference between the purpose of close to radical treatment of patients with palliative care in order to alleviate the suffering of the extension of life to improve quality of life; have only terminally ill people to alleviate symptoms and even caused by the role of comfort such as pain treatment paralysis coma and bleeding dyspnea palliative the number of radiation treatment can be from several to dozens of specific conditions should be based on conditions and equipment may be, but it must be the aim of not increasing the suffering of patients in the event of the principle of treatment of radiation reaction or greater decline in scores KS may modify, as appropriate, treatment programs by the Department of irradiation treatment of the site have symptoms usually less available high-dose radiotherapy
3. Radiotherapy before surgery: surgical resection aimed at increasing the rate of reduction surgery in the risk of causing disseminated tumor surgical resection of the estimated patients have no difficulty in high-dose preoperative radiotherapy less; such as a huge tumor or surgical resection of foreign invasion is estimated that there are difficulties Conventional radiotherapy can be separated from radiotherapy to surgery generally about 50 days longer than three months is appropriate
4. Radiotherapy after surgery: preoperative underestimation for surgery to remove the tumor cases did not complete the focus should be placed in the local residual silver tag folder in order to accurately position when radiotherapy
5. Intraluminal short-distance radiotherapy: the limitations applicable to the foci in the bronchial technology can be installed after the bronchoscopy the bronchial lesions Department catheter placed with Iridium (192Ir) brachytherapy for in vitro irradiation and treatment with improved
Table 17-2 monotherapy different pathological types of lung cancer on the efficient
Drug-small-cell squamous cell carcinoma% carcinoma%%% large cell carcinoma
Cyclophosphamide 38 20 20 23
Ifosfamide 63 27 23 36
CCNU 15 30 20 17
ACNU 38 16 17 --
Vincristine 4,210,200
Vindesine 24 13 29 20
Etoposide 40 25 12 0
Adriamycin 30 20 15 25
Epirubicin 57 7 7 --
Methotrexate 30 25 30 12
Methyl benzyl hydrazine 63 27 23 36
Cisplatin 17 19 19 19
Carbon-platinum 41,777
IV chemotherapy
Chemotherapy over the past two decades the rapid development of widely used information from at home and abroad to see the small cell lung cancer, whether early or late than the sure cure for even a small number of reports of non-small cell lung cancer also have a certain effect but has yet to be only palliative role chemotherapy in recent years to improve the industry's role in lung cancer is no longer limited to the advanced inoperable lung cancer as a systemic treatment and often included in the comprehensive treatment of lung cancer
(B) chemotherapy for small cell lung cancer small cell lung cancer as a result of the biological characteristics of the present with the exception of a few recognized that without sufficient evidence of intrathoracic lymph node metastasis who should be the preferred chemical treatment outside
1 to adapt to levy
(1) confirmed by pathology or cytology in patients with small cell lung cancer
(2) KS points in the 50 to 60 hours or more
(3) expected survival time in a month or more
(4) age ? 70 years of age
2. Contraindication
(1) aging and ailing persons or cachexia
(2) heart, liver function disorder
(3) leukocytes of poor bone marrow function in the 3 × 109 / L platelets in the following 80 × 109 / l (direct count) below
(4) fever and infection complications, such as bleeding tendency
3. Commonly used programs: except in special circumstances not generally a single-drug treatment of international and national clinical cooperative group recommended a more effective program include:
(1) CAO (Shanghai Chest Hospital)
Intravenous cyclophosphamide in the first day of 1000mg/m2
Adriamycin 50-60mg/m2 the first day of intravenous
Intravenous vincristine 1mg/m2 the first day of
One cycle every three weeks for each course of treatment for 2-3 weeks
(2) COMVP (National Institute of collaborative programs chemotherapy)
Lactam ring 500-700mg/m2 scales the first 18 days of intravenous
Article 1mg/m2 intravenous vincristine l8 days
Methotrexate intravenous or intramuscular injection 7-14mg/m2 No. 351012 days
Etoposide 100mg/m2 intravenous drip No. 3 ~ 7 days
Repeat every three weeks for 2 ~ 3 cycles for a course
3.ECHO (MDAuderson Hospital and Tumor Institute)
Etoposide 100mg intravenous infusion (3 hours) the first 3-5 days
Central scales 1000g/m2 amide infusion (1 hour) days of the first l
Adriamycin 60mg/m2 infusion (15-30 minutes) the first day l
Lmg/m2 vincristine infusion (15-30 minutes) the first 18 days
Every 3 weeks for a 3-cycle is a cycle of treatment
4.CMC (NCI / VA Shanghai Chest Hospital)
Lactam ring scales 500mg/m2 weekly intravenous x3 or 1000 ~ 1500mg/m2 intravenous injection of the second day of fasting CCNU 50 ~ 70mg/m2 oral first night
Methotrexate 10mg/m2 intravenous injection 2 times per week x6 or 30mg/m2 day 2
One cycle every three weeks for 2 to 3 cycles for a course of treatment
5.CV (IE Smith1987)
Carbon-platinum (carboplatin) 300mg/m2 intravenous infusion of the first l-day
Etoposide 100mg/m2 infusion 1 to 3 days
Four weeks per cycle for a 4-cycle course of treatment
Before and after surgery to surgery or chemotherapy for the tumor by chemotherapy after surgery to reduce the conditions of patients should, as far as possible to remove the original tumor resection of the possibility of local recurrence of preoperative chemotherapy in the general course of 2 to 3 inadequate appropriate treatment to prevent disease and long course of treatment caused by excessive fibrosis difficulties caused by the operation of any pre-operative chemotherapy has made it clear there were intrathoracic lymph node metastasis should be used for the I period without intrathoracic lymph node metastasis whether preoperative chemotherapy is still needed to be exploration of post-operative chemotherapy a greater impact after long-term survival is important to stress the application of the general in favor of chemotherapy more than 4 to 6 cycles of chemotherapy may be effective if it is estimated that surgical resection can not be clean and disease can not be found during all of the net should also be given to all regional radiation therapy
(C) non-small cell lung cancer chemotherapy for non-small cell lung cancer drugs may be effective but the efficiency of a number of low and very few can achieve complete remission
1. To adapt to sign:
(1) by pathology or cytology confirmed adenocarcinoma or squamous cell carcinoma but not in stage ? surgery and postoperative recurrence and metastasis, or other reasons should not I ? period of surgery patients
(2) surgical exploration by pathological examination were the following circumstances: ? residual foci; ? intrathoracic lymph node metastasis; ? lymphatic or blood clots in the tumor thrombus; ? poorly differentiated cancer
(3) chest or pericardial effusion required the use of local chemotherapy
2. Taboos imposed: with small cell carcinoma
3. Commonly used programs: single-drug treatment for non-small cell lung cancer is very low and should be an efficient use of combined chemotherapy (1) CAP:
Intravenous cyclophosphamide 400mg/m2 days of the first l
Adriamycin 40 ~ 50mg/m2 intravenous injection of the first l-day
40 ~ 80mg/m2 cisplatin intravenous day 1
One cycle every three weeks for a treatment period of 2-3
Injection of cisplatin to patients prior to transfusion 500ml glucose 5% 10 5% glucose saline and then cisplatin 500m1 in l ~ 2 hours, half an hour after the instillation of oral furosemide 20mg continues to drip 500mI Ringer's solution and 10% chloride 10m1 K vomiting to prevent and reduce the infusion of dexamethasone at the same time 5 ~ 10mg intramuscular injection or intravenous infusion of metoclopramide (total amount of 40 ~ 90mg)
(2) MFP:
Intravenous instillation of mitomycin 5-6mg/m2 No. 11529 days
Fluorouracil 500mg intravenous infusion of the first day 101217193l333840
Intravenous infusion of cisplatin 30mg the first 3 to 5 days 24 ~ 26 days
6 weeks per cycle every 2 ~ 3 cycles for a course
(3) CAMB
Cyclophosphamide 500 ~ 700mg/m2 intravenous injection of the first day l815222936
Adriamycin 40mg/m2 intravenous instillation first l22 days
Methotrexate 7 ~ 14mg/m2 intravenous drip No. 1012171931333840 days
Pingyangmycin 10mg intramuscular injection the first day 35ll131719242631333840
Every six weeks for a cycle period of 2 ~ 3 - treatment
(4) PE:
Etoposide 100mg intravenous No. l-5 days
Cisplatin (DDP) 80mg/m2 intravenous hydration the first four weeks of each l-day course of treatment for a
Adriamycin 50mg/m2 still shared the first two days of intravenous
Pleural and pericardial injection fluid should be done as far as possible, and then pumped into the drug
However, in order to prevent mediastinal swing to each extract to be no more than 1000m1 usually 5 ~ 7 days of each extract more than 3 times a change of drug-free medium for more than effect effusion drainage should be closed or silicone insert small drainage water-sealed bottle to be useful After the injection of liquid drugs do Pai folder and then pipe 24 ~ 48 hours after extubation of the drugs can be selected:
(1) Immunomodulator: Corynebacterium short (CP) 7mg saline soluble in 40 ~ 60ml in about 80% of patients can be effective after the first injection
(2) chemotherapy drugs:
? MBP: mitomycin C 5 ~ 6mg/m2 capacity in 20 ~ 40ml of normal saline
Pingyangmycin: 10 ~ 20mg dissolved in saline in 20 ~ 40ml
Cisplatin: 50 ~ 80mg dissolved in saline in 20 ~ 40ml
? CP:
Dissolved in saline CTX 500mg/m2 in 20 ~ 40ml
DDP 50mg/m2 dissolved in saline in 20 ~ 40ml
Above drugs can be injected into a joint or single-drug medicine chest with a single dose may be increased when the l / 3 into the patient should be advised bed rest and every 5 to 10 minutes to change position so that uniform distribution of drug exposure and pleural cavity pericardial injection drugs should be appropriate reduce the l / 3 dose or choice of local reactions less common drug thiotepa to send 40 ~ 60mg / or DDP50mg / times, many patients in the injection l ~ 3 times is expected to control pleural effusion of pericardial effusion may have a certain effect
(D) attention to matters of lung cancer chemotherapy
1. At present, chemotherapy for lung cancer in general it can not achieve radical chemotherapy may be of a certain stage with surgery or radiation therapy to strengthen the local or regional tumor control at the same time as far as possible, chemotherapy should be based on the patient's tolerance to give higher doses for lung cancer chemotherapy for a certain degree of gastrointestinal reaction and bone marrow suppression is difficult to avoid the number of treatment should be based on patient's response and efficacy of an appropriate increase to achieve complete remission, as far as possible
2. The interval treatment of drug toxicity as a result of existing in the drug often can be after the extension of several weeks during each week intervals from the date of the beginning of chemotherapy every 4 to 6 weeks of drug toxicity must be followed by the disappearance of the response a course
3. Chemotherapy drug or in the process of dressing change indications
(1) treatment of 1 or 2 is still the progress of disease or treatment has become stable but deteriorated again in the rest period
(2) toxicity of 3 to 4 pairs of a certain threat to patient health
(3) there are complications such as fever> 38 degrees or have bleeding tendencies
(4) patients with rapid deterioration of the general situation there cachexia
Five complications of lung cancer chemotherapy
(A) of the superior vena cava syndrome caused by chemotherapy for lung cancer with superior vena cava syndrome surgery if possible every effort should be made on surgery for repair or replacement of inferior vena cava is regrettable that the majority of the patients had surgery in late opportunity lost if patients with acute upper superior vena cava should be immediately given to the role of the rapid and effective anti-cancer drug therapy feasible, such as the impact of high-dose cyclophosphamide adriamycin nitrogen mustard can be alone to radiotherapy combined with chemotherapy in succession should be noted that the acute phase of chemotherapy and then radiation therapy can not be Radiotherapy may be a result of edema caused by superior vena cava or even give rise to increase the symptoms of asphyxiation caused by chronic obstructive best if used before radiation therapy in the acute stage can be properly co-ordinated with the application of corticosteroids such as hydrocortisone to give the song 100 ~ 200mg intravenous infusion or strong and Song 5 ~ 10mg oral diuretics at the same time given to most patients can be alleviated in a number of survival but only 2 to 5 months
(B) of the chemotherapy of brain metastases from lung cancer with brain metastasis is the best treatment for localized radiation therapy but if the body that there is no other Department of intracranial metastasis transfer for a single lesion can craniotomy and radiotherapy combined with chemotherapy in our hospital have case of lung cancer patients with brain metastases occurred in line surgical resection of brain metastases after radiotherapy combined with chemotherapy survived for 18 years now
For brain metastases to systemic medication may be the basis of cell types depending on whether the drug through the blood-brain barrier, such as ethyl nitrosourea sodium cyclohexyl nitrosourea and other fat-soluble substances on the brain through the blood-brain barrier transfers corticosteroid treatment can be used to alleviate symptoms of cerebral edema but continuous use may affect the patient's survival time if the transfer is for the unilateral internal carotid artery (carotid artery or by the superior thyroid artery) the role of the rapid infusion of anti - cancer drug
(C) pleural effusion caused by lung cancer chemotherapy in the diagnosis of lung cancer are 1% of patients with pleural effusion have been no indications at this time surgery to receive chemotherapy only a temporary effect of the drugs commonly used are as follows:
1 mustard: In operation under sterile pleural effusion within the pump as much as possible to do (there are small catheter placed) 200m1 by 0.4mg/kg diluted with normal saline injected into the chest once again the largest amount of not more than 20mg immediately after injection so that patients position to transform the direction of continued about 15 minutes to ensure uniform liquid distribution of all the inner surface of the chest once a week for 55% efficient ~ 87% a week before and after the drug should pay attention to the situation of bone marrow function and whole body
2. Ah Ping: The response rate of about 64% ~ 88% of the drug will enable the emergence of inflammatory adhesion pleural space can be used to start the disappearance of 50 ~ 100mg dissolved in saline injected in the chest lomI if the patient does not respond to every 2 to re-re-injected on the 5th 100 ~ 200mg until the liquid can also be used to reduce up to 600 ~ 800mg single injection of the main reactions of local pain fever patients are still some low blood pressure
3. Tetracyclines: tetracycline as a sclerosing agent for cancer treatment of pleural effusion are generally placed in a closed chest catheter to 500mg of tetracycline dissolved in 30ml normal saline injected into the thoracic cavity with normal saline and then 10m1 clamp pipe cleaning catheter closure of six hours and change of position while at the same time and then drainage tube? a href = "http://jbk.39.net/keshi/pifu/pifubing/490b3.html" target = "_blank" class = blue> carbuncle procyonoides broom ? ? scratch? about four hours to determine the liquid and then pulled out without drainage patients was reported for other drugs (nitrogen mustard, etc.) this method fails to successfully control the growth of liquid 3 to 19 months Satoshi Kitamura also reported using 500mg2 weeks doxycycline intrapleural injection 2 or 3 times the liquid can completely disappear
4. Other: self-adriamycin for adenocarcinoma pleural effusion caused by intrathoracic better of the first 6 ~ 12mg addition Xiaoliu mustard can also be used 30 ~ 40mg / times 5 - fluorouracil 750 ~ 1000mg / times yet to gel Gold (198Au) colloidal phosphorus (32P) and the polio vaccine type ? ? vaccinia vaccine
Prognosis ??
Although in the treatment of lung cancer has made great progress such as: surgery radiotherapy chemotherapy combination therapy as well as new anti-cancer drugs available but still very poor prognosis of lung cancer treatment in patients with lung cancer 5-year survival rate was 14% and 30 years ago 11% of lung cancer is a high mortality rate was mainly due to the lack of early diagnosis and effective treatment in most patients, even early in the first visit for systemic diseases
The impact of prognostic factors of lung cancer include: age of site types and stages of cancer surgery and chemotherapy are man-made factors that control center or violations pleural dirty poor prognosis of early lung cancer are of the view that most often due to lung cancer after 2 ~ 3-year recurrence in this period should increase the number of follow-up after the first two years on average should be 3 to 4 times to review and X-ray taken after 2 to 3 years and reviewed 2 times usually taken X-ray examination of blood CEA Bronchoscopy CT and bone scan only when there are clinical indications for the use of
Aug
23
Irritating cough, sputum expectoration, and in particular bloodshot chest pain symptoms, such as easy for people to think of lung cancer, but in fact a variety of clinical manifestations of lung cancer. Experts point out that many of the initial discomfort of patients with lung cancer occurred in extra-pulmonary. With lung cancer a number of seemingly “eight-pole” of the symptoms, the culprit in cancer cells arising from it is biologically active substances.
“In addition to irritating cough, sputum expectoration, and in particular the blood, such as chest pain symptoms, clinical manifestations of lung cancer and tumor location, size, whether oppression or violation of adjacent organs, nerves or blood vessels, and whether or not transfer is also closely related to . “The First Affiliated Hospital of Jinan University Cardiothoracic Surgery Zheng, deputy director of the successful doctor said, for example, in patients with advanced lung cancer can lead to bronchial obstruction due to tumor shortness of breath or difficulty breathing, or esophageal compression due to lymph nodes led to difficulty swallowing, or hoarseness caused by recurrent laryngeal nerve involvement, but also can have symptoms such as fever, weight loss and systemic failure.
Part of lung cancer can also produce some bioactive substances. “These biologically active substances of clinical symptoms caused by lung cancer with no apparent relationship, not easy for most people think of lung cancer,” Zheng said smoothly, medically referred to as lung cancer is usually the “extra-pulmonary manifestations” or “paraneoplastic syndrome.” Cervical bone hyperplasia? Medium-term lung cancer! 59-year-old early this year, Chen began to feel discomfort in the right shoulder and upper limb. Usually very small because of his illness, think this is a small problem, no treatment has been. One month later, the symptoms gradually increase as a result, Chen has been urging the family to the hospital for examination. The doctor asked him to carry out cervical spine films and chest X-ray inspection.
“Problem is not big, so why spend more?” Chen stubborn cervical only a chip shot, the report as a “cervical bone hyperplasia.” He went to small clinics “Hyperosteogeny cervical” treatment, the symptoms really started to improve, and this enhanced Chen’s “confidence.” However, a few months later, Mr and right shoulder and right upper extremity pain more and more serious, as well as the effects of sleep. Chen obediently The doctor requested a chest X-ray film. The results of one out jump everyone scared: “the shadow of the right upper apex diameter of 6 cm, a small amount of fluid right chest, the nature of unknown origin!” The doctor told the family: “According to chest X-ray results,
First of all, consider the lung, but not the early stage of the! “Incredible Chen immediately make arrangements for family members to the chest CT examination, microscopic examination of bronchial fiber, whole body bone scan, as well as to find cancer cells, such as pleural effusion samples. The results showed that Chen’s ordeal turns out to be lung cancer, and has reached the medium-term. The only comfort is that there have not yet found distant metastasis of cancer cells. However, Chen’s condition at this time, surgical removal of lesions can complete, the doctor said frankly, “not sure. “Apex long tumor cough, Chen??no experience, but lung cancer is one of the many” extra-pulmonary manifestations “or” Vice-cancer
Syndrome “in patients with in miniature. According to Zheng smooth analysis, Chen apex of lung cancer occurred in parts distant from the main bronchus, so cough, respiratory symptoms, such as??obvious, but also as a result of relatively hidden location, so the symptoms appear relatively late . wait until the tumor around the nerve and muscle appeared to be pain in the shoulder and upper extremity performance as the main clinical symptoms, therefore, also known as the “Pancoast tumor.”
It is reported that this type of lung cancer patients with symptoms as early as the mid-chest, shoulder or upper limb pain in the main, easily misdiagnosed as “cervical bone hyperplasia” or “shoulder arthritis.” If not treated in time, the tumor will continue to foreign invasion, in addition can cause the chest, shoulder and upper limb pain, but also as a result of tumor compression on the vena cava caused by violations of the upper limb edema or thoracic cancer cells led to the first sympathetic ganglion “Horner sign” The emergence of the performance for the ipsilateral blepharoptosis, pupillary narrowing enophthalmos and facial and other non-Khan.
It is worth mentioning that, the special position of lung cancer: clinical tumor known as a long thoracic location of the entrance, near a large number of important blood vessels and nerves. Moreover, since the tumor is often difficult to find, check out one of most advanced in the vicinity of blood vessels, nerves and chest wall has been affected more than the operation very difficult and risky. Therefore, for early detection and early treatment is the key.
Guard against lung cancer “of extra-pulmonary performance of” lung cancer “of extra-pulmonary manifestations” or “paraneoplastic syndrome” is a variety show. For example, lung cancer cells generated by adrenocorticotropic hormone (ie, ACTH), can cause “Cushing’s syndrome” (Cushing “ssyndrome). Zheng said smoothly, the normal ACTH concentrations in human body by a very good control, to maintain normal body need, but if a large number of lung cancer cells to produce ACTH, can generate large amounts of adrenal glucocorticoids, resulting in a round face, back, such as thick and thin limbs, a special body for the performance of similar services over the performance of hormones,
In fact, it is “Cushing’s syndrome.”
Part of lung cancer “paraneoplastic syndrome” in patients with the treatment because of joint pain, and even has long-term use of anti-rheumatoid drugs, the last line chest imaging of pulmonary lesions found. That lung cancer caused by joint disease, known as the “lungs of joint disease.” If swelling of distal fingers or toes to look like fingers or toes drumstick, clinically referred to as “clubbing fingers”, the lung disease of the joints, known as hypertrophic pulmonary arthropathy.
There are a small number of patients with lung cancer for male breast increase performance, that is growing, “breast”, or high blood calcium, sensory peripheral neuropathy, such as abnormal or decreased muscle strength. However, Mr smooth to emphasize that all of these symptoms are not caused as a result of cancer metastasis, after tumor resection in the corresponding with the disappearance of bioactive substances disappear.
“In addition to irritating cough, sputum expectoration, and in particular the blood, such as chest pain symptoms, clinical manifestations of lung cancer and tumor location, size, whether oppression or violation of adjacent organs, nerves or blood vessels, and whether or not transfer is also closely related to . “The First Affiliated Hospital of Jinan University Cardiothoracic Surgery Zheng, deputy director of the successful doctor said, for example, in patients with advanced lung cancer can lead to bronchial obstruction due to tumor shortness of breath or difficulty breathing, or esophageal compression due to lymph nodes led to difficulty swallowing, or hoarseness caused by recurrent laryngeal nerve involvement, but also can have symptoms such as fever, weight loss and systemic failure.
Part of lung cancer can also produce some bioactive substances. “These biologically active substances of clinical symptoms caused by lung cancer with no apparent relationship, not easy for most people think of lung cancer,” Zheng said smoothly, medically referred to as lung cancer is usually the “extra-pulmonary manifestations” or “paraneoplastic syndrome.” Cervical bone hyperplasia? Medium-term lung cancer! 59-year-old early this year, Chen began to feel discomfort in the right shoulder and upper limb. Usually very small because of his illness, think this is a small problem, no treatment has been. One month later, the symptoms gradually increase as a result, Chen has been urging the family to the hospital for examination. The doctor asked him to carry out cervical spine films and chest X-ray inspection.
“Problem is not big, so why spend more?” Chen stubborn cervical only a chip shot, the report as a “cervical bone hyperplasia.” He went to small clinics “Hyperosteogeny cervical” treatment, the symptoms really started to improve, and this enhanced Chen’s “confidence.” However, a few months later, Mr and right shoulder and right upper extremity pain more and more serious, as well as the effects of sleep. Chen obediently The doctor requested a chest X-ray film. The results of one out jump everyone scared: “the shadow of the right upper apex diameter of 6 cm, a small amount of fluid right chest, the nature of unknown origin!” The doctor told the family: “According to chest X-ray results,
First of all, consider the lung, but not the early stage of the! “Incredible Chen immediately make arrangements for family members to the chest CT examination, microscopic examination of bronchial fiber, whole body bone scan, as well as to find cancer cells, such as pleural effusion samples. The results showed that Chen’s ordeal turns out to be lung cancer, and has reached the medium-term. The only comfort is that there have not yet found distant metastasis of cancer cells. However, Chen’s condition at this time, surgical removal of lesions can complete, the doctor said frankly, “not sure. “Apex long tumor cough, Chen??no experience, but lung cancer is one of the many” extra-pulmonary manifestations “or” Vice-cancer
Syndrome “in patients with in miniature. According to Zheng smooth analysis, Chen apex of lung cancer occurred in parts distant from the main bronchus, so cough, respiratory symptoms, such as??obvious, but also as a result of relatively hidden location, so the symptoms appear relatively late . wait until the tumor around the nerve and muscle appeared to be pain in the shoulder and upper extremity performance as the main clinical symptoms, therefore, also known as the “Pancoast tumor.”
It is reported that this type of lung cancer patients with symptoms as early as the mid-chest, shoulder or upper limb pain in the main, easily misdiagnosed as “cervical bone hyperplasia” or “shoulder arthritis.” If not treated in time, the tumor will continue to foreign invasion, in addition can cause the chest, shoulder and upper limb pain, but also as a result of tumor compression on the vena cava caused by violations of the upper limb edema or thoracic cancer cells led to the first sympathetic ganglion “Horner sign” The emergence of the performance for the ipsilateral blepharoptosis, pupillary narrowing enophthalmos and facial and other non-Khan.
It is worth mentioning that, the special position of lung cancer: clinical tumor known as a long thoracic location of the entrance, near a large number of important blood vessels and nerves. Moreover, since the tumor is often difficult to find, check out one of most advanced in the vicinity of blood vessels, nerves and chest wall has been affected more than the operation very difficult and risky. Therefore, for early detection and early treatment is the key.
Guard against lung cancer “of extra-pulmonary performance of” lung cancer “of extra-pulmonary manifestations” or “paraneoplastic syndrome” is a variety show. For example, lung cancer cells generated by adrenocorticotropic hormone (ie, ACTH), can cause “Cushing’s syndrome” (Cushing “ssyndrome). Zheng said smoothly, the normal ACTH concentrations in human body by a very good control, to maintain normal body need, but if a large number of lung cancer cells to produce ACTH, can generate large amounts of adrenal glucocorticoids, resulting in a round face, back, such as thick and thin limbs, a special body for the performance of similar services over the performance of hormones,
In fact, it is “Cushing’s syndrome.”
Part of lung cancer “paraneoplastic syndrome” in patients with the treatment because of joint pain, and even has long-term use of anti-rheumatoid drugs, the last line chest imaging of pulmonary lesions found. That lung cancer caused by joint disease, known as the “lungs of joint disease.” If swelling of distal fingers or toes to look like fingers or toes drumstick, clinically referred to as “clubbing fingers”, the lung disease of the joints, known as hypertrophic pulmonary arthropathy.
There are a small number of patients with lung cancer for male breast increase performance, that is growing, “breast”, or high blood calcium, sensory peripheral neuropathy, such as abnormal or decreased muscle strength. However, Mr smooth to emphasize that all of these symptoms are not caused as a result of cancer metastasis, after tumor resection in the corresponding with the disappearance of bioactive substances disappear.
