National Health Research Institutes (NHRI) Division of Cancer Research Taiwan Cooperative Oncology Group (TCOG) 128 No. 128, Yen-Chiu-Yuan Road, Sec. 2, NanKang, Taipei 11529, Taiwan, R.O.C. TEL : (02) 2653-4401 FAX : (02) 2782-3755 http://www.nhri.org.tw
1982 20 (http://www.nhri.org.tw)...1...2...6...11...13...16...16...19...24...26...27
1982 1997 6000 12~15%85~88% 15~18% 5 10% 1. Horner's 2. A. 1 2
B. C. D. E. 3. (paraneoplastic syndrome) A. (myasthenic syndrome) Eaton-Lambert (dermatomyositis) (polymyositis) B. C. (a) 20% (b) (SIADH) ( 90% ) 3 4
4. / 1. 2. / 3. A. X 5 6
X X B. X X 1 X C. Pancoast tumor D. () 4. (hamartoma) 5. 7 8
6. IIIA IIIB (extended) 7. T4 8. (T3 T4) 9. 9 10
(surgical margin) (satellite tumor) (postobstructive) ( ) (grade) (pathological staging, ptnm) (angiolymphatic invasion) (perineural invasion) (perinodal tumor extension) ( ) ( ) A. Squamous cell carcinoma () variant: spindle cell (squamous) carcinoma ( [ ] ) B. Small cell carcinoma ( ) variants: mixed small cell/large cell carcinoma ( / ) combined small cell carcinoma ( ) Acinar adenocarcinoma () Papillary adenocarcinoma () Solid carcinoma with mucus formation ( ) variants: bronchioloalveolar adenocarcinoma ( ) spindle cell (adeno) carcinoma ( ) D. Large cell carcinoma ( ) variants: giant cell carcinoma ( ) clear cell carcinoma ( ) E. Adenosquamous carcinoma ( ) F. Non-small cell neuroendocrine carcinomas ( ) Carcinoid tumor ( ) Atypical carcinoid tumor () Large cell neuroendocrine carcinoma ( ) G. Bronchial gland carcinomas ( ) Adenoid cystic carcinoma () Mucoepidermoid carcinoma ( ) Others ( ) H. Other (specify) C. Adenocarcinoma ( ) 11 12
TNM T N M (clinical staging, ctnm) (surgical staging, stnm) (pathological staging, ptnm) 1. (T stage) X T3 T4 2. (N stage) X X 3. A. 90% ~ 95% B. C. (50% ~ 100%) 13 14
4. (M stage) 5. 6. X ( ) A. X B. X (a) (b) (alkaline phosphatase) C. (N2/N3 ) / (Performance Status) 15 16
TX X T0 T1S T1 3 (lobar bronchus) T2 3 2 T3 ( superior sulcus ) 2 T4 N0 N1 N2 N3 M0 M1 IA T1 N0 M0 IB T2 N0 M0 IIA T1 N1 M0 IIB T2 T3 N1 N0 M0 M0 IIIA T3 T1-3 N1 N2 M0 M0 IIIB T4 N0-2 M0 T N3 M0 IV T N M1 *Nx, Mx 17 18
200cGy 1. 1.1 1.2 1.2.1 Tis T0 T1 T2 N0 N1 M0 1.2.2 T3 T4 N2 N3 M0 1.2.3 (M1) 1.3 1.3.1 1.3.2 1.3.3 (Performance Status) 2. 2.1 Tis T0 T1 T2 N0 N1 M0 2.1.1 Tis N0 M0 2.1.2 T1-2 N0 M0 ( ) (chemoprevention) 2.1.3 T1-2 N1 M0 ( ) 19 20
2.2 T3 T4 N2 N3 M0 2.2.1 T3 N0 M0 ( ) ( ) 2.2.2 A T3 N1 M0 2.2.1 2.2.3 A T1-3 N2 M0 ( ) 2.2.4 Superior sulcus tumor (T3 N0-1 M0) 2.2.1 2.2.5 (T3 N0-1 M0) 2.2.1 2.2.6 B T4 N0-2 M0 ( ) (concurrent chemoradiotherapy) / 2.3 2.2.7 B T1-4N3M0 ( ) 2.2.6 2.3 (T4) (M1) 2.3.1 B T4 N0-3 M0 21 22
2.3.2 T N M1 2.3.1 / 200cGy 1. 1.1 1.1.1 1.1.2 1.2 1.2.1 1.2.2 1.2.3 (Performance Status) 2. 2.1 2.1.1 ( cisplatin VP-16) 2.1.2 23 24
2.1.3 ( ) 2.1 2.1.4 2.2 2.2.1 2.2.2 2.2.3 2.2.1 1. 91 1992, 1, S1-7 2. Myers JL, Askin FB and Yousem SA. Association of directors of anatomic and surgical pathology. Recommendations for the reporting of resected primary lung carcinomas. Am. J. Clin. Pathol. 1995, 104: 371-374. 3. Ihde DC, Bunn PA Jr. and Hansen HH. Clinical practice guidelines for the treatment of unresectable non-small cell lung cancer. J. Clin. Oncol. 1997, 8: 2996-3018. 4. Ihde DC, Bunn PA Jr. and Hansen HH. Clinical practice guidelines for the treatment of unresectable non-small cell lung cancer: how useful are they? Am. Soc. Clin. Oncol. 8 th Annual Fall Education Conference, Fall Educational Book. 1997, pp 39-56. 5. Minna JD, Sekido Y, Fong KM and Gazdar AF. Cancer of the lung. In: Cancer: Principle and Practice of Oncology. 5 th ed., Devita VT Jr, Hellman S, Rosenberg SA, eds. Philadelphia: Lippincott-Raven. 1997, pp 849-949. 6. Lung Cancer: Principle and Practice. Pass HI, Mitchell JB, Johnson DH and Turrisi AT, eds. Philadelphia: Lippincott-Raven. 1996. 7. Physicians' Desk Query (PDQ) NCI's Comprehensive Cancer Database: non-small cell lung cancer and small cell lung cancer. 1998. 25 26
( ) ( ) TCOG TCOG 27 28