80years since the20thcentury onwards, the context of lung cancer has become the world's highest incidence and mortality of cancer, and the rise year by year.In China, Beijing, Shanghai, Guangzhou, Hefei, cancer, lung cancer ranks first in group.More than 40 years of onset, peak age of onset between60-79years of age, young of lung cancer in recent years are not uncommon.Male and female prevalence ratio of2.3:10race, family history and smoking on lung cancer implications.
The treatment of lung cancer incidence according to different parts of the pathological type and to take the lung cancer treatment are also different.
Treatment of lung cancer therapy (1)pathological type: can be divided into small cell lung cancer and non-small cell lung cancer (including squamous cell carcinoma, adenocarcinoma, large cell carcinoma, etc.).
Small cell lung cancer preferred chemotherapy, systemic chemotherapy and chest radiotherapy if simultaneously, the better.In complete remission, prophylactic brain irradiation can further.Of localized small cell lung cancer can also take chemotherapy, radiotherapy and surgery combination of comprehensive treatment program for extensive small cell lung cancer Zeyi chemotherapy, radiotherapy based.
Preferred non-small cell lung cancer surgery, preoperative neoadjuvant chemotherapy can be first, and then after giving radiotherapy or chemotherapy.If the patients had no surgical indication, then the line chemotherapy, radiotherapy and integrated approach to minimally invasive treatment.
Treatment of lung cancer therapy (2)incidence area: According to the disease site, lung cancer can be divided into central lung cancer (occurs in the main trachea, main bronchus and segmental bronchi of cancer) and peripheral lung cancer.According toTNMstaging, there are surgical indications of early and mid-term surgical treatment of lung cancer should strive for; per surgical indications, according to the results of bronchoscopy, and percutaneous endoscopic therapy to minimally invasive treatment of the main treatment method.
Treatment of lung cancer therapy (3)minimally invasive tumor therapy airway
cryotherapy: commonly used refrigeration equipment for theCO 2refrigeration device can be rigid or flexible bronchoscope bronchoscopic guidance, the frozen probe inserted into the lesion site, freezing the tumor.The results show that the soft texture of cryotherapy on the bronchial cavity tumors, such as low-grade malignant tumors (cylindrical tumor, carcinoid) a good effect on the vascular-rich tumors or bleeding associated with hemoptysis who have a certain effect.Infiltrates the bronchial lumen or cavity of the narrow range of longer treatment may be better than laser treatment, but severe airway narrowing, especially when more than50%luminal narrowing when reached, should be used with caution .When the growth of lung cancer in the bronchial lumen, may severely obstructed airway, causing respiratory distress, obstructive pneumonia and atelectasis, bronchoscopic treatment frozen, can smooth the airway, improving ventilation, drainage of airway secretions help.Cryotherapy slower onset but, unlike laser therapy, electrocoagulation resection as fast, usually8-10days after the effect was obvious, and need to be repeated several times.Has been shown, Cryotherapy combined with chemotherapy or radiotherapy have synergistic effects, can improve the quality of life of patients and prolong survival time.Acute severe airway obstruction should be preferred hyperthermia.
hyperthermia: include laser, high-frequency electric knife, oxygen knife, microwave, can quickly remove the tumor, smooth airway obstructive symptoms.The larger the tumor, difficulty in breathing are more obvious, but also with radiotherapy, photodynamic therapy and local chemotherapy, if necessary, within the stent placement.
tracheal lumen local drug injection: on a clear tracheal tumors are malignant, chemotherapy drugs can be injected in vivo tumor, interleukin-2gene drugs, with frozen, heat, etc., play a synergistic therapeutic effect.
photodynamic therapy(PDT): PDTin early tracheal a bronchial carcinoma (lesions <lcm, clear boundary) up to radical results.Of advanced cancer is palliative treatment to play.For the larger cavity cancer before photodynamic therapy, can be frozen or heated with a method of reduction in lesion thickness, re-PDT, can often improve the outcome.Necessary, radiotherapy or stent.PDTis very simple intravenous injection prior to the photosensitizer,24 – 48hours later, under the guidance of the fiber optic bronchoscope into the trachea lesions, and then use the specific wavelength of the laser (typically630nmor650nm)irradiation5 -30minutes, the second and third days and then repeat the exposure time (usually2-3times a course.)Day after irradiation to the tumor necrosis material off the surface, the need for timely use of bronchoscopy to remove necrotic material, to prevent blockage of the airway, causing suffocation.According to foreign reports, afterPDTof patients with lung cancer recentlyIclinical cure rate of 100%, 2-year follow-up all alive, survived for more than5years up to88%; II, IIIa, IIIb, IVperiod median survival of22.5months, respectively,5.7months,5.5months and5months, disease remission time and quality of life conditions have been reported no less than the majority of therapy.There are also reports of non-lung trachea afterPDTof tumor metastasis by blocking threshold from 85%to13%, breathing difficulty, hemoptysis, cough and quality of life were significantly improved survival time prolonged.
intracavitary brachytherapy: there are generally two methods.Intracavitary radiotherapy for the installation of a is first filled with isotope facilities, or derive the source tube to the appropriate lesion site, verified by the X-position, and then the treatment planning system to calculate and optimize the dose distribution with satisfactory results treatment.After-loading brachytherapy has the advantage of precise treatment available to patients and medical staff compartment remote control, very safe.
There is also a radioactive seed implantation is usually bundled with radioactive particles, including the stent, both on the tracheal stenosis play a supportive role, but also the tumor brachytherapy to control further tumor growth.Bronchoscope under direct vision can also be directly implanted into theIparticles of large unresectable tracheal tumor, to remove a large tumor in the trachea caused by airway obstruction and clinical symptoms of obstructive pneumonia, tumor local control rate 85%.