2011年NCCN非小细胞肺癌诊断治疗指南中文.ppt
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1、Printed by Dong Zhao on 7/26/2011 3:30:20 AM. For personal use only. Not approved for distribution. Copyright 2011 National Comprehensive Cancer Network, Inc., All Rights Reserved. Copyright National Comprehensive Cancer Network 2011. All rights reserved. “NCCN”, the NCCN logo, and “National Compreh
2、ensive Cancer Network” are registered trademarks of the National Comprehensive Cancer Network. The Chinese edition of NCCN Clinical Practice Guidelines in Oncology-Non-Small Cell Lung Cancer Guideline 2011 is the Chinese adapted version of NCCN Clinical Practice Guidelines in Oncology-Non-Small Cell
3、 Lung Cancer Guideline, V.3.2011 as permitted and endorsed by NCCN. It is the collaborative outcome of the National Comprehensive Cancer Network and Chinese key opinion leaders of the field. The original guideline and Chinese edition are both available at: nccn.org. To view the most recent and compl
4、ete version of the guideline, go online to nccn.org. These Guidelines and illustrations herein may not be reproduced in any form for any purpose without the express written permission of the NCCN. These Guidelines are a work in progress that will be refined as often as new significant data becomes a
5、vailable. The NCCN Guidelines are a statement of consensus of its authors regarding their views of currently accepted approaches to treatment. Any clinician seeking to apply or consult any NCCN guideline is expected to use independent medical judgment in the context of individual clinical circumstan
6、ce to determine any patients care or treatment. The National Comprehensive Cancer Network makes no warranties of any kind whatsoever regarding their content, use or application and disclaims any responsibility for their application or use in any way. This publication should not be used for commercia
7、l purpose. It is provided for free to Chinese medical professions with the support of the unrestrictive educational grant of Shanghai Roche Pharmaceuticals Ltd. which exerts no influence to the formation of the Chinese edition of NCCN Clinical Practice Guidelines in Oncology-Non-Small Cell Lung Canc
8、er Guideline 2011. Printed by Dong Zhao on 7/26/2011 3:30:20 AM. For personal use only. Not approved for distribution. Copyright 2011 National Comprehensive Cancer Network, Inc., All Rights Reserved. National Comprehensive Cancer Network, Inc. All rights reserved. These guidelines and this illustrat
9、ion may not be reproduced in any form without the express written permission of NCCN. The Chinese edition 2011 is the collaborative outcome of the National Comprehensive Cancer Network and Chinese key opinion leaders of the field. Translated and adapted with permission and endorsement from the Natio
10、nal Comprehensive Cancer Network. To view the most recent and complete version of this or any other guideline, visit nccn.org. * David S. Ettinger, MD/Chair The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins Wallace Akerley, MD Huntsman Cancer Institute at the University of Utah Hossein
11、Borghaei, DO, MS Fox Chase Cancer Center Andrew Chang, MD University of Michigan Comprehensive Cancer Center Richard T. Cheney, MD Roswell Park Cancer Institute Lucian R. Chirieac, MD Dana-Farber/Brigham and Womens Cancer Center Thomas A. DAmico, MD Duke Comprehensive Cancer Center Todd L. Demmy, MD
12、 Roswell Park Cancer Institute Ramaswamy Govindan, MD Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine Frederic W. Grannis, Jr., MD City of Hope Comprehensive Cancer Center Leora Horn, MD, MSc Vanderbilt-Ingram Cancer Center Thierry Jahan, MD UCSF Helen Di
13、ller Family Comprehensive Cancer Center Anne Kessinger, MD UNMC Eppley Cancer Center at The Nebraska Medical Center Ritsuko Komaki, MD The University of Texas M. D. Anderson Cancer Center Feng-Ming(Spring) Kong, MD, PhD, MPH Universit y of Michigan Comprehensive Cancer Center Mark G. Kris, MD Memori
14、al Sloan-Kettering Cancer Center Lee M. Krug, MD Memorial Sloan-Kettering Cancer Center Inga T. Lennes, MD Massachusetts General Hospital Cancer Center Billy W. Loo, Jr., MD, PhD Stanford Comprehensive Cancer Center * Renato Martins, MD Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alli
15、ance Janis OMalley, MD University of Alabama at Birmingham Comprehensive Cancer Center Raymond U. Osarogiagbon, MD St. Jude Childrens Research Hospital/University of Tennessee Cancer Institute Gregory A. Otterson, MD The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and S
16、olove Research Institute Jyoti D. Patel, MD Robert H. Lurie Comprehensive Cancer Center of Northwestern University Mary Pinder-Schenck, MD H. Lee Moffitt Cancer Center T2b, N0)和IIB期(T3, N0) NSCL-2) IIB期(T3侵犯胸壁等, N0)和IIIA期(T4侵犯心脏等, N01; T3, N1) NSCL-4) IIIA期(T13, N2)和分散的肺结节(IIB、IIIA、IV期) NSCL-6) IIIB
17、期(T13, N3) NSCL-9) IIIB期(T4侵犯心脏等, N23)和IV期(M1a) 胸腔或心包积液) NSCL-10) IV期(M1b:单个转移灶) NSCL-11) National Comprehensive Cancer Network, Inc. All rights reserved. These guidelines and this illustration may not be reproduced in any form without the express written permission of NCCN. The Chinese edition 2011
18、 is the collaborative outcome of the National Comprehensive Cancer Network and Chinese key opinion leaders of the field. Translated and adapted with permission and endorsement from the National Comprehensive Cancer Network. To view the most recent and complete version of this or any other guideline,
19、 visit nccn.org. “ NSCL-13 复 发或 转移患者全身治 疗 的评估 流 程 修订为首先明确 组织学亚 型,然后 根 据 组织学亚 型推荐 EGFR检测。 EGFR检测对于以下肺癌组织学类型为1类推荐:腺癌、大细胞癌和NSCLC NOS。 对鳞癌推荐EGFR检测。 本页现为对EGFR突变阳性的腺癌、大细胞癌、NSCLC NOS和鳞癌的一线全身治疗。 新增脚注:“中国的荟萃分析中鳞癌 E G F R 基因突变率为10%,日本研究中显示有突变的鳞癌 EGFR-TK I治疗缓解率达到30%,疾病控制率70%,中位PFS为3个月,这些数据支持鳞癌EGFR突 变检测。Yi-Long
20、 Wu et al, Epidermal growth factor receptor mutations and their correlation with gefitinib therapy in patients with non-small-cell lung cancer: a meta-analysis based on updated individual patient data from six medical centers in mainland China. J Thorac Oncol. 2007; 2: 430-439. Takehito Shukuya, et
21、al. Efficacy of gefitinib for non-adenocarcinoma non-small-cell lung cancer patients harboring epidermal growth factor receptor mutations: A pooled analysis of published reports. Cancer Sci, doi: 10.1111/j.1349-7006.2011.01887.x, 2011.” 新增脚注“y”:注明厄洛替尼适用于体力状态评分04的患者。 NSCL-14 本页现为对EGFR突变阴性或未知的腺癌、大细胞癌和
22、NSCLC NOS的一线全身治疗。 删除了化疗1周期后的肿瘤反应评估。 培美曲塞换药维持由2B类改为2A类。 NSCL-15 本页现为对EGFR突变阴性或未知的鳞状细胞癌的一线全身治疗。 删除了化疗1周期后的肿瘤反应评估。 NSCL-16 体力状态评分02新增贝伐珠单抗作为含铂两药方案的可选联合用药,适用于一线治疗中用 过厄洛替尼的腺癌患者。 NSCL-A 3-2 分子学诊断研究: “EGFR和K-ras”评估项中新增第57条。 新增EML4-ALK评估项。 NSCL-B 4-1 第二条:增加了“高危患者考虑行立体定向放疗时,建议由包含肿瘤放射医生的多学科团体进行综 合评估”。 NSCL-B
23、4-2至NSCL-B 4-4 新增页面,阐述IIIA期(N2)肺癌外科治疗中存在的争议。 NSCL-C 放射治疗原则有多处修订,详见内页。 NSCL-C 7-5 表2标题由“常规分割放疗的推荐剂量”修订为“常规分割放疗的常用剂量”。 NSCL-C 7-6 表4标题由“肺部肿瘤SBRT方案和适应证” 修订为“常用SBRT方案”。 NSCL-E 删除了多西他赛巩固方案。 修改脚注“*”: 随机研究资料支持”修订为“研究资料支持”。 MS-1 讨论部分根据流程图更新。 “ ( 9 “ PREV-1 第一条肺癌病例比例“90%”修订为“85%90%”。 新增第二条 长期吸烟容易导致第二原发癌、治疗并发
24、症、药物相互作用、其它吸烟相关疾病、生 活质量降低和生存期缩短。 NSCL-1 基线评估“建 议戒 烟”选项修订为“戒 烟 劝告、辅导和用药”(N S C L-12 随诊所 述也做了此修 订)。 新增脚注“c”:T3, N0指肿瘤7 cm或伴卫星结节(NSLC-2所述也做了此修订)。 新增脚注“e”:对胸腔(心包)积液细胞病理学检测进行说明。 NSCL-2 新增推荐脑MRI检查适用于IB期肺癌,为2B类推荐。 NSCL-3 淋巴结采样注明为“系统性”。 IA期,切缘阳性辅助治疗中将化放疗方案删除。 IB/IIA期,切缘阳性再次手术切除列为“首选”,化放疗+化疗改为放疗+化疗。 II A/IIB
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