National Cancer Center of the 327 cases of patients with T3, the results of counting the total 5-year survival rate was 26% Niuyuesilong – Kettering Hospital, complete resection of T3 showed the 5-year survival of patients with 42%, while patients with incomplete resection none survived more than 2.5 years due to the reports mentioned above use the old international staging of lung cancer, so the results include some of T3N0M0 patients, so high but, overall, the survival rate of T3 compared to patients with N2 stage patients, surgical resection can achieve better survival in patients with T3 tumors invading the chest wall is better than the prognosis of patients with tumor invasion of mediastinal pleura, so at the present view is that, especially T3, and chest wall invasion or proximal bronchial involvement in patients with T3 should be complete surgical resection requires resection of the removal of accommodation to improve the survival of invalid
N2 non-small cell of the treatment of lung cancer there is controversy, the domestic means of the examination, restrictions on the N2 is difficult to clear of the preoperative staging, the majority of claims pouring lobectomy plus flatter mediastinal dissection, the view was abroad at the present will be divided into N2 N2 for minor surgery lesions and not suitable for surgery in N2 disease N2 disease in patients with small groups advocated the line at the present system of mediastinal cream curry favor radical resection to reach the purpose, the 5-year survival rate of patients reported abroad as 20 ~ 30%
patients with clinical N2 disease at the present majority opinion does not advocate surgery abroad, studies suggest that this group of patients after surgical removal of almost no 5-year survival of patients
non-small cell lung cancer patients before surgery first advocated neoadjuvant chemotherapy, neoadjuvant chemotherapy can in theory cut off the primary tumor and the tumor cells pour flatter, increasing the chance of radical surgery to eradicate micro-metastasis, to prevent the acceleration of value-added operation, reducing the possibility of surgery at the same time spread chemotherapy after surgery can be met at the present sensitivity of the existing three clinical randomized controlled trials support the results of neoadjuvant chemotherapy in N2 the effectiveness of the treatment of patients
In short, IIIA non-small cell of of lung cancer, the preferred mode of treatment for a new adjuvant therapy after surgery, neoadjuvant therapy to neoadjuvant chemotherapy, chemotherapy program should be the foundation of platinum combination chemotherapy pedicle surgery 2-3 times could be arranged after chemotherapy to lung hilar and mediastinal resection as the standard leaching flatter surgical dissection, there were residual tumor, postoperative radiotherapy should be; radical radiotherapy after surgery is not yet determined the comments, IIIA postoperative chemotherapy in patients prefer
3.IIIB and IV of the treatment of patients
IIIB Conceiving of T4 and / or N3 lesions, at the present that both are unable to complete resection, radiotherapy, chemotherapy or a combination of the patients was IIIB standard treatment, generally do not consider the operation of foreign invasion has been reported for the poured flatter bulge and no transfer of T4 lung resection all patients with tracheal sleeve resection of trachea and contralateral main bronchus anastomosis, postoperative 5-year survival rate can be about 20% have been reported in patients on T4 Intervention chemotherapy in lung cancer underwent extended resection, operative mortality was 9%, 3 year survival rate was 54%, but because of small number of cases remains to be further research to prove the value of these treatment modalities at the present standard treatment of patients with IIIB that chemotherapy
eras that the IV for the general good standard treatment of patients with systemic chemotherapy and supportive care for the primary non-small cell, but lung cancer after lung resection line Lingding brain metastases were found in patients, as long as no other surgical contraindications, should craniotomy resection of brain metastases, lung, cancer and brain metastases Lingding found over the same period, and the two can be completely resection of brain metastases should be removed, and then in the short term the primary tumor resection Mandell reported 104 cases of non-small cell lung cancer treatment Lingding experience brain metastases, 35 patients with routine surgery and radiotherapy, the average survival time was 16 months, and 69 cases of pure radiation, the average survival is only 4 months so at the present that the existence of World Wide Fund for brain metastases or adrenal metastasis may have chosen to consider surgery
can effectively control the attack again, local radiotherapy and chemotherapy does not eliminate sensitive tumor cells, without increasing side effects of chemotherapy limit the dose of chemotherapy may improve survival in patients with a study of 132 cases of foreign SCLC underwent radical surgery, the overall 5-year survival rate was 23%, of which T1-2N0 patient was 28 ~ 60%, T1-2N1 patient was 9 ~ 31%, T3 or N2 patients and 3.6% at the present surgical treatment of small cell lung cancer, there are two modes: (1) surgery chemotherapy (2) chemotherapy surgery, a study by the University of Toronto for the I of the SCLC patients, comprehensive treatment of chemotherapy plus surgery compared with radiotherapy chemotherapy, the survival rate of patients with high LCSG studies suggest that chemotherapy surgery radiotherapy and chemotherapy the median survival between the two groups of and there was no difference in survival rates, and thus are still controversial comprehensive coverage abroad, post-operative chemotherapy for SCLC patients with 5-year survival was 9 ~ 83%, but the lack of large scale randomized controlled trials, chemotherapy and radiotherapy after surgery chemotherapy treatment can not be made after comparison of a firm conclusion, at the present that to the I, II stage SCLC patients (particularly in patients with I) can be implemented include the comprehensive surgical treatment
IV. lung cancer prognosis
1. prognostic factors of lung cancer
Conceiving of the prognostic factors of lung cancer in three areas: (1) cancer cases: stage, differentiation, community school type; (2) treatment the use of essentials: radical surgery, chemotherapy programs, treatment, radiation dose, style pattern; (3) status of patients: whole body functional status of individual differences in sensitivity to chemotherapy, immune capacity
I NSCLC, the 5-year survival rate after radical operation is about 70%; II NSCLC, the 5-year survival rate after radical operation is about 40-50%; chest wall invasion of IIIA NSCLC after radical expansion of 5 year survival rate is about 40%, ipsilateral mediastinal involvement IIIA cream curry favor of patients with postoperative 5-year survival rate is about 30% (10-40%); carina affected part of the line IIIB carina resection of NSCLC 5-year survival rate of up to 20%; for surgery I, II of 5-year survival rate of SCLC patients is about 9 ~ 65%
five. VATS in lung cancer diagnosis and treatment effectiveness
1.VATS utility in the staging of lung cancer
VATS examination can clearly pathological examination of pleural effusion and pleural metastasis of the judge, as the addition of mediastinoscopy to clear shower flatter lower mediastinum staging the neck, in addition to replace the former chamberlain to detect aortic mediastinotomy shower window flatter
2.VATS partial resection of lung cancer under the
partial lung resection due partial re-attack rate, long-term survival of patients, so partial resection of lung cancer is not considered radical surgery, at the present VATS line partial resection of lung cancer applies only to cardiopulmonary dysfunction can not tolerate thoracotomy or lobectomy in patients with T1N0M0 for peripheral lung cancer in the lung can be cutting stapling wedge resection; for the buried nodules in the lung parenchyma can be laser surgery
3.VATS lobectomy under
VATS lobectomy for lung cancer lines still exist at the present controversy, the focus of debate, mainly in (1) the thoroughness of operation: Can the system be clean of mediastinal cream curry favor (2) the safety of surgery on 298 patients with lung cancer McKenna, of 233 cases in which I (78%), II of 27 patients (9%), IIIA of 38 (13%) underwent VATS lobectomy, transfer thoracotomy was 6%, no intraoperative bleeding occurred, perioperative only one patient died of mesenteric vein thrombosis, which I 4-year survival rate of patients was 70%, the study suggests that VATS lobectomy is feasible and safe, efficacy inferior to conventional surgery
1. TNM staging non-small cell lung cancer of the Central Plains (T) stage definitions
2. at the present non-small cell lung cancer surgery in radical surgery of mediastinal cream curry favor
disposal of punishment style pattern
3. I, II non-small cell lung cancer patients comprehensive treatment of the model
4. IIIA non-small cell lung cancer therapy of