tailieunhanh - Chapter 085. Neoplasms of the Lung (Part 12)

Non-Small Cell Lung Cancer NSCLC Stages I and II Surgery In patients with NSCLC stages IA, IB, IIA and IIB (Table 85-2) who can tolerate operation, the treatment of choice is pulmonary resection. If a complete resection is possible, the 5-year survival rate for N0 disease is about 60–80%, depending on the size of the tumor. The 5-year survival drops to about 50% when N1 (hilar node involvement) disease is present. The extent of resection is a matter of surgical judgment based on findings at exploration. Clinical trials have shown that lobectomy is superior to wedge resection in reducing the rate of. | Chapter 085. Neoplasms of the Lung Part 12 Non-Small Cell Lung Cancer NSCLC Stages I and II Surgery In patients with NSCLC stages IA IB IIA and IIB Table 85-2 who can tolerate operation the treatment of choice is pulmonary resection. If a complete resection is possible the 5-year survival rate for N0 disease is about 60-80 depending on the size of the tumor. The 5-year survival drops to about 50 when N1 hilar node involvement disease is present. The extent of resection is a matter of surgical judgment based on findings at exploration. Clinical trials have shown that lobectomy is superior to wedge resection in reducing the rate of local recurrence. Pneumonectomy is reserved for patients with tumors involving multiple lobes or very central tumors and should only be performed in patients with excellent pulmonary reserve. In addition patients undergoing a right-sided pneumonectomy after induction chemotherapy and radiation therapy see below have a high mortality rate and should be carefully selected before surgery. Wedge resection and segmentectomy potentially by VATS are reserved for patients with poor pulmonary reserve and small peripheral lesions. Radiotherapy with Curative Intent Patients with stage I or II disease who refuse surgery or are not candidates for pulmonary resection should be considered for radiation therapy with curative intent. The decision to administer high-dose radiotherapy is based on the extent of disease and the volume of the chest that requires irradiation. Patients with distant metastases malignant pleural effusion or cardiac involvement are not considered candidates for curative radiation treatment. The long-term survival for patients with all stages of lung cancer who receive radiation with curative intent is about 20 . In addition to being potentially curative radiotherapy may increase the quality and length of life by controlling the primary tumor and preventing symptoms related to local recurrence in the lung. Treatment with curative .