2018-05-16
T2abN0的患者如果切缘为阳性,则应该接受
1)再切除术加化疗;
或2)化放疗加化疗。
IA期切缘阳性患者不再推荐术后同步化放疗,因为没有获得相关数据的支持。同样因为缺乏数据支持, IB和IIA期(T2b,N0)切缘阳性患者及IIA和 IIB期切缘阴性患者不再推荐术后化放疗加化疗。
对于手术切缘阴性的II期病变(包括T1ab-2a, N1; T2b, N1;和T3, N0),推荐化疗加或不加放疗(放疗为3类推荐)。
如果上述患者手术切缘为阳性,可选治疗方法包括:
1)再次手术切除加化疗;
2)化放疗联合化疗。T1-3N2 (只在手术探查和纵隔淋巴结清扫时才发现)且切缘阳性的患者可予化放疗加化疗。切缘阴性的患者可予化疗加放疗。
NCCN指南(NCCN 2A)建议T2abN0且切缘阴性患者中有高危特征的患者接受辅助化疗。注意:ACCP,CACA,ASCO指南均无此推荐。
低分化癌(包括神经内分泌瘤)
脉管受侵
楔形切除术
肿瘤>4 cm
脏层胸膜受累
Nx
NCCN guideline. Non-Small Cell Lung Cancer 2016.4
ACCP. Treatment of Stage I and II Non-small Cell Lung Cancer. Diagnosis and Management of Lung Cancer,3rd ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. 2013
ACCP. Treatment of Stage III Non-small Cell Lung Cancer. Diagnosis and Management of Lung Cancer,3rd ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. 2013
ACCP. Treatment of Stage IV Non-small Cell Lung Cancer. Diagnosis and Management of Lung Cancer,3rd ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. 2013
ACCP. Follow-up and Surveillance of the Patient With Lung Cancer After Curative-Intent Therapy. Diagnosis and Management of Lung Cancer,3rd ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. 2013
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