一前言阮綜合醫療社團法人阮綜合醫院上消化道癌醫療團隊於 2010 年開始著手擬定胃癌治療共識, 藉由多專科醫師參與團隊會議共同討論之機制, 依據 2010 年美國 National

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1 阮綜合醫療社團法人阮綜合醫院胃癌診療共識胃癌醫療團隊擬定 Reference: NCCN Clinical Practice Guideline in Oncology TM, Gastric Cancer, V1.2010

2 一前言阮綜合醫療社團法人阮綜合醫院上消化道癌醫療團隊於 2010 年開始著手擬定胃癌治療共識, 藉由多專科醫師參與團隊會議共同討論之機制, 依據 2010 年美國 National Comprehensive Cancer Network (NCCN) 治療指引, 參酌國家衛生研究院資訊, 輔以國內外最新研究文獻, 並結合本院現有之設備人力專才與臨床實務及團隊醫師研究成果, 擬定出阮綜合醫院胃癌治療指引共識每年將持續以多專科團隊會議機制進行討論和修訂, 期能提升本院胃癌病人之診療品質

衛生研究院資訊, 輔以國內外最新研究文獻, 並結合本院現有之設備人力專才與臨床實務及團隊醫師研究成果, 擬定出

3 二診療共識內容評估診斷治療追蹤病史, 理學檢查 Nutritional and performance status evaluation CXR CBC/DC SMA Tumor markers* Abdomen contrastenhanced CT scan Panendoscopy and biopsy Stage IA (T1N0) Mucosa: <2cm Mucosa: 2cm Mucosa: any Submucosa: <1.5cm Submucosa: 1.5cm Submucosa: any EMR*,ESD Ψ, MG Ω A ESD or MAG MGA MGA MGB MGB 見表三 Optional: 1. PET/CT or PET scan 2. Endoscopic Ultrasound 3. Laparoscopy 4. UGI series *Endoscopic mucosal resection Ψ Endoscopic submucosal dissection Ω Modified gastrectomy (see 表二 )

5cm Submucosa: 1.5cm Submucosa: any EMR*,ESD Ψ, MG Ω A ESD or MAG MGA MGA MGB MGB 見表三 Optional: 1. PET/CT or PET scan 2.

4 評估診斷治療輔助治療追蹤病史, 理學檢查 Nutritional and performance status evaluation CXR CBC/DC SMA Tumor markers* Abdomen contrastenhanced CT scan Panendoscopy and biopsy Stage IB (T1N1, T2N0) Stage IIA T1<2cm N1 T1>2cm N2 N1 T2 T1 T2 T3 N0 N2 N1 N0 MG Ω B Standard G Standard G Standard G Standard G+ Chemotherapy Chemotherapy 見表三 Optional: 1. PET/CT or PET scan 2. Endoscopic Ultrasound 3. Laparoscopy 4. UGI series Stage IIB 胃腺癌 T1 T2 T3 T4a N3 N2 N1 N0 Extended G Standard G Standard G+ Standard G+ Chemotherapy Ω Modified Gastrectomy 見表二

Standard G Standard G Standard G Standard G+ Chemotherapy Chemotherapy 見表三 Optional: 1. PET/CT or PET scan 2. Endoscopic Ultrasound 3.

5 評估診斷治療輔助治療追蹤病史, 理學檢查 Nutritional and performance status evaluation CXR CBC/DC SMA Tumor markers* Abdomen contrastenhanced CT scan Panendoscopy and biopsy Stage IIIA Stage IIIB T2N3 T3N2 T4aN1 T3N3 T4bN0 T4bN1 Extended G Standard G+ Extended G+ Chemotherapy (regimen see 表一 ) Chemotherapy (regimen see 見表三 Optional: 1. PET/CT or PET scan 2. Endoscopic Ultrasound 3. Laparoscopy 4. UGI series Stage IIIC T4aN2 T4bN2 T4bN3 Standard G+ Extended G+ 表一 ) + Radiation (optional) T4aN3 Gastrectomy 見表二

Extended G+ Chemotherapy (regimen see 表一 ) Chemotherapy (regimen see 見表三 Optional: 1. PET/CT or PET scan 2.

6 評估診斷治療追蹤病史, 理學檢查 Nutritional and performance status evaluation CXR CBC/DC SMA Tumor markers* Abdomen contrast- enhanced CT scan Panendoscopy and biopsy Stage IV (any T any N M1) M1 with good performance status (0-2) Urgent symptoms (bleeding, stenosis, malnutrition) Chemotherapy, radiotherapy or best supportive care Palliative surgery (resection, by-pass gastrostomy or enterostomy) 見表三 Optional: 1. PET/CT or PET scan 2. Endoscopic Ultrasound 3. Laparoscopy 4. UGI series

symptoms (bleeding, stenosis, malnutrition) Chemotherapy, radiotherapy or best supportive care Palliative surgery

7 一線化學治療處方 Published C/T Regimens Schedule Performance status Oxaliplatin 130mg/m2, IV, D1 Epirubicin50mg/m2, IV, D1 EOX Xeloda 625mg/m2 bid 3weeks (1cycle) 5-FU 600mg/m2, IV, (D1-5) Leucovorin 25mg/m2, IV, (D1-5) Cisplatin 40mg/m2, IV, ( D2 & D8 ) Epirubicin 20mg/m2, IV, ( D1 & D7 ) Etoposide 120mg/m2, IV, (D4, 5, 6) Cisplatin 80mg/m2, IV, D1 5-FU 800mg/m2, IV, D1-5 EEP FP Q21days 8cycles Q28days 6cycles Q28days 6cycles Q21days 8-12cycles 表一.1 (ECOG) 0&1 and age 70 (ECOG) 2 or age >70 (ECOG) 0&1 and age 70 (ECOG) 0&1 and age 70 Cisplatin 80mg/m2, IV, D1 Xeloda 2# po QD (day1-14), 3#PM (Day 1-14) ( mg/m2) XP Q21days 8-12cycles (ECOG) 0&1 and age 70

80mg/m2, IV, D1 5-FU 800mg/m2, IV, D1-5 EEP FP Q21days 8cycles Q28days 6cycles Q28days 6cycles Q21days 8-12cycles 表一.

8 門診一線化學治療處方 Published C/T Regimens Schedule Performance status 5-FU 600mg/m2, IV, (weekly) Leucovorin25mg/ms, IV, (weekly) For 6 months (ECOG) 0&1 and age 70 UFUR 2# bid For 6 months (ECOG) 2 or age >70 二線及二線之後的化學治療處方 Cisplatin 75mg/m2, IV, D1 Q21 days Docetaxel 75mg/m2, IV, D1 DCF 5-FU 750mg/m2, IV, (D1-5) Oxaliplatin 130mg/m2, IV, D1 Q21 days 8cycles Epirubicin50mg/m2, IV, D1 EOX Xeloda 625mg/m2 bid 3weeks (1cycle) 表一.2

二線及二線之後的化學治療處方 Cisplatin 75mg/m2, IV, D1 Q21 days Docetaxel 75mg/m2, IV, D1 DCF 5-FU 750mg/m2, IV,

9 Protocol of adjuvant chemoradiotherapy 放射治療處方 45 Gy (1.8 Gy/day) of RT given with 5-FU (400 mg/m2 per day) and leucovorin calcium (20mg/ms per day) on days 1 through 4 and last three days of RT Protocol of chemoradiation therapy as the primary treatment (1) 45 Gy (1.8 Gy/day) of RT given with 5-FU ( 400mg/m2 per day) and leucovorin calcium (20 mg/m2 per day) on days 1 through 4 and the last three days of RT (2) 5.4 Gy (1.8 Gy/day) of reduced boost field to small areas of residual disease

three days of RT Protocol of chemoradiation therapy as the primary treatment (1) 45 Gy (1.

10 Intraperitoneal hyperthermic chemotherapy ( continous hyperthermic peritoneal perfusion- CHPP) Indication: T3 Regimen: Cisplatin 90mg/3-4 liter lactated ringer solution Etoposide 90mg/3-4 liter lactated ringer solution Mitomycin C 30mg/3-4 liter lactated ringer solution 41~42 for 20~60minutes

liter lactated ringer solution Etoposide 90mg/3-4 liter lactated ringer

11 Type of Gastrectomy 表二 Gastrectomy Range of Resection Lymph Nodes Dissection Option MGA ( Modified Gastrectomy A) <2/3 of stomach D1+ NO.7@ Vagus preserving, MGB (Modified Gastrectomy B) <2/3 of stomach D1 + NO.7, 8a, 9 pylorus preserving Laparoscopic Standard >2/3 of stomach D2 Extended >2/3 of stomach D2 D3 Combined In case of lower third cancer, NO.8a nodes should be dissected Reconstruction: Billroth-I, and Roux-en-Y are more favored the Billroth-II

7, 8a, 9 pylorus preserving Laparoscopic Standard >2/3 of stomach D2 Extended >2/3 of stomach D2 D3 Combined

12 OPD vist PES CXR Abd sono Abd CT CEA & EUS CBC & 生化 CA199 Pre-Surgery * * * (0) * * (0) 3mo V V V 6mo V V V V 9mo V V V 12mo( 一年 ) V V V V V 15mo V V V 18mo V V V V 21mo V V V V V V V V 24mo( 二年 ) 30mo V V V V V V V V 36mo( 三年 ) 42mo V V V 48mo V V V V V 54mo V V V 60mo V V V V V 1.*:necessary 2.(o): Optional 3.(V) 手術後病人至少每三個月檢查一次, 持續 2 年 2 年後 ( 第 3~5 年 ), 每 6 個月檢查一次 5 年以後, 每年檢查一次 4. 全胃切除或是前端胃切除的病人, 一個月需注射維他命 B12 一次 5.EUS:endoscopic ultrasound 表三

V V V 54mo V V V 60mo V V V V V 1.*:necessary 2.(o): Optional 3.

一、口朊給藥護理技術操作標準

一、口朊給藥護理技術操作標準食道癌壹疾病導因一定義食道任何一處的組織細胞有了惡性的轉變發展出來的惡性腫瘤都叫做食道癌, 依細胞的來源又再區別為鱗狀上皮癌平滑肉癌等, 其中以由最內層黏膜上皮長出的癌最多再者, 食道上三分之二為由鱗狀上皮組成,

一 前 言 阮 綜 合 醫 療 社 團 法 人 阮 綜 合 醫 院 上 消 化 道 癌 醫 療 團 隊 於 2010 年 開 始 著 手 擬 定 胃 癌 治 療 共 識, 藉 由 多 專 科 醫 師 參 與 團 隊 會 議 共 同 討 論 之 機 制, 依 據 2010 年 美 國 National

一前言阮綜合醫療社團法人阮綜合醫院上消化道癌醫療團隊於 2010 年開始著手擬定胃癌治療共識, 藉由多專科醫師參與團隊會議共同討論之機制, 依據 2010 年美國 National